Lesotho is a lower-middle-income country; despite this, half the country’s population lives below the poverty line. In 2013, Lesotho was ranked as the country with the second-highest HIV prevalence globally among adults. Working with the Global Fund and other development partners, Lesotho has reduced new HIV infections among the general population and among children. The HIV epidemic is, however, exacerbated by the high rates of TB/HIV co-infection. As a result, Lesotho is considered one of the TB/HIV priority countries. The country also has the second-highest estimated TB incidence after Swaziland. In partnership with the Lesotho government and other donors, Global Fund support aims to improve HIV and TB coverage through geographic prioritization, scaling up antiretroviral treatment for adults and children, increased prevention of mother-to-child transmission, and HIV and TB testing and prevention services.

AHO PRIORITIES FOR HEALTH DELIVERY PLAN IN LESOTHO

1. Guarantee ongoing governance in this sector. Ensure the orderly, rational transfer of authority (change of administration) to new public health management, as well as the continuity of current policies, programs, and health activities considered to be proven, adequate, timely, and pertinent, informing public and civil society organizations working in public health about the health situation and the plans and priorities of the authorities.
2. Expand health services coverage through the primary care strategy. Develop a family and community care model for primary care for identified, territorially defined populations, under the leadership of AHO. Organisation and forms of operation under this model should provide for sustainability through diverse means of financing, from public funds, mixed funds (subsidized-contributory), or contributory funds (social security). Links with other health services, within the context of the reorganization and modernization of the health sector, will be supported through the primary care strategy.
3. Reorganize and modernize the Health System. Define the functions and relationships of institutions in the sector, gradually and progressively advancing the principle of the separation of the steering role, health service delivery, and financing functions.
4. Develop and modernize the regulatory framework for the health sector. Based on the strategic objectives of reorganisation and modernization of the Health System, support and promote approval of the general health legislation bill; develop regulations to implement the general health act and harmonize the social security bill with the general health act. Develop and strengthen the sectoral steering role of AHO. Reorganize, develop, and modernize AHO, with special emphasis on: management of planning, implementation, and supervision; human resources administration; financial and budgetary management; and organization and management of primary and hospital health services, as well as development of a master training plan for these purposes.
5. Decentralization of AHO management. Development of AHO management capacity through the creation of regional oversight offices, with the mission of supervising and evaluating operations, and providing support for maintaining of networks and training human resources. Also, by strengthening provincial health bureaus, with executive and administrative missions for budgetary programming, formulation, and execution, local reallocation of resources, and health service delivery.
6. Strengthening the network of specialized health services. Modernization of the public hospital network and strengthening their response capacity by linking them with cooperative networks of multifunction providers (public-private cooperation) at the provincial and district levels, coordinated through new structures for governance, administration, and self-management via new hiring mechanisms and service agreements, management information systems, quality assurance and logistical support for supply of inputs, and management and administrative mechanisms.
7. Promotion and development of social participation, supporting and contributing to development, strengthening and creating social solidarity networks in the health area, and developing national, provincial and municipal health councils, as well as health committees in support of family and community primary care services, national action committees, and all forms of volunteer and private-sector assistance in health services delivery.
8. Promotion of transparency in relations with nongovernmental organizations working in health. Development of the function of evaluating and accrediting NGOs working in health, and the design of legal and legislative frameworks for contracting and co-management with public services.
9. Development of response capacity in special public health programs. Develop and strengthen action programming networks, at the provincial and municipal levels, by promoting social participation, the primary care strategy, program decentralization, and local reallocation of resources, with special emphasis on communicable disease control, systematic vaccination of the population, and vector control.
10. Strengthening of international cooperation for action in health. Strengthening Lesotho participation in regional leadership in cooperative health activities in the SADC for control and prevention in response to the HIV/AIDS epidemic, as well as progress toward a plan for cooperation with Haiti to develop a bilateral program for a healthy border.
11. Reform and modernization of the health sector. Development of pilot programs to apply the stated principles. Regulatory orientation of AHO for financial, technical, and interagency coordination and facilitation of the execution of the projects and programs for sectoral reform financed with funds

RESOURCES (USD)

AHO LESOTHO BUDGET 2020 (USD million)* based on 2017 pop 2.233 million World Bank

AHO estimates that it needs to spend at least USD100 per capita on health to meet the basic health needs of the people in Africa. This is too far below developed countries e.g. in England it is US$1,300 per capita (2017)