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MSF in Lesotho, 2007
Field Staff: 24
Reason for intervention:
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Lesotho, also known as the Mountain Kingdom, is a small landlocked country surrounded by South Africa. Of its 1.8 million inhabitants, an estimated 23,000, more than 1% of the entire population, die each year of HIV-related causes. By far the leading cause of death among HIV-positive people is tuberculosis (TB). More than 90 per cent of TB patients in areas where MSF works are also infected with HIV.
Over two years, more than 2,200 people have started anti-retroviral treatment (ART) in MSF-supported structures. The program is based at Scott hospital in Morija, 40 kilometers south of the capital, Maseru, and supports 14 primary care clinics in remote rural areas. The health facilities supported by MSF serve a population of 220,000, including an estimated 35,000 people living with HIV/AIDS.
In addition to providing ART, MSF works with hospital management and staff to give comprehensive care, including HIV counseling and testing, prevention of mother-to-child transmission, early diagnosis of HIV in infants and management of opportunistic infections and co-infections, particularly TB.
By the end of 2007, over 21,000 people had been tested for HIV (34 per cent HIV-positive), vertical transmission from mother to child was reduced to six per cent when both the mother and the baby received an intervention and for whom an early test (DNA-PCR) result for the baby was available. TB and HIV services were integrated so that HIV-positive patients are systematically screened for TB and TB patients are routinely offered an HIV test. Co-infected patients can therefore benefit from a ‘one-stop service’. Efforts were also made to improve diagnosis of TB, including smearnegative and drug-resistant TB.
The program achieved these results within a short timeframe by training more nurses; ensuring weekly visits to each clinic by MSF mobile medical teams; recruiting and training ‘HIV/TB lay counselors’ (mostly members of the community living with HIV/AIDS enrolled on the program) to take on multiple tasks, including adherence support; strengthening laboratory and pharmacy capacity at the district hospital; and promoting treatment literacy, openness about HIV and community involvement in service delivery.
An acute shortage of healthcare workers threatens further scale-up of activities in Lesotho and hopes for long-term continuity of services all the more daunting. There are fewer than 100 doctors in the entire country, most from other African countries, who are working in Lesotho while awaiting their certification to work in South Africa, where they can get higher-paying jobs, so their stay in Lesotho is usually only temporary. Additionally, in June, at a time when the HIV-related workload was increasing sharply, over half the professional nursing posts in the 14 clinics supported by MSF and 30 per cent of professional nursing posts at the district hospital were vacant.
In May, the team in Lesotho, together with other projects in the Southern African region made the decision to launch a report on the healthcare worker crisis. This was reinforced by advocacy at national and international levels for measures to improve retention and recruitment of professional health staff and ensure ‘task-shifting’ of certain clinical tasks from doctors to nurses and non-clinical tasks from nurses to lay health workers. Without fundamental change, the prospects for expanding access to ART and improving quality of care in the long-term are bleak.
MSF has worked in Lesotho since 2006.