Lesotho – FY 2010 Approved Funding by Program Area, Agency and Funding Source*

Date: 2011 Description: FY 2010 Approved Funding by Program Area, Agency and Funding Source © PEPFAR

*Only appropriations from the GHCS (State) fund account are notified by the Global AIDS Coordinator.

The Kingdom of Lesotho is a small, mountainous country of 1.87 million people with the third highest HIV prevalence in the world, estimated at 23.2%. Lesotho’s hyperendemic HIV situation is driven by heterosexual practices such as multiple and concurrent sexual partnerships and transactional and intergenerational sex. These practices, together with low levels of full male circumcision and low consistent condom use, result in a high number of preventable infections.

Lesotho’s HIV/AIDS response is led and coordinated by the National AIDS Commission (NAC), a semi-autonomous government body. Implementation of the national response lies primarily with the Ministry of Health and Social Welfare (MOHSW) and a number of other government ministries who are responsible for aspects of the response. Funding is provided both through the Government of Lesotho’s (GOL) annual budget, and Global Fund resources. The National Strategic Plan (NSP) lays out a framework for responding to the epidemic through work in four strategic areas: prevention; treatment, care, and support; impact mitigation; and management, coordination, and support mechanisms. The current NSP (2006 – 2011) also serves as the platform for the Partnership Framework recently signed between the USG and the GOL, now available at http://www.pepfar.gov/frameworks/lesotho/index.htm. The Partnership Framework lays out the guiding principles and goals of the USG-Lesotho joint efforts to combat the AIDS epidemic. The goals of the Partnership Framework are translated into action within the PFIP, which demonstrates plans to increase country ownership of the HIV/AIDS response in Lesotho including the development of capacity within both the GOL and civil society.

In FY 2010, PEPFAR anticipates that over half of the Lesotho budget will be allocated to HSS and prevention programming, which both directly contribute to the sustainability of the national response to HIV. Much of the HSS funding will go to supporting training and retention of healthcare workers, which directly addresses the critical human resources crisis the GOL faces in implementing the national response to HIV/AIDS. In addition, relevant government ministries’ inputs have been heavily weighted when considering the allocation of funding among partners and the choice of partners for new projects. The PEPFAR team has negotiated a cooperative agreement directly with the MOHSW, which will help build the MOHSW’s capacity to lead the response.

HSS is also a significant area in which PEPFAR is partnering with the Millennium Challenge Account-Lesotho (MCA-L) to maximize the impact of PEPFAR resources in Lesotho. MCA-L plays a major role in HSS in Lesotho through funding for improved health management systems and refurbishment of health facilities countrywide. This is done in coordination with the GOL, PEPFAR, and other development partners. The MCA-L health-related strategic objectives include: integrated quality HIV care; effective decentralization with ownership by health staff and communities; improved human resources; and information, infection control and waste management systems.

In concert with the MCA-L programs, PEPFAR Lesotho will work with the MOHSW to develop national laboratory policies, pre-service and in-service training curricula for laboratory scientists, augment the MCA-L and the MOHSW’s blood banking system through the construction of three additional blood collection centers capable of collection, testing and distribution of blood and blood products, and train a cohort of nurses to support the new health facilities rehabilitated by MCA-L. This synergy between MCA-L’s investments in the healthcare system infrastructure and PEPFAR’s innovative programs to address human resources issues will improve health outcomes and promote the sustainability of Lesotho’s health and social welfare system.

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