Lesotho: Solving Transportation Problems and Saving Lives in Lesotho (December 2010)

What's the first thing that comes to mind when you think about innovation for health? DNA tests? Smart phones? How about ponies? In Lesotho, these four-legged vehicles might just be the best idea yet.

Lesotho is a tiny country landlocked within South Africa. It has 2 million people, mostly living in rural areas, and a geographic size about the same as Maryland. Despite its small size, it has big HIV statistics. One in four adults is HIV-positive, and more than 20,000 people are newly infected each year. Many people live in mountainous areas that are connected to larger towns and cities by a network of winding and unreliable roads.

Small clinics in the mountains serve as crucial outposts for health care. The roads to the mountains, however, are often unusable due to heavy summer rains and winter snowstorms. Clinics consequently can't order lab tests or receive a steady flow of drugs and supplies for four months per year or more. HIV patients, who need medication daily, and those seeking their HIV status, can't wait that long.

To fill this need, the U.S. Government supports the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to collaborate on an innovative way to reach those in need in Lesotho. The Horse Riding for Health program engages local pony riders - selected with input from the community - to transport blood tests, drugs, and supplies between remote mountain health clinics and better-equipped hospitals at sea level. The transport system allows people to receive HIV test results sooner, access life-saving drugs, and ensure an uninterrupted supply of medication.

When roads are navigable by two-wheels, motorcycle riders join the journey to further speed the process of rushing blood to the lab or medication to people living with HIV/AIDS in Lesotho's remote mountainous terrain.

The benefits aren't limited to individuals receiving care; research shows that faster diagnosis and treatment for HIV leads to fewer future cases in the community. This is partly because if people know their HIV status, they are less likely to transmit the disease to others. For a pregnant woman, access to an HIV test and results can be the difference between life and death for her baby.

Just a few years ago, even if expectant mothers knew they were HIV-positive, all they could do was hope for the best. In addition to improving transportation systems, the U.S. Agency for International Development (USAID), through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and EGPAF have rolled out comprehensive services to prevent mother-to-child HIV transmission throughout Lesotho. Today, 80 percent of mothers have access to treatment and counseling programs that can allow their babies to be born HIV-free.

These efforts support the prevention of mother-to-child transmission (PMTCT) program that was initiated in 2005 by Lesotho's Ministry of Health. Since its inception, at least 70 percent of HIV-positive mothers have given birth to HIV-negative babies, according to the health ministry. This program is a living example of how a coherent antiretroviral treatment program can help HIV-positive mothers give birth to healthy babies.

Lesotho's Health Minister Mphu Ramatlapeng stated, "Our success in PMTCT is notable. More than 70 out of 100 HIV-positive mothers access PMTCT. We are getting close to 100 percent coverage in one or two years...We stand with pride in various national, sub-region and international meetings to give testimony of how much Lesotho has succeeded in the fight against HIV and Aids."

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