National University of Lesotho (NUL) Consuls & Bristol Myers Squibb Foundation

National University of Lesotho (NUL) Consuls

National University of Lesotho (NUL) Consuls was granted $424,345 over 36 months to help improve HIV and TB treatment outcomes by strengthening community healthcare services in order to inform national policy, programming and allocation of resources.


High HIV prevalence and high maternal and under-five mortality rates are the main concerns of the government of Lesotho. Currently, Lesotho has the second highest HIV prevalence in the world, while maternal and under-five mortality rates are among the highest in the region. According to the Ministry of Health Annual Joint Reviews, AIDS, TB and heart problems are among the top ten leading causes of adult mortality in Lesotho and this has been the case since 2009. In children, pneumonia, diarrhea, dehydration and malnutrition are among the top ten leading causes of death in the past seven years. The present coalition government has among its high-priority policy programs “to robustly address HIV and AIDS, infant mortality and services to the elderly and people with disabilities”.

The role of community health workers (CHW) in health education, referral to health services and adherence support is well documented in Lesotho and in the region. Given the type of assistance provided by community health workers in TB treatment adherence, referral of pregnant women, support for HIV testing and treatment and referral for chronic diseases, NUL and the Ministry of Health believe this group of health workers can help the Ministry to address these major health concerns.

The anticipated help of community health workers is premised on the understanding that this group understands and performs its duties accordingly. It is also NUL Consuls understanding that for this group to perform its duties, it must get the necessary support from both the community and the Ministry of Health.

This proposal aims to evaluate the health status of the communities within the catchment areas of the 18 health service areas, the competencies and challenges of community health workers, and the policy framework under which the group is working. The identified deficiencies and challenges would be addressed mainly through training and interventions. It is believed these would help to improve the health status of these communities.


This project will consist of three phases. The first phase studies the current system in place. This includes the role of CHWs as well as their challenges and effectiveness. The project will also study the role played by primary healthcare (PHC) on community healthcare and how CHWs are integrated into that care.

The second phase involves intervention, which aims to establish and strengthen the role of CHWs in management of treatment outcomes of HIV, AIDS and TB. The project will also empower CHWs economically, increase their education on HIV, AIDS and TB, and support them with any other needs uncovered in phase one.

The final phase involves the evaluation of the project. The project will be monitored and tracked throughout and include regular reporting. Evaluation will focus on the impact of this project on community healthcare system effectiveness, primary healthcare system responsiveness, and impact on policy.


  • Ministry of Health
  • District Health teams
  • NGOs involved in HIV and other relevant health services