The support for Rethabile in Lesotho
We meet Rethabile (21) in the district national Mafeteng Hospital. She’s visiting the maternal and neonatal health ward with her 3 months old son, Realeboha. The first time she visited the ward was for an antenatal care visit. As part of a standard procedure, she was offered to get HIV tested. Unfortunately, her results came back positive and showed she was infected. “I went home, where I live with my mother and shared this news. My mother was supportive and after some time I was able to accept my HIV illness.”
To prevent transmitting the virus to her unborn child and for own wellbeing, Rethabile started taking medication during her pregnancy. She spent the last days of her pregnancy at the hospital so called waiting area. By doing so, she gave birth under assistance of a midwife. This worked in her favor as she needed blood transfusion. Disappointingly, her newborn son was diagnosed with HIV, most probably because she started preventive treatment only later in her pregnancy. “I am fortunate to live close to the hospital. My mother accompanies me to the doctor for my monthly check-ups, as it is not always easy to look after Realeboha while going to the doctor. I feel comfortable coming to the ward and collecting my next treatment doses. The nurses also know me well by now.”
Rethabile’s treatment is going well - she takes her medication daily as prescribed. Realeboha is also being treated and receives his daily syrup dose. The boy’s health and growth are steadily monitored. Rethabile is planning ahead for their future. She plans to study to become an accountant.
Meanwhile, the nurses say the program set up by Health Works really helped. Since 2014, Lesotho Ministry of Health is implementing the Health Sector Performance Enhancement project for maternal and new-born health. Performance Based Financing (PBF), as a major component of it, consists of rewarding health facilities based on agreed upon goals and set of measurements. The project resulted so far to an increase of patients visiting the maternal health services. With the provided program incentive, the team is able to provide food for women while waiting to go into labor and heat the waiting area. Women now also receive a package with sanitary pads after child birth, or at their follow up visit, together with a set of baby cloths and a blanket to keep their baby warm. Nurses provide information to pregnant women on own and newborn care during their visits, and attend group talks on the importance of daily medicine intake for HIV treatment. Women living far away from the ward commonly receive transport costs covered through the project.
The PBF project is present in six districts of Lesotho: Quthing, Leribe, Mokhotlong, Thaba Tseka, Mafeteng and Mohale’s Hoek. Health Works provides technical assistance and collaborates with a partner organization (MCDI) as a specialised team on the project at central, district and community level: building the capacity of key health staff, data verification of service delivery, satisfaction surveys and coaching health facilities in implementing the approach.
 The demographic and health survey (DHS) 2014 by Lesotho’s Ministry of Health mentions a HIV/AIDS prevalence of 30% for female and 19% for male all ages. The risks for women to die (in their life time) during, or in the following weeks after giving birth is 1 in 38 women. At least 25% of all children below 18 years of age are orphaned (one, or both parents died) (Demographic and Health Survey/DHS 2014, Ministry of Health).