The small African nation of Lesotho is focused on improving healthcare through strategic initiatives. One such initiative is the HIV and TB Sustainability Roadmap 2025. The roadmap reaffirms the Government of Lesotho’s commitment to ending HIV and TB as a public health concern. The roadmap also calls for continued and unwavering political leadership in the response, while also driving for a reduction in dependency on external donor funding, amongst others.
The HIV/TB Sustainability Roadmap (2025–2030) outlines a structured, data-driven framework to ensure long-term sustainability in the national HIV and tuberculosis response. In 2025, the focus will be on developing the roadmap through comprehensive stock-taking, establishing a multi-sectoral secretariat for coordination, launching real-time data dashboards, and creating feedback mechanisms to guide evidence-based policymaking. This phase will conclude with a finalized, adaptable roadmap equipped for effective implementation, monitoring, and evaluation. In 2026, emphasis shifts to executing the transformation plan, assessing progress, and identifying best practices through stakeholder dialogues and a mid-term health sector review, ensuring the roadmap evolves based on lessons learned. The 2027 mid-term review will refine objectives and strategies using updated health data to address emerging needs. By 2028, preparations for the comprehensive review will involve evaluating progress toward 2030 targets and assessing the impact of short-term objectives. In 2029, continuous monitoring will ensure the roadmap remains aligned with national and global HIV/TB goals, optimizing interventions as needed. Finally, 2030 will mark the culmination of efforts with a final impact assessment, documentation of achievements, and the launch of a new strategic phase—laying the groundwork for sustained, adaptive, and resilient HIV/TB health responses beyond 2030.
Importantly, HIV/TB Sustainability Roadmap (2025–2030) also identifies the following challenges for Lesotho’s HIV and TB response; 1) Ineffective execution of coordination mandate across ministries, coupled with frequent political shifts, undermines focus and limits funding for HIV and TB initiatives; 2) Reliance on external aid and limited private sector investment undermines financial resilience. The National HIV and AIDS Strategic Plan (2023–2028) faces a funding gap of LSL 1.2 billion (US$63.4 million), while only 35% of the National TB budget is domestically funded, leaving a 51% gap; 3) Restrictive laws and slow policy implementation hinder service access for marginalized populations; 4) Underfunded community-led organizations lack resources for effective monitoring, implementation, innovation, and training; 5) Gaps in primary healthcare infrastructure and facility-based care limit reach and accessibility for underserved populations; 6) Nationwide workforce shortages and the absence of an absorption plan for donor-funded health workers, coupled with supply chain inefficiencies, result in frequent stockouts of essential medicines and commodities.
Lesotho’s HIV/TB Sustainability Roadmap (2025–2030) aims to these challenges through a unified, politically committed, and domestically financed response; a robust financing model that increases domestic resources and reduces aid dependence; a progressive legal framework advancing human rights, gender equality, and healthcare access; empowered community-led networks driving HIV/TB targets with sustainable funding and data systems; a universal healthcare model ensuring over 95% HIV testing coverage, reducing new infections, and improving multidrug-resistant TB (MDR-TB) management; and a fully integrated, sustainable health system supported by domestic funding, reliable medicine supply chains, a skilled workforce, and modern health information systems for data-driven decision-making.
Lesotho’s Minister of Health Selibe Mochoboroane stated that the roadmap is a testament to Lesotho’s commitment to high-impact, person-centred healthcare, drawing upon comprehensive national and international insights. Lesotho’s Deputy Prime Minister Nthomeng Justina Majara highlighted the success of Lesotho in addressing HIV and TB and stated that Lesotho has made tremendous progress in the HIV response with over 95% of the population aware of their HIV status, 94% of those diagnosed on life-saving treatment (ART), and 99% of those on ART achieving viral suppression. Positive strides have been made in the battle against tuberculosis (TB) with TB incidence declining by 33% and TB/HIV co-infection rates dropping to 48.6%. She stated that the roadmap is more than a document—it is a reaffirmation of the government’s commitment to ending HIV and TB as public health threats and a call to action for continued unwavering political leadership for HIV and TB response, alongside a gradual reduction in dependency on external donor funding, resilient health systems, and keeping communities at the centre of the response.
