Lesotho: Score Justification Summary

2026

1.1 Antimicrobial resistance (AMR)

1.1.1 AMR surveillance, detection and reporting

1.1.1a National plan for AMR priority pathogens

Score: 100

Lesotho has published an AMR plan, and it covers surveillance, detection, and reporting.

Lesotho's National Action Plan on Antimicrobial Resistance 2021–2026 was published in March 2021. Strategic Objective 2 (SO2) of the plan is "To strengthen knowledge and evidence-base through surveillance and research," which is pursued through several "specific interventions". To enhance detection, Strategic Intervention 2.1 aims to "Strengthen laboratories capacity to detect, and analyze AMR at all sectors" by procuring diagnostic equipment and training laboratory professionals. Strategic Intervention 2.3 seeks to build a "One Health antimicrobial resistance surveillance system that integrates data sharing from human, water, environment and agricultural sectors" through the establishment of a multi-sectoral system, the development of national guidelines, and participation in the Global Antimicrobial Resistance and Use Surveillance System (GLASS). Chapter V on the "Monitoring and Evaluation Framework" outlines mechanisms for routine data collection, evaluation, and feedback to report progress to national and international bodies., with an aim to establish a "multi-sectoral AMR surveillance reporting and information sharing system" and develop specific reporting frameworks. ¹

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 0

There is no evidence of a national laboratory system which tests for priority AMR pathogens in Lesotho.

Strengthening laboratories’ capacity to detect and analyze antimicrobial resistance is a key priority of Lesotho’s National Action Plan on Antimicrobial Resistance 2021-2026, published in March 2021. ² Specifically, per Strategic Intervention 2.1, the country will aim to “procure diagnostic equipment and supplies for antimicrobial determination” and “capacitate laboratory and pharmacy professionals on detection and analysis of AMR and reporting of antimicrobial medicines consume &/ use patterns.” Strategic Intervention 2.2 aims to strengthen collaboration between national and external laboratories on AMR diagnostics and to advocate for the adoption of internationally recognized standards for AMR detection. ³ However, there is no evidence on the website of Lesotho’s Ministry of Health or Ministry of Agriculture and Food Services of any concrete measures that have been taken toward these objectives. ⁴⁵

Lesotho has one national reference laboratory located in its capital Maseru; this facility provides specialized diagnostic services for tuberculosis. ⁶ The Joint External Evaluation conducted in 2017 of Lesotho’s health system by the World Health Organization stated that by the end of that year, Lesotho would have three laboratories with “microbiology capacity” in the country. ⁷ However, there is no evidence that these laboratories have since been established ⁸⁹.

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no evidence that the government of Lesotho conducts environmental detection or surveillance activities for antimicrobial residues or AMR organisms.

Lesotho has a National Action Plan on Antimicrobial Resistance, which was published in March 2021 and covers the years 2021-2026. However, it does not address any current or planned initiatives to conduct environmental surveillance for AMR organisms. ¹⁰

Per the 2024 Tracking Antimicrobial Resistance (AMR) Country Self-Assessment Survey (TrACSS), Lesotho reported that it has neither a “national assessment of risks for residues of antimicrobial compounds […] in the environment” nor “legislation and/or regulation to prevent contamination of the environment with antimicrobials.” ¹¹

There is no additional evidence on the websites of Lesotho's Ministry of Health, Ministry of Agriculture, Food Security and Nutrition, or Department of Environment that the country conducts surveillance for AMR organisms in the environment. ¹²¹³¹⁴

1.1.2 Antimicrobial control

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

There is national regulation in place in Lesotho requiring prescriptions for antibiotic use by humans, but there are gaps in its enforcement.

According to the Drugs of Abuse Act, adopted by the Government of Lesotho in 2008, high-risk drugs may not be taken or given out without a prescription; however, this law does not address antibiotics specifically, and there are no antibiotics listed in Schedules 1, 2, or 3 of the law. ¹⁵

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, antibiotics are prescription-only for both humans and animals in Lesotho. ¹⁶ However, there is no evidence of a specific framework or regulation that requires prescriptions for antibiotics. No evidence of this could be found on the website of Lesotho's Ministry of Health or the Lesotho Legal Information Institute, which maintains a database of national legislation in Lesotho. ¹⁷¹⁸

According to Lesotho's National Action Plan on Antimicrobial Resistance, adopted in 2021, the country will aim to "capacitate health personnel on rational prescribing and dispensing of antimicrobials." ¹⁹ A 2014 study published in the Journal of Public Health in Africa found that antibiotics were highly over-prescribed in the country. ²⁰

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 50

There is national regulation in place in Lesotho requiring prescriptions for antibiotic use in animals, but there are gaps in its enforcement.

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, antibiotics are prescription-only for both humans and animals in Lesotho. ²¹ However, there is no evidence of a specific framework or regulation that requires prescriptions for antibiotics. No evidence of this could be found on the website of Lesotho's Ministry of Health or the Lesotho Legal Information Institute, which maintains a database of national legislation in Lesotho. ²²²³

A 2024 paper in the Journal of Applied Veterinary Sciences found that veterinary antibiotics are frequently used irrationally and stored inappropriately in Lesotho. ²⁴

According to Lesotho's National Action Plan on Antimicrobial Resistance, adopted in 2021, the country will prioritize improving standards for antimicrobial use in animals. ²⁵ However, there is no evidence on the website of the country's Ministry of Health or Ministry of Agriculture, Food Security and Nutrition that any specific measures have been undertaken or that any new regulations have been adopted in this area. ²⁶²⁷

1.2 Zoonotic disease

1.2.1 National planning for zoonotic diseases/pathogens

1.2.1a Laws/plans on zoonotic disease

Score: 0

There is no evidence that Lesotho has national legislation, plans, or equivalent strategy documents for zoonotic disease prioritization, detection and reporting.

In October 2024, Lesotho’s Ministry of Health adopted an Integrated Master Plan on Neglected Tropical Diseases covering the period from 2024 to 2030. Per the plan, Lesotho will aim to improve health care workers’ awareness of human rabies and its management, update the national guidelines for rabies, strengthen surveillance, maintain vaccine availability, and strengthen risk communication. Other diseases addressed by this strategy include soil-transmitted helminthiasis, schistosomiasis, leprosy, yaws, scabies, and snakebite envenoming; apart from rabies, it does not address any other zoonotic diseases as such and does not lay out a plan for addressing zoonotic diseases overall. ²⁸

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, anthrax and rabies are the priority zoonoses in Lesotho, while bovine brucellosis and tuberculosis are also of concern. According to this report, surveillance of zoonotic diseases is limited, transportation of samples is poor, veterinary knowledge is limited, and communication between the Ministry of Health and the Ministry of Agriculture and Food Security occurs only on an ad hoc basis. ²⁹

According to a 2016 article by the Interafrican Bureau for Animal Resources, Lesotho has a National Livestock Policy. ³⁰ This policy, if it exists, is not publicly available on the websites of the Ministry of Agriculture and Food Security. ³¹

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 100

Lesotho has national legislation for risk identification and reduction for zoonotic disease spillover events from animals to humans.

There is no evidence of additional policies that address zoonotic disease spillover on the websites of the Ministry of Health or the Ministry of Agriculture and Food Security. ³⁵³⁶

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

Lesotho does have national plans that account for surveillance and control of multiple zoonotic pathogens.

Lesotho is a high-risk country for dog rabies, according to the United States Centers for Disease Control (CDC). ³⁸ According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, anthrax and rabies are the priority zoonoses in Lesotho, while bovine brucellosis and tuberculosis are also of concern. According to this report, surveillance of zoonotic diseases is limited, transportation of samples is poor, veterinary knowledge is limited, and communication between the Ministry of Health and the Ministry of Agriculture and Food Security occurs only on an ad hoc basis. ³⁹

A paper published in 2020 in the International Journal of Environmental Research and Public Health claims that anthrax poses a high risk to public health in Lesotho due to the fact that meat is largely sourced from informal slaughter facilities. ⁴⁰

There is no further evidence of policies addressing multiple zoonotic pathogens on the websites of the Ministry of Health or the Ministry of Agriculture and Food Security. ⁴¹⁴²

Lesotho's National Action Plan on Antimicrobial Resistance, adopted in 2021, does not address any specific zoonotic pathogens. ⁴³

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 0

There is no evidence that Lesotho has a department or other entity functioning as a interministerial multi-sectoral coordinating mechanism dedicated to zoonotic disease.

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, communication between Lesotho's Ministry of Health and the Ministry of Agriculture and Food Security occurs only on an ad hoc basis; it states that multisectoral collaboration is "evident in a number of activities conducted jointly" by these two ministries but there is no official policy formalizing this collaboration. The report recommended the establishment of a Memorandum of Understanding between the two ministries to facilitate communication and data sharing. ⁴⁴ However, there is no evidence on either ministry's website that such an agreement has been adopted. ⁴⁵⁴⁶

In 2024, Lesotho’s Ministry of Health, supported by the World Health Organization, conducted a multi-sectoral “resource-mapping exercise” to identify opportunities for collaboration across sectors in the area of health security. The workshop was attended by multiple ministries, including the Ministry of Health, Ministry of Agriculture, Ministry of Natural Resources, and others. However, there is no evidence that this exercise resulted in the formation of an official multi-sectoral unit for addressing zoonotic or other diseases. ⁴⁷

1.2.1e Presence of One Health strategic plan

Score: 0

There is no evidence that Lesotho has a One Health strategic plan in place. ⁴⁸⁴⁹

1.2.2 Surveillance systems for zoonotic diseases/pathogens

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 0

There is no evidence that Lesotho has a national mechanism for owners of livestock to conduct and report on disease surveillance to a central agency.

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, there is a system for routine screening for brucellosis in dairy cows in which owners are required to bring milk samples to a laboratory. However, this system is not continuous in that each cow is tested only once. All other animal diseases, according to the report, rely on community reporting and passive surveillance – active sampling is only done in response to outbreaks. ⁵⁰

In 2019, the Food and Agriculture Organization (FAO) of the United Nations partnered with the Lesotho's Ministry of Agriculture and Food Security (MAFS) and the Department of Livestock Services (DLS) to strengthen the country's animal disease surveillance system. As part of this initiative, trainings were carried out for veterinary and livestock production personnel to raise awareness of the importance of surveillance and reporting. This project also spearheaded the piloting of the Event Mobile Application (EMA), a mobile-based phone application for timely animal disease reporting. ⁵¹ However, there are no recent updates on the FAO's website or on the websites of Lesotho's Ministry of Health or its Ministry of Agriculture and Food Security to suggest that this system is still in place and actively being used. ⁵²⁵³⁵⁴ A recent (January 2024) article on the FAO's website lists Lesotho as a country where the EMA has "been successfully implemented" but there are no details as to whether it has actively been used beyond the pilot phase. ⁵⁵

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no evidence of legislation or regulations that safeguard the confidentiality of information generated through surveillance for animals in Lesotho.

Mechanisms for livestock owners in Lesotho to conduct ongoing disease surveillance or report outbreaks are weak. According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, there is a system for routine screening for brucellosis in dairy cows in which owners are required to bring milk samples to a laboratory. However, this system is not continuous in that each cow is tested only once. All other animal diseases, according to the report, rely on community reporting and passive surveillance – active sampling is only done in response to outbreaks. ⁵⁶

Lesotho does have a Data Protection Act, adopted in 2012, which pertains to the protection of personal information more broadly. It does not specifically address the treatment of information generated during animal surveillance activities. However, per Article 16 of the law, personal information may only be processed if, given the purpose for which it is processed, it is adequate, relevant and not excessive." ⁵⁸

No further evidence of such policies could be found on the websites of the Ministry of Health or the Ministry of Agriculture and Food Security. ⁵⁹⁶⁰

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is no evidence that Lesotho conducts surveillance of zoonotic disease in wildlife, poultry, or livestock.

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, most animal diseases rely on community reporting and passive surveillance – active sampling is only done in response to outbreaks. ⁶¹ For example, in 2021, a farmer in Maseru District reported the death of 300 chickens to the country’s Central Veterinary Diagnostic Laboratory (CVDL). The farm was visited by a team from the Animal Health Division of the Department of Livestock Services, which confirmed an outbreak of highly pathogenic avian influenza (A/H5N1). ⁶² There is no evidence on the websites of the Ministry of Health or the Ministry of Agriculture and Food Security that surveillance is conducted on an ongoing basis. ⁶³⁶⁴ According to the JEE report, in the case of rabies, Lesotho's animal health division is alerted on the presentation of dog bites, or when owners of dogs or cows report death or strange behaviour of their animals. ⁶⁵

1.2.3 International reporting of animal disease outbreaks

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is evidence of a mechanism for reporting notifiable diseases to the World Organisation for Animal Health (WOAH).

In 2021, a farmer in Maseru District reported the death of 300 chickens to the country’s Central Veterinary Diagnostic Laboratory (CVDL). The farm was visited by a team from the Animal Health Division of the Department of Livestock Services, which confirmed an outbreak of highly pathogenic avian influenza (A/H5N1). This outbreak was then reported to the WOAH (formerly OIE). ⁶⁶ In recent years, Lesotho has also provided reports to the WOAH on anthrax (2019 and 2025). ⁶⁷

1.2.4 Animal health workforce

1.2.4a Number of veterinarians per 100,000 people

Score: 0

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 0

1.2.5 Private sector and zoonotic disease

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is no evidence that Lesotho has a national plan on zoonotic disease that includes mechanisms for working with the private sector.

There is no evidence of a national plan or other strategy on zoonotic diseases in Lesotho on the websites of the country's Ministry of Health or Ministry of Agriculture and Food Security. ⁶⁹⁷⁰

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, zoonotic disease outbreaks are reported to animal health authorities, but there is no indication that the private sector is formally or informally engaged in this process. ⁷¹ According to the same report, there are a number of private veterinarians in the country, but they rarely ship specimens to a laboratory for confirmation. ⁷²

Lesotho has a national strategic plan, adopted in 2024, that includes provisions for strengthening the government’s partnerships with the private sector; for example, the plan states that the government will increase the private sector’s involvement in food systems and support for smallholder farms. However, there is no specific evidence of current or planned private sector engagement in the control of zoonotic diseases. ⁷³

1.3 Biosecurity

1.3.1 Whole-of-government biosecurity systems

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no evidence that Lesotho has a record of the facilities in which especially dangerous pathogens and toxins are stored or processed.

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, Lesotho does not have any government laboratories that store microbes, pathogens, or toxins. ⁷⁴

According to a 2025 paper by representatives of the Africa Centers for Disease Control and Prevention (Africa CDC), Lesotho does not have a multisectoral list of High Consequence Agents and Toxins of Concern (HCAT). ⁷⁵

Lesotho appears to have submitted a Confidence-Building Measure report under the Biological Weapons Convention in 2024, but its content is not publicly available. ⁷⁶ There is also no further evidence found in the Verification Research, Training and Information Centre (VERTIC) database. ⁷⁷ No additional evidence could be found on the websites of the Ministry of Health or the Ministry of Agriculture and Food Security. ⁷⁸⁷⁹ The Department of Environment's website has a portal dedicated to biosafety but there is no specific information about the storage or processing of dangerous pathogens in the country. ⁸⁰

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

Lesotho does not have in place measures related to biosecurity which address requirements such as physical containment, operation practices, failure reporting systems, and/or cybersecurity of facilities in which especially dangerous pathogens and toxins are stored or processed.

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, Lesotho does not have any government laboratories that store microbes, pathogens, or toxins. ⁸¹

In 2023, a program was proposed to design a comprehensive national oversight program for biosafety and biosecurity in Lesotho. The program was to entail the development of a comprehensive protocol for the safe and secure use, storage, disposal, and containment of dangerous pathogens in the country. However, the program was never approved or launched. ⁸²

Lesotho is a part of the Africa Centers for Disease Control and Prevention (Africa CDC) Biosafety and Biosecurity Initiative (BBI), which was launched in 2019. According to a report published in 2025, Lesotho is committed to aligning its national biosecurity and biosafety legislation with international standards but there is no central coordinating entity, no nationally adopted standards, and no legislation addressing the transfer, storage, or disposal of High Consequence Agents and Toxins of Concern (HCAT). ⁸³

Lesotho's Environment Act, adopted in 2008, contains provisions for the management of dangerous materials and hazardous waste. For example, it states that the Director of the Department of Environment is responsible for adopting standards for the classification of hazardous wastes and dangerous materials. It also states that Department of Environment is responsible for issuing guidelines related to the registration, packaging, advertising, import/export, labeling, distribution, storage, transportation, monitoring, disposal, and restriction of toxic or hazardous chemicals. However, it does not provide specifics on what substances are covered. ⁸⁴ No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database or on the websites of the Ministry of Health or the Ministry of Agriculture and Food Security. ⁸⁵⁸⁶⁸⁷

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is no evidence that Lesotho has an established agency responsible for the enforcement of biosecurity legislation and regulations.

The Lesotho Department of Environment's website has a portal dedicated to biosafety, but there are no materials on the website about biosecurity. ⁸⁸ Additionally, per the 2008 Environment Act, the Department is responsible for overseeing the implementation of regulations and guidelines on the handling of dangerous wastes/materials, but biosecurity is not explicitly addressed. ⁸⁹ Additionally, the World Health Organization's 2017 Joint External Evaluation (JEE) report on Lesotho had found that the country has "no biosecurity systems in place for human, animal or agricultural facilities." ⁹⁰

Additionally, Lesotho is a part of the Africa Centers for Disease Control and Prevention (Africa CDC) Biosafety and Biosecurity Initiative (BBI), which was launched in 2019. According to a report published in 2025, Lesotho is committed to aligning its national biosecurity and biosafety legislation with international standards but there is no central coordinating entity, no nationally adopted standards, and no legislation addressing the transfer, storage, or disposal of High Consequence Agents and Toxins of Concern (HCAT). ⁹¹

There is no evidence that either the Ministry of Health or Ministry of Agriculture and Food Security is responsible for overseeing biosecurity regulations in Lesotho. ⁹²⁹³ No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database. ⁹⁴

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no public evidence showing that Lesotho has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities.

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, Lesotho does not have any government laboratories that store microbes, pathogens, or toxins. Laboratories that conduct cultures store the samples for up to a week before destroying them. ⁹⁵

The web pages of Lesotho's Ministry of Health, Department of Environment, Ministry of Agriculture and Food Security, the Ministry of Defense and National Security, and the Ministry of Communications, Science and Technology do not contain any information about biosecurity, facilities storing or processing dangerous pathogens. ⁹⁷⁹⁸⁹⁹¹⁰⁰¹⁰¹ No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁰² Lesotho appears to have submitted a Confidence-Building Measure report under the Biological Weapons Convention in 2024, but its content is not publicly available. ¹⁰³

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 0

There is no evidence that Lesotho has in-country capacity to conduct Polymerase Chain Reaction (PCR)-based testing for anthrax and/or ebola.

Lesotho has one National Reference Laboratory in its capital, Maseru, which provides specialized laboratory services for the diagnosis of tuberculosis, including culture and drug susceptibility testing. ¹⁰⁴ However, there is no evidence that this laboratory has the capacity to conduct PCR testing for anthrax or ebola (the laboratory has no online presence).

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, national laboratory systems in Lesotho are able to conduct tests for cholera, HIV, malaria, measles, meningitis, rubella, tuberculosis, typhoid and shigellosis in humans, but it is unclear what type of testing is done. ¹⁰⁵

No additional evidence could be found on the website of Lesotho's Ministry of Health. ¹⁰⁶

Liselo Labs, a biotechnology company with laboratories in South Africa, Lesotho (Maseru), Namibia, Botswana, and Angola, conducts PCR testing for COVID-19, but there is no evidence that the labs have the capacity to conduct PCR testing for other diseases. ¹⁰⁷

1.3.2 Biosecurity training and practices

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no evidence that Lesotho requires biosecurity training for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials.

Lesotho's Environment Act, adopted in 2008, contains provisions for the management of dangerous materials and hazardous waste and prohibits unauthorized handling of such substances, but training is not explicitly required by this law. ¹⁰⁹

Lesotho is a part of the Africa Centers for Disease Control and Prevention (Africa CDC) Biosafety and Biosecurity Initiative (BBI), which was launched in 2019. According to a report published in 2025, officials in Lesotho have received training in biosecurity fundamentals, risk assessment methodologies, and insights into relevant international legal frameworks. However, the report states that Lesotho does not have an in-service training program curriculum for biosecurity. ¹¹⁰

In 2024, a project was proposed to strengthen and sustain awareness of biosecurity best practices among human and animal laboratory staff in Lesotho using a train-the-trainer methodology. However, the project was never approved or implemented. ¹¹¹

No additional evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database for Lesotho or on the website of the country's Ministry of Health or Ministry of Defense. ¹¹²¹¹³¹¹⁴

1.3.3 Personnel vetting: regulating access to sensitive locations

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no evidence that Lesotho has regulations or licensing conditions that require drug testing, background checks, or psychological or mental fitness checks for personnel with access to especially dangerous pathogens, toxins, or biological materials.

Lesotho’s Environment Act, adopted in 2008, provides the legal framework for applying for a license to generate, store, handle, transport, or dispose of hazardous waste, but potentially dangerous pathogens and other substances are not covered. The licensing framework for hazardous waste does not require that applicants undergo any sort of testing. ¹¹⁵

Lesotho is a part of the Africa Centers for Disease Control and Prevention (Africa CDC) Biosafety and Biosecurity Initiative (BBI), which was launched in 2019. This initiative has provided trainings to officials in Lesotho on biosafety and biosecurity fundamentals, but there is no evidence that this has led to the adoption of complex licensing conditions. ¹¹⁷

1.3.4 Transportation security

1.3.4a National transport regulations for Category A and B infectious substances

Score: 0

There is no evidence that Lesotho has regulations on the safe and secure transport of Category A or B infectious diseases.

Lesotho’s Environment Act, adopted in 2008, provides the legal framework for applying for a license to generate, store, handle, transport, or dispose of hazardous waste, but infectious diseases and other substances are not covered. ¹²¹

The World Health Organization's 2017 Joint External Evaluation (JEE) report on Lesotho had found that the country has "no biosecurity systems in place for human, animal or agricultural facilities." ¹²²

No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database. ¹²³ Lesotho appears to have submitted a Confidence-Building Measure report under the Biological Weapons Convention in 2024, but its content is not publicly available. ¹²⁴ No relevant information could be found on the website of the country's Ministry of Health. ¹²⁵

According to a 2017 Joint External Evaluation (JEE) report by the World Health Organization, Lesotho has a "functional" specimen transportation system from all 10 districts of the country, including a helicopter service for emergencies. ¹²⁶

1.3.5 Cross-border transfer and end-user screening

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no evidence that Lesotho has regulations or legislation in place to oversee the cross-border and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential.

Lesotho's export/import protocol is governed by the 1984 Export and Import Control Act which does not appear to have been updated since its adoption. The law states that the country may at any time determine that certain classes of goods may not be imported, but it does not address dangerous pathogens, toxins, or other substances. ¹²⁷

No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database. ¹²⁸ Lesotho appears to have submitted a Confidence-Building Measure report under the Biological Weapons Convention in 2024, but its content is not publicly available. ¹²⁹ No relevant information could be found on the website of the country's Ministry of Health. ¹³⁰

1.4 Biosafety

1.4.1 Whole-of-government biosafety systems

1.4.1a Biosafety laws/regulations

Score: 0

There is no evidence that Lesotho has enacted biosafety legislation or regulations.

Lesotho's Department of Environment participates in biosafety activities. ¹³¹ As a signatory to the Cartagena Protocol on Biosafety, Lesotho has three national points of contact for biosafety, all of whom work for the Department of Environment within the Ministry of Tourism, Environment and Culture. ¹³² However, there is no evidence on the Department's website that it has adopted any comprehensive biosafety legislation.

The country does have a Biosafety Bill, adopted in 2007, which exclusively covers Genetically Modified Organisms (GMOs) and efforts to mitigate their impact on biodiversity and human health. In the law, biosafety is narrowly defined as "the goal of ensuring that the development and use of genetically modified organisms and products made from them do not
negatively affect plant, animal or human health." ¹³³ An updated version of this bill was tabled in 2022 which contains the same narrow focus on GMOs. The 2022 revision does not appear to have been adopted into law. ¹³⁴

The country also has a Draft National Biosafety Policy, which was published in 2005 (it is unclear whether it was ever formally adopted). The policy pertains to the "safe application of biotechnology" and mitigation of biotechnology's impacts on biodiversity. Like the Biosafety Bill, it concentrates overwhelmingly on GMOs. ¹³⁵ A 2024 report by the International Union for Conservation of Nature found that this legislation "lack[s] implementation capacity and alignment with international protocols." ¹³⁶

Lesotho is a part of the Africa Centers for Disease Control and Prevention (Africa CDC) Biosafety and Biosecurity Initiative (BBI), which was launched in 2019. According to a 2025 report, this initiative has provided trainings to officials in Lesotho on biosafety and biosecurity fundamentals and international biosafety standards. ¹³⁷

No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database. ¹³⁸ Lesotho appears to have submitted a Confidence-Building Measure report under the Biological Weapons Convention in 2024, but its content is not publicly available. ¹³⁹

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

Lesotho does not have an established agency responsible for the enforcement of biosafety legislation and regulations.

Lesotho's Department of Environment participates in biosafety activities. ¹⁴⁰ As a signatory to the Cartagena Protocol on Biosafety, Lesotho has three national points of contact for biosafety, all of whom work for the Department of Environment within the Ministry of Tourism, Environment and Culture. ¹⁴¹ However, there is no evidence of a law or regulation specifically empowering the department with oversight over biosafety legislation.

Lesotho’s Environment Act, adopted in 2008, states that the Department of Environment is responsible for overseeing regulations related to the handling of hazardous wastes and other materials in the country. However, it does not explicitly address biosafety. ¹⁴²

Lesotho is a part of the Africa Centers for Disease Control and Prevention (Africa CDC) Biosafety and Biosecurity Initiative (BBI), which was launched in 2019. According to a 2025 report, Lesotho does not have a lead entity responsible for regulating national biosafety standards. ¹⁴³

No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁴⁴ Lesotho appears to have submitted a Confidence-Building Measure report under the Biological Weapons Convention in 2024, but its content is not publicly available. ¹⁴⁵ No information was found on the website of Lesotho's Ministry of Health. ¹⁴⁶

1.4.2 Biosafety training and practices

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no evidence that Lesotho has a required biosafety training program for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.

In the 2017 Joint External Evaluation (JEE) report by the World Health Organization, Lesotho was reported to have a robust human biosafety program, with trained safety officers in each laboratory and at the national level who undergo yearly safety trainings and are provided with personal protective equipment. The JEE also found that Lesotho's educational institutions have units on biosafety and that laboratories in the country follow International Organization for Standardization (ISO) standards. ¹⁴⁷ However, there is no evidence of comprehensive biosafety legislation in the country and thus no evidence that such training is required.

Lesotho's Department of Environment has conducted a number of activities related to biosafety training. In 2017, it conducted a series of workshops across the country that aimed to help teachers mainstream biosafety into their curricula. ¹⁴⁸ In 2019, it let a series of trainings for laboratory personnel on quality management. ¹⁴⁹ As part of the Africa Centers for Disease Control and Prevention (Africa CDC) Biosafety and Biosecurity Initiative (BBI), which was launched in 2019, officials in Lesotho have received trainings on biosafety, but there is no evidence that these trainings have included personnel working in facilities with dangerous materials. ¹⁵⁰

No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁵¹ Lesotho appears to have submitted a Confidence-Building Measure report under the Biological Weapons Convention in 2024, but its content is not publicly available. ¹⁵²

1.5 Dual-use research and culture of responsible science

1.5.1 Oversight of dual-use research

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no evidence that Lesotho has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

According to a 2025 report, the Africa Centers for Disease Control (Africa CDC) is working with a number of countries, including Lesotho, to urge national governments to adopt laws on dual-use research. ¹⁵³ However, there is no evidence in Lesotho's national legal database that any such laws have been adopted. ¹⁵⁴

In 2021, Lesotho's Ministry of Communications, Science and Technology adopted a Research and Innovation Policy. The policy does not address dual-use research or research with potentially dangerous pathogens. ¹⁵⁵

No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁵⁶ Lesotho appears to have submitted a Confidence-Building Measure report under the Biological Weapons Convention in 2024, but its content is not publicly available. ¹⁵⁷ The Biological Weapons Convention National Implementation Measures Database reports no publicly available information about dual-use research in Lesotho. ¹⁵⁸

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no evidence that Lesotho has adopted legislation and/or regulation requiring oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

According to a 2025 report, the Africa Centers for Disease Control (Africa CDC) is working with a number of countries, including Lesotho, to urge national governments to adopt laws on dual-use research. ¹⁵⁹ However, there is no evidence in Lesotho's national legal database that any such laws have been adopted. ¹⁶⁰

No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁶² Lesotho appears to have submitted a Confidence-Building Measure report under the Biological Weapons Convention in 2024, but its content is not publicly available. ¹⁶³ The Biological Weapons Convention National Implementation Measures Database reports no publicly available information about dual-use research in Lesotho. ¹⁶⁴

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is no evidence that Lesotho has an agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research.

According to a 2025 report, the Africa Centers for Disease Control (Africa CDC) is working with a number of countries, including Lesotho, to urge national governments to adopt laws on dual-use research. ¹⁶⁵ However, there is no evidence in Lesotho's national legal database that any such laws have been adopted. ¹⁶⁶

Lesotho's Department of Environment is involved in a number of biosafety activities, such as providing trainings and serving as the country's national points of contact for international biosafety treaties. ¹⁶⁸ However, there is no evidence that the department is responsible for overseeing dual-use research.

No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁶⁹ Lesotho appears to have submitted a Confidence-Building Measure report under the Biological Weapons Convention in 2024, but its content is not publicly available. ¹⁷⁰ The Biological Weapons Convention National Implementation Measures Database reports no publicly available information about dual-use research in Lesotho. ¹⁷¹

1.5.2 Screening requirements for providers of genetic material

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no evidence that Lesotho has national legislation or regulations that require the screening of synthesized DNA before it is sold.

Lesotho's Biosafety Bill (2007) and Draft National Biosafety Policy (2005) both pertain to the safe use of Genetically Modified Organisms (GMOs) and efforts to mitigate their impact on biodiversity in the country. However, neither law covers the screening of synthesized DNA or requirements for the commercial use of GMOs. ¹⁷²¹⁷³ The proposed 2022 revision of the Biosafety Bill (not passed into law) also did not address screening requirements for synthesized DNA. ¹⁷⁴

No further evidence could be found in the Verification Research, Training and Information Centre (VERTIC) database. ¹⁷⁵ Lesotho appears to have submitted a Confidence-Building Measure report under the Biological Weapons Convention in 2024, but its content is not publicly available. ¹⁷⁶

There is also no relevant evidence to be found on the website of Lesotho's Ministry of Trade and Industry. ¹⁷⁷

1.6 Immunization

1.6.1 Vaccination rates

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 100

Foot-and-mouth disease (FMD) vaccination figures are publicly available for livestock in Lesotho.

According to the World Organisation for Animal Health (WOAH), Lesotho does not practice vaccination against FMD. However, WOAH also reports that despite not vaccinating livestock against FMD, the country is free of the disease as of May 2025. ¹⁷⁸

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

Lesotho has a national immunization strategy, and it includes a plan to ensure equitable distribution and strategies to overcome socioeconomic and geographic barriers to vaccination.

The latest revision of Lesotho's Expanded Program on Immunisation Comprehensive Multi-Year Plan was published in 2018 and covered the years 2018-2022. The program, led by the Ministry of Health, contained measures to increase immunization coverage, introduce new vaccines, improve the vaccine supply and cold chain, develop waste management and transportation guidelines, eliminate measles and polio in Lesotho, and enhance the country's capacity for immunization planning, leadership, and monitoring. ¹⁷⁹

The plan explicitly addresses immunization equity and socioeconomic/geographic disparities. Key metrics for measuring equity include the percentage gap in vaccine coverage between the highest and lowest socioeconomic quintiles, the number of districts with vaccine coverage above 80 percent, and the number of high risk communities identified for accelerated immunization programming. Proposed equity-related measures include intense social mobilization and the periodic hire of helicopters, horses, and donkeys to reach remote areas. ¹⁸⁰

Efforts to mitigate barriers to vaccination have been supported by international organizations such as UNICEF Lesotho; for example, in July 2025, UNICEF Lesotho reported that a new vaccine store had been built in the remote highlands of Thaba-Tseka with temperature-regulated cold chain equipment, backup power, and dedicated space for vaccine management. ¹⁸¹

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 100

Lesotho has a national immunization strategy, and it includes measures to address vaccine hesitancy and build public trust in vaccines.

Strategic Objective 2 of the plan outlines a number of measures aimed at increasing public trust in vaccines, including: conducting dialogues to transmit information and respond to people's concerns and fears; utilizing social media tools and Internet-based technologies; including immunization in the basic education curriculum; recruiting "new voices" such as religious leaders, educators, social media personalities, family physicians, community health workers, and trained immunization champions; and training healthcare workers on effective communication techniques to address vaccine hesitancy and maintain trust. ¹⁸³

The plan also included the development of a "vaccine hesitancy group"; however, no evidence could be found on the website of the country's Ministry of Health that such a group currently exists. ¹⁸⁴

1.6.1e National advisory group for immunization strategy/plan

Score: 100

Lesotho has a national advisory group that provides technical guidance and advice on the immunization strategy to the government.

Lesotho's Ministry of Health was responsible for overseeing the Expanded Program on Immunisation Comprehensive Multi-Year Plan, which was published in 2018 and covered the years 2018-2022. According to this plan, a National Immunization Technical Advisory Group (NITAG) was to be formed to advise the government on the implementation of this plan. ¹⁸⁵ The NITAG was to provide recommendations to the government on issues such as whether to switch from the TT vaccine to the Td vaccine, and whether to introduce the hepatitis B vaccine for newborns. ¹⁸⁶ According to the World Health Organization's National Immunization Advisory Mechanism website, as of 2024, Lesotho's NITAG is active and has met 4 times. However, it is unclear how many people make up the NITAG or whether experts public health, infectious disease, epidemiology, pediatrics, or immunology are represented. ¹⁸⁷ Lesotho's NITAG does not have a public presence and there is no information on the website of the country's Ministry of Health about NITAG meetings or other activities. ¹⁸⁸

1.6.1f Presence of an immunization programme for influenza

Score: 0

There is no evidence that Lesotho has an immunization program for influenza.

Lesotho's Expanded Program on Immunisation Comprehensive Multi-Year Plan, which was published in 2018 and covered the years 2018-2022, did not contain any specific provisions for influenza; the only diseases mentioned in the document by name are measles, polio, tetanus, hepatitis B, rubella, smallpox, tuberculosis, diphtheria, whooping cough, human papillomavirus, and HIV. ¹⁸⁹

It is also not clear how widespread influenza vaccination coverage is in Lesotho. Data on influenza vaccine coverage in Lesotho has been missing from the World Health Organization's Joint Reporting Form (JRF) database since 2018 (the first year for which data is available). ¹⁹⁰ Data on Lesotho's vaccination schedule for influenza is also missing from this database. ¹⁹¹

In 2025, Lesotho became the first country in Africa to pilot the AFRO Influenza Surveillance Platform (AFFLU). The AFFLU platform allows users at surveillance sites to collect and manage real-time data on influenza and other respiratory viruses. The technology is expected to help the Ministry of Health improve early detection of outbreaks and rapid response to affected areas. ¹⁹² However, the adoption of AFFLU does not seem to be underpinned by a comprehensive immunization strategy.

No further information of an influenza immunization program was found on the website of Lesotho's Ministry of Health. ¹⁹³

1.7 Climate change adaptation and vector transmission

1.7.1 Health system resilience

1.7.1a Strategy/plan for resilience of health system

Score: 100

Lesotho has a strategy to develop a health system that is resilient to climate change and it includes the threat of infectious diseases.

In 2017, Lesotho's Ministry of Energy and Meteorology adopted a National Climate Change Policy. The policy establishes 22 strategic measures to ensure that stakeholders address climate change impacts by mainstreaming adaptation and mitigation actions into all relevant sectors while promoting sustainable development. It aims to promote climate-resilient social, economic, and environmental development by building adaptive capacity and strengthening the resilience of communities and ecosystems to climate variability and extremes. ¹⁹⁴

Section 3.10 of the policy discusses climate change impacts on human health. It states what while Lesotho is largely free from climate-related diseases due to its high altitude and low temperatures, this is likely to change in the future as the transmission zone for diseases such as malaria expands. Dry conditions in the spring and summer may lead to increases in conditions such as tuberculosis and waterborne infections like typhoid and dysentery. Specific policy interventions to address this challenge include the improvement of data recording, reporting, and analysis for climate-sensitive diseases "at all levels of service delivery"; enhanced knowledge of the health sector on the impacts of climate change; strengthened technical capacity to manage climate-change related health risks; strengthened early warning surveillance systems for climate-related diseases; and identification of vulnerable groups to climate-sensitive diseases. ¹⁹⁵

A 2021 climate change Country Profile by the World Bank suggested that climate change may increase the spread of vector-borne diseases such as malaria, dengue fever, yellow fever, rift valley fever, and schistosomiasis. ¹⁹⁶

Early Detection

2.1 Laboratory systems strength and quality

2.1.1 Lab capacity for detecting priority diseases

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 50

There is evidence of in-country capacity to test for at least 5 of the 10 WHO-defined core tests in Lesotho.

As of the World Health Organization's 2017 Joint External Evaluation, Lesotho had the capacity to test for cholera, HIV, malaria, measles, meningitis, rubella, tuberculosis, typhoid, and shigellosis. However, it is unclear what testing methodologies are used or how widely available the tests are. ¹⁹⁷

There is no data on the World Health Organization's Influenza Surveillance Report dashboard for the prevalence of influenza in Lesotho. ¹⁹⁸ In 2025, Lesotho adopted the AFRO Influenza Surveillance Platform to improve its surveillance of the disease, but there is no publicly available evidence that Polymerase Chain Reaction (PCR) testing is widely practiced for its diagnosis. ¹⁹⁹

There is no evidence as to whether virus cultures for poliovirus are performed in Lesotho. Lesotho has been polio-free since 2005. ²⁰⁰

Serological testing for HIV is performed in Lesotho. In 2022, the country's Ministry of Health released guidelines for the use of antiretroviral therapy for HIV prevention, which outlines best practices for performing blood tests to diagnose HIV. ²⁰¹

Microscopy for tuberculosis testing is available in Lesotho. Tuberculosis testing in Lesotho is done using GeneXpert, smear microscopy, and the TB LAM antigen test. ²⁰²

There is no publicly available evidence of Lesotho's capacity to perform rapid diagnostic testing for plasmodium spp. or bacterial cultures for Salmonella enteritidis serotype Typhi. No such information could be found on the website of Lesotho's Ministry of Health or on the World Health Organization's country portal for Lesotho. ²⁰³²⁰⁴

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no evidence that Lesotho has a plan or other strategy for conducting testing during a public health emergency.

In 2024, the Government of Lesotho launched the Emergency, Preparedness, and Response Flagship Initiative Roadmap with the support of the World Health Organization (WHO) and Africa Centers for Disease Control (Africa CDC). The three pillars of this initiative are 1) promoting the resilience of systems for emergencies, 2) transforming surveillance systems, and 3) strengthening and utilizing response groups for emergencies. ²⁰⁵ As part of this initiative, Lesotho launched a multisectoral training program for health emergency responders, which was completed by a total of 49 people. ²⁰⁶ However, the exact text of this roadmap is not publicly available, nor is the content of the training modules, so it cannot be confirmed whether there is a plan for conducting testing. This information could not be found on the websites of the WHO, Africa CDC, or Lesotho's health ministry. ²⁰⁷²⁰⁸²⁰⁹

Additionally, in 2025, Lesotho convened its inaugural National Steering Committee meeting for the Pandemic Fund Southern Africa Multicountry Project. The project, funded by the Pandemic Fund, is aimed at combating disease outbreaks and bolstering Lesotho’s pandemic/epidemic preparedness and response infrastructure. ²¹⁰ However, there is no evidence that this project includes a specific plan for testing; the four pillars listed on the Pandemic Fund’s website include “improving the detection of climate-related threats,” “strengthening laboratory capacity,” “increasing public health, emergency, and surge workforce capacity” and “reinforcing [emergency preparedness and response] governance and collaboration.” ²¹¹ There is no additional information about the details of this project on the website of Lesotho's health ministry. ²¹²

2.1.2 Laboratory quality systems

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 100

Lesotho has a national reference laboratory which is accredited.

According to the website of the Strengthening Laboratory Management Toward Accreditation (SLMTA) program, which is supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Lesotho has two laboratories with ISO 15189 accreditation. SLMTA reports that Lesotho’s National Tuberculosis Reference Laboratory received SADCAS – ISO 15189 accreditation in March 2024, as did the Motebang Regional Hospital Molecular Lab and TB Lab. ²¹³ The National Tuberculosis Reference Laboratory, which has the ISO 15189:2012 accreditation, is located in Lesotho’s capital Maseru and conducts tuberculosis testing using fluorescent microscopy, Ziehl-Neelsen microscopy, culture, drug susceptibility testing, line probe assay, and GeneXpert MTB/RIF assay. ²¹⁴

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

Lesotho has a national reference laboratory which is subject to external quality assurance review.

Lesotho's National Tuberculosis Reference Laboratory, located in its capital Maseru, has the ISO 15189:2012 accreditation and conducts tuberculosis testing using fluorescent microscopy, Ziehl-Neelsen microscopy, culture, drug susceptibility testing, line probe assay, and GeneXpert MTB/RIF assay. ²¹⁵ It received accreditation March 2023 from the Southern African Development Community Accreditation Service (SADCAS). SADCAS requires that accredited institutions undergo periodic on-site assessment, and accreditation is re-confirmed on an annual basis. Additionally, accredited institutions must undergo a full re-assessment at least 6 months prior to the end of the accreditation cycle. ²¹⁶

2.2 Laboratory supply chains

2.2.1 Specimen referral and transport system

2.2.1a Nationwide specimen transport system

Score: 100

There is sufficient evidence that Lesotho has a nationwide specimen transport system.

The World Health Organization's (WHO) 2017 Joint External Evaluation (JEE) report found that Lesotho has a specimen transport system for human specimens from all 10 districts, including a helicopter service for emergencies; however, 80% of specimens are transported by the non-governmental organization Riders for Health, while DHL is used for out-of-country transportation. Additionally, per the JEE, there is no transport system for animal specimens. The report argues that the fact that Lesotho’s regional specimen transportation system is funded by WHO raises sustainability issues. ²¹⁷

According to the website of Riders for Health, its transport system covers the entire country of Lesotho, with a fleet of 286 vehicles, 76 staff members, and 250 trained drivers. ²¹⁸ In 2023, Riders for Health transported 460,821 samples in Lesotho, covering a total of 897,206 kilometers. ²¹⁹

2.2.2 Laboratory cooperation and coordination

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is no evidence of a plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak in Lesotho.

In 2024, the Government of Lesotho launched the Emergency, Preparedness, and Response Flagship Initiative Roadmap with the support of the World Health Organization (WHO) and Africa Centers for Disease Control (Africa CDC). The three pillars of this initiative are 1) promoting the resilience of systems for emergencies, 2) transforming surveillance systems, and 3) strengthening and utilizing response groups for emergencies. ²²⁰ However, the the exact text of this roadmap is not publicly available, so it cannot be confirmed whether it includes provisions for expedited licensing of laboratories during public health emergencies. This information could not be found on the website of the World Health Organization, Africa Centers for Disease Control, or Lesotho's Ministry of Health. ²²¹²²²²²³

Additionally, in 2025, Lesotho convened its inaugural National Steering Committee meeting for the Pandemic Fund Southern Africa Multicountry Project. The project, funded by the Pandemic Fund, is aimed at combating disease outbreaks and bolstering Lesotho’s pandemic/epidemic preparedness and response infrastructure. ²²⁴ However, there is no evidence that this project includes the development of a plan to rapidly authorize laboratories during public health emergencies. Its four pillars include “improving the detection of climate-related threats,” “strengthening laboratory capacity,” “increasing public health, emergency, and surge workforce capacity” and “reinforcing [emergency preparedness and response] governance and collaboration.” ²²⁵ There is no additional information about the details of this project on the website of Lesotho's health ministry. ²²⁶

2.3 Real-time surveillance and reporting

2.3.1 Indicator and event-based surveillance and reporting systems

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

There is evidence that Lesotho is conducting ongoing event- and indicator-based surveillance, but no evidence that the data generated by these systems are analyzed on a daily basis.

The DHIS2 disease surveillance system is in use as Lesotho’s national surveillance platform. ²²⁷ DHIS2 is an integrated disease surveillance platform that incorporates both indicator-based and event-based surveillance (EBS). Features of DHIS2 include flexible data collection which can accommodate weekly or daily surveillance; case-based surveillance; notifications, alerts and outbreak thresholds; interoperability with laboratory systems; automated surveillance reports; offline tools; and analytics. ²²⁸ The WHO's 2017 Joint External Evaluation (JEE) report found that DHIS2 was in place in all 10 districts of Lesotho. ²²⁹ Additionally, in 2024, the WHO conducted an event-based surveillance training for 3,455 community leaders from across Lesotho in order to strengthen village health workers' ability to detect diseases at an early stage. ²³⁰

Data generated by DHIS2 are not publicly available on the websites of Lesotho's Ministry of Health or the WHO, and there is no evidence that they are analyzed on a daily basis. ²³¹²³² The 2017 JEE report stated that health facilities in Lesotho compile weekly reports and submit them to district level, after which it is transmitted to the national level; however, it is unclear how often this information is analyzed. ²³³

The Africa Centers for Disease Control (Africa CDC), a health agency of the African Union (of which Lesotho is a member), has developed comprehensive event-based surveillance guidelines to be applied by Member States. The Lesotho Ministry of Health was involved in drafting Africa CDC's 2023 EBS guidelines. The guidelines include recommendations for implementing detection, triage, verification, risk assessment, and alerts about acute health risks. Specific EBS approaches included in the guidelines include media scanning, event reporting hotlines, facility event-based surveillance (at veterinary clinics, wastewater facilities, human health facilities, etc.), and community event-based surveillance. ²³⁴

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

There is evidence that Lesotho has a mechanism for reporting notifiable diseases to the World Health Organization within the set timeline.

According to the World Health Organization's (WHO) 2017 Joint External Evaluation (JEE) report, Lesotho's national IHR focal point is a three-person team at the national level which is responsible for reporting public health events to the WHO. ²³⁵ As of 2017, Lesotho had not reported any Public Health Events of International Concern (PHEIC), and there is no evidence on the website of the WHO that it has done so since. ²³⁶²³⁷ While it seems that Lesotho formally has a mechanism for reporting events to the WHO, its capacity score for "IHR coordination and national IHR focal point functions and advocacy" in the 2024 IHR State Parties Self-Assessment Annual Reporting Tool (SPAR) was below the regional and global average. ²³⁸

2.3.2 Interoperable, interconnected, electronic real-time reporting systems

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

Lesotho's government operates an electronic reporting surveillance system at both the national and sub-national level.

The DHIS2 electronic disease surveillance system is in use as Lesotho’s national surveillance platform. ²³⁹ DHIS2 is an integrated disease surveillance platform that incorporates both indicator-based and event-based surveillance (EBS). Features of DHIS2 include flexible data collection which can accommodate weekly or daily surveillance; case-based surveillance; notifications, alerts and outbreak thresholds; interoperability with laboratory systems; automated surveillance reports; offline tools; and analytics. ²⁴⁰ The WHO's 2017 Joint External Evaluation (JEE) report found that DHIS2 was in place in all 10 districts of Lesotho. ²⁴¹

DHIS2 has been in use in Lesotho since 2015; initially, 10 central Ministry of Health users, 50 district-level users, and 25 program managers were trained in use of the software. DHIS2 was also rolled out across all of Lesotho's ten districts in 2015. ²⁴²

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 50

Lesotho has an electronic reporting surveillance system which collects ongoing laboratory data, but there is not sufficient evidence that it can be disaggregated and analyzed.

The DHIS2 electronic disease surveillance system is in use as Lesotho’s national surveillance platform. ²⁴³ DHIS2 is an integrated disease surveillance platform that incorporates both indicator-based and event-based surveillance (EBS). Features of DHIS2 include flexible data collection which can accommodate weekly or daily surveillance; case-based surveillance; notifications, alerts and outbreak thresholds; interoperability with laboratory systems; automated surveillance reports; offline tools; and analytics. ²⁴⁴ DHIS2 has support for real-time monitoring. ²⁴⁵ DHIS2 was implemented in Lesotho in 2015. ²⁴⁶

DHIS2 has support for disaggregating data for further breakdown by categories such as age and gender. However, there is no evidence on the website of the Ministry of Health that Lesotho disaggregates data in its instance of DHIS2. ²⁴⁷ A 2022 World Bank Group report in partnership with the Ministry of Health states that Lesotho lacks a legal policy framework for data sharing and data are often not available at the level of disaggregation a user demands. ²⁴⁸

2.3.3 Wastewater surveillance

2.3.3a National wastewater surveillance programme or initiative

Score: 100

In April 2024, Lesotho established Environmental Surveillance (ES) for poliovirus detection, making it the 44th African country to implement this. ²⁴⁹ As part of this, the Ministry of Health, with technical support from the World Health Organization, now regularly collects sewage or wastewater contaminated with human fecal matter to test for the presence or absence of poliovirus. This complements existing acute flaccid paralysis (AFP) surveillance and strengthens polio detection sensitivity by capturing evidence of virus circulation even in the absence of reported cases. The system is currently active with two functional sample collection sites.

2.4 Surveillance data accessibility and transparency

2.4.1 Coverage and use of electronic health records

2.4.1a Common usage of electronic health records

Score: 50

Electronic health records are used in Lesotho, but their use is limited.

Lesotho has a system called eRegister, an electronic medical record (EMR) system that was in use at 187 out of 277 health facilities as of July 2024. eRegister was built using the Bahmni project, an open-source EMR system designed for low resource settings; it was implemented and rolled out in Lesotho in 2018. However, it covers only HIV, tuberculosis, and prevention of mother to child transmission (PMTCT) services. ²⁵⁰ In 2022, the World Bank Group reported that e-Register's interoperability with other platforms like the DHIS-2 surveillance system was limited and recommended that the platform be scaled up to cover more conditions. ²⁵¹

Lesotho's 2024 National Digital Transformation Strategy states that the country's digital health landscape is "highly fragmented and not designed to support interoperability," specifically citing DHIS2 and e-Register. ²⁵² The strategy calls for the development of a "digital government interoperability framework" to address these issues. ²⁵³

Health workers in Lesotho have cited poor network connectivity and electricity supply issues as barriers to the effective use of EMR systems. ²⁵⁴

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no evidence that the national public health system has access to electronic health records of individuals in Lesotho.

Lesotho has a system called eRegister, an electronic medical record (EMR) system that was in use at 187 out of 277 health facilities as of July 2024. eRegister was built using the Bahmni project, an open-source EMR system designed for low resource settings; it was implemented and rolled out in Lesotho in 2018. ²⁵⁵ However, the World Bank Group has reported that some e-Register data is hosted on local servers at health facilities, meaning it is not available to national public health officials. ²⁵⁶ Additionally, while data are collected at local health facilities and then transmitted to the district and national level, they are often shared at an aggregated level, meaning patient-level information is not available. ²⁵⁷ Additionally, e-Register is currently (as of 2024) only used for HIV, tuberculosis, and prevention of mother to child transmission (PMTCT) services. ²⁵⁸

No information could be found on the website of Lesotho's Ministry of Health indicating that the national public health system has access to individual-level electronic health records. ²⁵⁹

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is no evidence of standards to ensure data is comparable in Lesotho.

Riders for Health, a nongovernmental organization deployed across Lesotho to support sample specimen transport, utilizes the Data Observation Toolkit (DOT) software. DOT automates data quality checks and detects anomalies. It has been used by DOT to manage quality control of data for the nearly half a million specimens being transported annually for infectious disease monitoring in Lesotho. ²⁶⁰ However, there is no evidence that DOT is in use in Lesotho beyond Riders for Health.

A 2021 report by the Lesotho Millennium Development Agency (LMDA) found that ministries in Lesotho are marked by poor reporting compliance, duplication of efforts, and contradicting information and data which hampers access to and comparative use of data. ²⁶¹

A 2022 World Bank Group report also found that there are limited standards for health data governance, which has led to siloization and duplication of systems. ²⁶²

No evidence of data comparability standards could be found on the website of Lesotho's Ministry of Health or the Ministry of Communications, Science and Technology. ²⁶³²⁶⁴

2.4.2 Data integration between human, animal and environmental health sectors

2.4.2a Data sharing mechanisms

Score: 0

There is no evidence of established mechanisms for animal, human, and wildlife surveillance to share data.

The World Health Organization's 2017 Joint External Evaluation (JEE) for Lesotho notes that there is no formal communication for sharing epidemiological data and reports between the animal and human health sector and that collaboration happens only on an ad hoc basis. There is a system in place for routine surveillance of brucellosis in dairy cows, but it is not continuous. ²⁶⁵

This is confirmed by a 2022 World Bank Group report, which cites a lack of a legal or policy framework to facilitate data sharing as an issue that limits coordination in the health sector. ²⁶⁶

One of the objectives of Lesotho's 2024 National Digital Transformation Strategy is the development of data-sharing principles and standards to mitigate the current absence of data sharing/storage standards across the government. ²⁶⁷ However, this strategy does not specifically mention health data or disease surveillance.

No evidence of further data mechanisms could be found on the website of Lesotho's Ministry of Health or the Ministry of Communications, Science and Technology. ²⁶⁸²⁶⁹

2.4.3 Transparency of surveillance data

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 0

Lesotho does not make de-identified health surveillance data on infectious diseases publicly available on government websites.

No current surveillance data for any diseases could be found on the website of Lesotho's Ministry of Health. During the COVID-19 pandemic, the Ministry posted periodic updates about new and cumulative case numbers. The last COVID update was posted in January 2022. ²⁷⁰

Lesotho's Bureau of Statistics publishes an annual Health Statistics Report which contains an overview of data on hospital admissions; the reports do not include data about infectious diseases apart from a small overview of HIV prevalence data. ²⁷¹ There is also a Lesotho Data Portal which contains fragmented data about economic indicators, mortality, life expectancy, and other statistics, but no data about infectious diseases is available on the portal. ²⁷²

Some data on disease prevalence is available on Lesotho's country portal on the World Health Organization website, but even this is limited to tuberculosis. ²⁷³

No additional evidence could be found on the websites of the Ministry of Communications, Science and Technology or the Ministry of Agriculture and Food Security. ²⁷⁴²⁷⁵

2.4.4 Ethical considerations during surveillance

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

Lesotho has legislation that safeguards the confidentiality of identifiable health information for individuals.

Per Article 29 of Lesotho's Data Protection Act, adopted in 2012, data pertaining to an individual's spiritual, religious or philosophical beliefs, race or ethnic origin, trade union membership, political affiliation, health, sexual life or criminal behavior is subject to protection and can only be processed with the individual's explicit consent. Medical professionals and healthcare institutions are exempt from this provision if an individual's personal health data must be processed in order to provide them with the appropriate treatment or care; in such cases, the data may be processed but must be done so confidentially. ²⁷⁶ The law does not specifically mention health surveillance activities.

The Data Protection Act (Part 2) provides for the creation of a Data Protection Commission, but as of 2024, it was yet to be established; its establishment is one goal of the country's 2024 National Digital Transformation Strategy. ²⁷⁷

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

Lesotho has legislation that safeguards the confidentiality of identifiable health information for individuals, but it does not mention protections from cyber attacks.

Per Article 29 of Lesotho's Data Protection Act, adopted in 2012, data pertaining to an individual's spiritual, religious or philosophical beliefs, race or ethnic origin, trade union membership, political affiliation, health, sexual life or criminal behavior is subject to protection and can only be processed with the individual's explicit consent. Medical professionals and healthcare institutions are exempt from this provision if an individual's personal health data must be processed in order to provide them with the appropriate treatment or care; in such cases, the data may be processed but must be done so confidentially. ²⁷⁸ However, the law does not contain any provisions aimed at protecting data from cyber attacks.

In 2025, the Lesotho Communications Authority (LCA) released Cybersecurity Regulatory Guidelines. This document contains a brief section on data protection which states that communications operators in the country must ensure that data is backed up in the event of system failure, and that they must encrypt sensitive data at rest and in transit to protect the confidentiality and integrity of critical information. Cyberattacks are not discussed comprehensively in this document. ²⁷⁹ Lesotho also has a Computer Security Incident Response Team (Ls ComCSIRT) with an online interface for reporting cybersecurity incidents. However, there is no information on Ls ComCSIRT's website specifically about safeguarding the confidentiality of health data. ²⁸⁰

2.4.5 International data sharing

2.4.5a Cooperative commitments or agreements within regions

Score: 0

Other than regional general agreements, there is no evidence that Lesotho has made commitments to share surveillance data for more than one disease with other countries during public health emergencies.

Lesotho is a State Party to the International Health Regulations (published 2005, amended in 2024) as of June 2007. Article 6.1 requires State Parties to "notify WHO, by the most efficient means of communication available, by way of the National IHR Focal Point, and within 24 hours of assessment of public health information, of all events which may constitute a public health emergency of international concern within its territory". After notifying WHO, State Parties must "continue to communicate to WHO timely, accurate and sufficiently detailed public health information available to it on the notified event, where possible including case definitions, laboratory results, source and type of the risk, number of cases and deaths, conditions affecting the spread of the disease and the health measures employed". ²⁸¹ So while this framework necessitates the sharing of surveillance data with the WHO but does not specify provisions to share with other countries.

Additionally, Article 6 of the Southern African Development Community's (SADC) Protocol on Health (published 1999), states that Member States shall "share information on health systems research and surveillance and co-operate and assist each other in its dissemination" and "co-operate and assist each other in regional surveillance with respect to communicable and non-communicable diseases". ²⁸² Lesotho is a founding member of the SADC, which was established in 1980 as the Southern African Development Coordination Conference (SADCC). ²⁸³

Additionally, as a member of the African Union, Lesotho is served by the Africa Centers for Disease Control and Prevention (Africa CDC). Africa CDC has released guidance and frameworks on public health data sharing; for example, in 2024, it released a Strengthening Cross Border Surveillance and Information Sharing in Africa Strategic Framework, which proposes interventions to bolster data sharing among Member States. However, this guidance is not binding and does not specifically mention data sharing measures during public health emergencies. ²⁸⁴ Africa CDC's 2023 Digital Transformation Strategy also underlines the importance of data sharing and provides for the creation of a "digital health data governance mechanism at the continental level to […] streamline health data sharing on the continent, including genomic, surveillance and diagnostic data." A goal of this strategy is for each Member State to have a regulatory framework around health data collection and sharing. This strategy is also not binding and does not constitute a requirement for Member States to share surveillance data. ²⁸⁵

Lesotho's 2024 National Digital Transformation Strategy mentions the development of comprehensive guidelines for cross-border data transfers but does not provide details or make any specific commitments. ²⁸⁶

No further evidence of specific country-level commitments to share surveillance data could be found on the websites of Lesotho's Ministry of Health or its Ministry of Communications, Science and Technology. ²⁸⁷²⁸⁸

2.5 Case-based investigation

2.5.1 Case investigation and contact tracing

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 0

There is no evidence that Lesotho has a national system to provide support at the sub-national level to conduct contact tracing in the event of a public health emergency.

As part of the Southern Africa Tuberculosis and Health Systems Support Project, Lesotho opened a number of wellness centers (6 as of March 2024) in hospitals with infection prevention and control capacity; services provided by these centers include contact tracing of tuberculosis cases. There is no evidence that this project supports contact tracing efforts for other diseases or during acute public health emergencies. ²⁸⁹

Additionally in 2025, Partners in Health reported that it is working with communities in Lesotho to increase the use contact tracing for tuberculosis. There is no evidence that these interventions are targeted to other diseases besides tuberculosis. ²⁹⁰

During the COVID-19 pandemic, the World Health Organization (WHO) deployed rapid response teams across Lesotho to carry out detection, reporting, and contact tracing. ²⁹¹

No additional evidence could be found on the website of Lesotho's Ministry of Health that the government supports contact tracing in subnational health systems. ²⁹²

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is no evidence that Lesotho provides wraparound services to enable infected people and their contacts to self-isolate or quarantine.

During the COVID-19 pandemic, the World Bank’s emergency COVID-19 response in Lesotho was to provide support to the government in enhancing isolation and clinical care capacity for infected patients, including the provision of “psychosocial and essential social support.” However, there is no evidence that this included any form of economic support. ²⁹³

No additional evidence of wraparound services for infected people could be found on the website of Lesotho's health ministry. ²⁹⁴

2.5.2 Point of entry management

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no evidence of an agreement between Lesotho's public health system and border control authorities to identify suspected and potential cases in international travelers.

The Lesotho Aliens Control Act of 1966 establishes that anyone entering Lesotho may be required to produce a medical certificate proving that they are free from any disease or illness. ²⁹⁵ The Public Health Order of 1970 gives border control officials the right to require medical examinations, detention, quarantine, cleansing, vaccination, isolation or medical surveillance of anyone entering Lesotho. This order also gives public health officials the authority to inspect trains or other conveyances to prevent the spread of communicable diseases. ²⁹⁶ However, neither of these laws specifically mentions active or future public health emergencies.

In 2020, Lesotho implemented temporary emergency regulations that required anyone who had travelled to a COVID-19 affected country and their contacts to self-quarantine for 14 days from the date of their arrival or last date of possible exposure. ²⁹⁷ Lesotho's COVID-19 lockdown restrictions were lifted in January 2022. ²⁹⁸

No further evidence could be found on the websites of Lesotho's Ministry of Health or its Home Office, which is responsible for implementing border control policies. ²⁹⁹³⁰⁰

2.6 Epidemiology workforce

2.6.1 Existence of applied epidemiology training program such FETP and FETPV

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

Applied epidemiology training program is available in Lesotho; there is no evidence that Lesotho provides resources for citizens to receive applied epidemiology training in other countries.

In 2022, Lesotho's Ministry of Health, supported by the United States Centers for Disease Control and Prevention (CDC) and the African Field Epidemiology Network (AFENET) launched a frontline field epidemiology training program. The first cohort began in September and was completed by 15 trainees from across Lesotho. ³⁰¹ As of January 2025, AFENET reported that it had graduated 4 cohorts, training a total of 68 graduates. The program is not TEPHINET-accredited. ³⁰²

The TEPHINET-accredited South Africa Field Epidemiology Training Program (SAFETP), founded in 2006, has also trained health professionals from Lesotho and other countries in sub-Saharan Africa. ³⁰³

There is no evidence on the website of Lesotho's Ministry of Agriculture and Food Security that the country has funding to send citizens to another country to participate in applied epidemiology training programs. ³⁰⁴

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

Lesotho has a field epidemiology training program (FETP) and it is explicitly inclusive of animal health professionals.

In 2022, Lesotho's Ministry of Health, supported by the United States Centers for Disease Control and Prevention (CDC) and the African Field Epidemiology Network (AFENET) launched a frontline field epidemiology training program. The first cohort began in September and was completed by 15 trainees from across Lesotho. ³⁰⁵ As of January 2025, AFENET reported that it had graduated 4 cohorts, training a total of 68 graduates. The program is not TEPHINET-accredited. ³⁰⁶

The exact number of animal health experts who have received training through the AFENET FETP is not publicly available, nor is the training's curriculum; however, AFENET explicitly reported in 2023 that among the 18 healthcare workers selected for that year's cohort, there were animal health experts in addition to experts in human health. ³⁰⁷

Additionally, AFENET employs a One Health approach to FETP which is explicitly inclusive of animal health. In June 2025, it held the Regional Frontline Field Epidemiology Training Program (FETP) One Health Mentors Workshop in Johannesburg, South Africa; mentors from Lesotho were present and were selected from the areas of human health, animal health, and environmental health. ³⁰⁸

There is no evidence on the AFENET website or on the website of Lesotho's Ministry of Health that the country has a separate FETPV program. ³⁰⁹³¹⁰

2.6.2 Epidemiology workforce capacity

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 100

Lesotho has at least 1 trained field epidemiologist per 200,000 people.

As of June 2025, 68 health care professionals in Lesotho had completed the African Field Epidemiology Network's (AFENET) field epidemiology training program (FETP). ³¹¹ As of 2024, Lesotho's population was roughly 2,300,000. ³¹² This works out to approximately 5.91 trained field epidemiologists per 200,000 residents of Lesotho.

Rapid Response

3.1 Emergency preparedness and response planning

3.1.1 National public health emergency preparedness and response plan

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 33.33

Lesotho has disease-specific emergency response plans, but there is no evidence of an overarching public health emergency response plan.

According to the World Health Organization's (WHO) 2017 Joint External Evaluation (JEE) report, Lesotho had developed a multi-hazard contingency plan for 2014-2015 that addressed public health hazards but at the time, it had "no national multi hazard public health emergency preparedness plan" ³¹³. There is some evidence that this plan had been updated since the JEE; a 2024 paper on disaster risk reduction in Lesotho cites a document titled Lesotho Multi-Hazard Contingency Plan 2020–2023 but does not elaborate on its contents. ³¹⁴ Neither revision of this plan is available on the website of Lesotho's Disaster Management Authority (DMA) or in Lesotho's national legislative database LesLII. ³¹⁵³¹⁶

According to the website of the Global Facility for Disaster Reduction and Recovery (GFDRR), GFDRR supported the development of a Multi-Hazard National Public Health Emergency Preparedness and Response Plan in Lesotho between 2019-2021. However, there is no evidence that this document was formally adopted and it is not available on the DMA's website or in the legislative database. ³¹⁷³¹⁸³¹⁹

Lesotho's Disaster Management Act, adopted in 1997, does not specifically address public health emergency preparedness or response. ³²⁰

As of 2017, the WHO reported that Lesotho's Ministry of Health had developed a national emergency contingency plan that included risk analyses for water- and food-borne epidemics and anthrax as well as a disease-specific plan for Ebola. ³²¹ None of these documents are available on the website of the Ministry of Health or the WHO. ³²²³²³

Lesotho does have a National Tuberculosis and Leprosy Strategic Plan; the latest revision covers the years 2018-2022. However, it does not lay out an emergency response plan, rather medium-to-long-term actions meant to promote the prevention of tuberculosis. ³²⁴

Finally, in 2024, the Government of Lesotho launched the Emergency, Preparedness, and Response Flagship Initiative Roadmap with the support of the World Health Organization (WHO) and Africa Centers for Disease Control (Africa CDC). The three pillars of this initiative are 1) promoting the resilience of systems for emergencies, 2) transforming surveillance systems, and 3) strengthening and utilizing response groups for emergencies. However, the exact text of this roadmap is not publicly available. ³²⁵

3.1.1b National public health emergency response plan published in past 3 years

Score: 0

Lesotho does not have an overarching public health emergency response plan.

According to the World Health Organization's (WHO) 2017 Joint External Evaluation (JEE) report, Lesotho had developed a multi-hazard contingency plan for 2014-2015 that addressed public health hazards but at the time, it had "no national multi hazard public health emergency preparedness plan" ³²⁶. There is some evidence that this plan had been updated since the JEE; a 2024 paper on disaster risk reduction in Lesotho cites a document titled Lesotho Multi-Hazard Contingency Plan 2020–2023 but does not elaborate on its contents. ³²⁷ Neither revision of this plan is available on the website of Lesotho's Disaster Management Authority (DMA) or in Lesotho's national legislative database LesLII. ³²⁸³²⁹

Lesotho's Disaster Management Act, adopted in 1997, does not specifically address public health emergency preparedness or response. ³³³

As of 2017, the WHO reported that Lesotho's Ministry of Health had developed a national emergency contingency plan that included risk analyses for water- and food-borne epidemics and anthrax as well as a disease-specific plan for Ebola. ³³⁴ None of these documents are available on the website of the Ministry of Health or the WHO. ³³⁵³³⁶

3.1.1c One health principles by covering multiple threat types

Score: 0

Lesotho does not have an overarching public health emergency response plan.

No evidence of such a plan could be found on the websites of Lesotho's Ministry of Health, the Disaster Management Authority, the World Health Organization, or in Lesotho's national legislative database. ³³⁸³³⁹³⁴⁰³⁴¹

Lesotho's 2021-2026 National Action Plan on Antimicrobial Resistance does explicitly follow One Health principles in order to "reflect the inter-sectoral nature of [antimicrobial resistance]". The AMR plan provides for the creation of a One Health antimicrobial surveillance system that integrates data sharing from human, water, environment and agricultural sectors. It also underlines the importance of inter-ministerial collaboration on AMR issues among entities such as the Ministry of Health, the Ministry of Agriculture and Food Security, the Ministry of Development Planning, and the Ministry of Tourism, Environment and Culture. ³⁴²

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

Lesotho does not have an overarching public health emergency response plan.

There is evidence that health equity is incorporated into other national public health strategies in Lesotho. For example, Lesotho's Expanded Programme on Immunisation Comprehensive Multi-Year Plan for 2018-2022 explicitly addresses immunization equity and socioeconomic/geographic disparities. Key metrics for measuring equity in this plan include the percentage gap in vaccine coverage between the highest and lowest socioeconomic quintiles, the number of districts with vaccine coverage above 80 percent, and the number of high risk communities identified for accelerated immunization programming. Proposed equity-related measures include intense social mobilization and the periodic hire of helicopters, horses, and donkeys to reach remote areas. ³⁴⁷

Additionally, Lesotho's 2018-2022 National Tuberculosis Strategic Program explicitly addresses health equity. One of its objectives is to strengthen the tuberculosis prevention and care infrastructure for vulnerable populations, including people living with HIV, children under 5 years of age, healthcare workers, miners and peri-mining communities, inmates, the mobile population, and people with other immunosuppressing conditions such as diabetes mellitus. ³⁴⁸

3.1.2 Private sector involvement in response planning

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

Lesotho does not have a specific mechanism for engaging with the private sector to assist with outbreak emergency preparedness and response.

The government of Lesotho contracts the not-for-profit social enterprise Riders for Health to provide sample transport services. ³⁵³ However, Riders for Health is primary funded by government contracts and fees for service. ³⁵⁴

Lesotho's 2018-2023 National Strategic Development Plan (NSDP II) includes extensive provisions for engaging the private sector in job creation and inclusive growth. It emphasizes developing a private sector-led growth model by institutionalizing regular high-level dialogue through bodies such as the Business Council, Private Sector Foundation, business chambers, farmers and agri-business associations and by directing the Government of Lesotho to create formal avenues for private sector participation in implementing the plan. It further establishes a dedicated unit under the Office of the Prime Minister that will be charged with addressing the private sector’s business challenges and facilitating investment climate reforms to underpin private-sector-led job creation. However, NSDP II does not address private sector engagement in public health emergency preparedness and response. ³⁵⁵

3.1.3 Non-pharmaceutical interventions planning

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 0

Lesotho does not have a plan or guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic.

No evidence of a multi-disease plan to implement NPIs could be found on the website of Lesotho's Ministry of Health or its Disaster Management Authority. Additionally, Lesotho does not have a publicly available overarching public health response plan. ³⁵⁶³⁵⁷

During the COVID-19 pandemic, Lesotho enacted measures to implement non-pharmaceutical interventions, including restrictions on travel into and out of the country, the requirement to wear a mask in all public places, a social distancing requirement of at least one meter, limitations on the operations of non-essential businesses and services, cleaning and disinfection of public spaces, and quarantine requirements for those with and without symptoms of COVID-19. ³⁵⁸ However, all lockdown measures were lifted in 2022. ³⁵⁹

There is some evidence that contact tracing (but not other NPIs) is in use for tuberculosis in Lesotho. Lesotho's Ministry of Health stipulates that when an individual has tested positive for tuberculosis, all members of the family and household must be screened for the disease. ³⁶⁰ Contact tracing is also in use for detecting HIV cases. ³⁶¹ However, there is no evidence that a requirement for contact tracing or other NPIs is in place for other diseases in the country. ³⁶²

3.2 Exercising response plans

3.2.1 Activating response plans

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 0

There is no evidence that Lesotho has activated its national emergency response plan or completed a national-level biological threat-focused exercise in the past year.

Lesotho does not have a publicly available overarching emergency response plan for infectious disease outbreaks or other public health events. It has a multi-hazard contingency plan which was reported in 2017 to cover public health hazards, but the plan is not publicly available. ³⁶³³⁶⁴ Lesotho's Disaster Management Act, adopted in 1997, does not lay out a plan for responding to infectious disease outbreaks. ³⁶⁵ While Lesotho is among the countries with the highest incidence in the world of both HIV and tuberculosis, there is no evidence on the website of the Ministry of Health that other infectious disease outbreaks have occurred in the country in the past year. ³⁶⁶³⁶⁷³⁶⁸ However, Lesotho's 2022-2023 Health Sector Annual Joint Review Report (the last publicly available annual report) discusses the Ministry of Health's response to small outbreaks of scabies, food poisoning, chicken pox, skin rashes/sores, and a variety of other unknown infectious illnesses. It states that, in the case of the scabies outbreak, specimens from the 12 suspected cases were taken and sent to the national reference library and the affected people were made to isolate at home pending receipt of the results. ³⁶⁹ No specific emergency response protocol is mentioned in this document.

There is also no evidence on the website of the Ministry of Health or of the World Health Organization that Lesotho has completed a national-level biological threat-focused exercise within the past year. ³⁷⁰³⁷¹

In October 2023, Lesotho’s Ministry of Health in partnership with the World Health Organization (WHO) held a three-day workshop to map financial and technical resources against the WHO's National Action Plan for Health Security, with participants divided into thematic groups – Prevent, Detect, Respond (covering emergency preparedness, emergency response operations, linking public health and security authorities, medical countermeasures, personnel deployment, and risk communication) and Other IHR-related hazards. However, this activity was strictly a resource-mapping exercise and did not include any simulation, tabletop drill, or other biological threat-focused exercise to test or practice response to a specific biological threat. ³⁷²

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 0

There is no evidence that Lesotho has, in the past year, identified a list of gaps and best practices in response or developed a plan to improve response capabilities.

However, in March 2024, the Government of Lesotho launched the Emergency, Preparedness, and Response Flagship Initiative Roadmap with the support of the World Health Organization (WHO) and Africa Centers for Disease Control (Africa CDC). The three pillars of this initiative are 1) promoting the resilience of systems for emergencies, 2) transforming surveillance systems, and 3) strengthening and utilizing response groups for emergencies. As part of this initiative, Lesotho also trained 50 responders to improve the country's response capabilities. ³⁷³³⁷⁴

No evidence of any more recent developments could be found on the websites of the Ministry of Health or World Health Organization. ³⁷⁵³⁷⁶

3.2.2 Private sector engagement in exercises

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no evidence that Lesotho has completed a national-level biological threat-focused exercise in the past year.

There is no evidence on the website of the Ministry of Health, the Disaster Management Authority, or of the World Health Organization that Lesotho has completed a national-level biological threat-focused exercise within the past year. ³⁷⁷³⁷⁸³⁷⁹

3.3 Emergency response operation

3.3.1 Emergency response operation

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 0

There is no evidence that Lesotho has an Emergency Operations Center.

In July 2024, it was reported that the Africa Centers for Disease Control and Prevention (Africa CDC) were investing USD 500,000 toward the establishment of a state-of-the-art emergency operations center in Lesotho. ³⁸¹ However, there is no evidence on the website of Africa CDC, the Disaster Management Authority, or the Ministry of Health that the center is currently operational. ³⁸²³⁸³³⁸⁴

The Disaster Management Act of 1997 stipulates that each district and village in Lesotho must have a Disaster Management Team responsible for assessing hazards, preparing emergency relief plans, coordinating the stockpiling of relief supplies, receiving and deciding on all applications for relief assistance, promoting awareness of disasters and mitigation tactics, and organizing training programs for relief workers. ³⁸⁵ However, these teams do not have an online presence and it is unclear whether they fulfill the functions of emergency operations centers.

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is no evidence that Lesotho has an Emergency Operations Center.

In July 2024, it was reported that the Africa Centers for Disease Control and Prevention (Africa CDC) were investing USD 500,000 toward the establishment of a state-of-the-art emergency operations center in Lesotho. ³⁸⁶ However, there is no evidence on the website of Africa CDC, the Disaster Management Authority, or the Ministry of Health that the center is currently operational. ³⁸⁷³⁸⁸³⁸⁹

The Disaster Management Act of 1997 stipulates that each district and village in Lesotho must have a Disaster Management Team responsible for assessing hazards, preparing emergency relief plans, coordinating the stockpiling of relief supplies, receiving and deciding on all applications for relief assistance, promoting awareness of disasters and mitigation tactics, and organizing training programs for relief workers. ³⁹⁰ However, these teams do not have an online presence and it is unclear whether they fulfill the functions of emergency operations centers.

In March 2025, the Commission of Water (COW), Lesotho Disaster Management Authority (DMA), World Vision, and the Lesotho Red Cross conducted a joint emergency drill to assess the response capabilities of various stakeholders in the event of the collapse of Metolong Dam. ³⁹¹ No evidence could be found on the DMA website that similar drills have been conducted for public health events. ³⁹²

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no evidence that Lesotho has an Emergency Operations Center.

In July 2024, it was reported that the Africa Centers for Disease Control and Prevention (Africa CDC) were investing USD 500,000 toward the establishment of a state-of-the-art emergency operations center in Lesotho. ³⁹³ However, there is no evidence on the website of Africa CDC, the Disaster Management Authority, or the Ministry of Health that the center is currently operational. ³⁹⁴³⁹⁵³⁹⁶

The Disaster Management Act of 1997 stipulates that each district and village in Lesotho must have a Disaster Management Team responsible for assessing hazards, preparing emergency relief plans, coordinating the stockpiling of relief supplies, receiving and deciding on all applications for relief assistance, promoting awareness of disasters and mitigation tactics, and organizing training programs for relief workers. ³⁹⁷ However, these teams do not have an online presence and it is unclear whether they fulfill the functions of emergency operations centers.

In March 2025, the Commission of Water (COW), Lesotho Disaster Management Authority (DMA), World Vision, and the Lesotho Red Cross conducted a joint emergency drill to assess the response capabilities of various stakeholders in the event of the collapse of Metolong Dam. ³⁹⁸ No evidence could be found on the DMA website that similar drills have been conducted for public health events. ³⁹⁹

3.4 Linking public health and security authorities

3.4.1 Public health and security authorities linked for a biological event

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There are no publicly available guidelines or other agreements between public health, animal health, private sector and security authorities to respond to a potential deliberate biological event in Lesotho. There is also no public evidence that an exercise to respond to a potential deliberate biological event has been conducted in Lesotho.

According to the World Health Organization’s (WHO) 2017 Joint External Evaluation (JEE) report, there is a memorandum of understanding (MoU) between the Ministry of Health and the Ministry of Defense and National Security on cooperation during a suspected or confirmed biological event. The JEE also states that the Ministry of Health conducts trainings on joint investigation and response with the Ministry of Defense and National Security, while also nothing that there is a need to develop better standard operating procedures on emergency coordination. ⁴⁰⁰

However, the MoU is not available on the website of the Ministry of Health or that of the Ministry of Defense. Neither website contains any information or news articles about exercises that have recently been carried out to respond to biological events. ⁴⁰¹⁴⁰² No further information could be found on the website of Lesotho's Disaster Management Authority. ⁴⁰³

3.5 Risk communication

3.5.1 Risk communication planning

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 0

There is no evidence that Lesotho has a risk communication plan intended for use during a public health emergency.

Lesotho reported low capacity for risk communication in its 2024 submission to the World Health Organization's (WHO) IHR States Parties Self-Assessment Annual Report (SPAR). ⁴⁰⁵

The Africa Centers for Disease Control and Prevention (Africa CDC), which supports the public health infrastructures of African Union Member States (including Lesotho), published a strategic plan in 2024 on Strengthening Cross Border Surveillance and Information Sharing in Africa that includes provisions to strengthen mechanisms for risk communication and community engagement (RCCE) on the continent. ⁴⁰⁶ However, there is no evidence on Africa CDC's website that it has supported any risk communication efforts specifically in Lesotho. ⁴⁰⁷

Lesotho's 1997 Disaster Management Act does not address risk communication. ⁴⁰⁸ No additional evidence of a risk communication plan could be found on the websites of the Ministry of Health or the Ministry of Communications. ⁴⁰⁹⁴¹⁰ However, the Ministry of Health's 2022-23 annual report stated that during the 2022-23 fiscal year, the ministry had 88 TV slots, 14 radio slots, 159 social media posts, 6 press conferences, and a number of press releases about health-related topics such as immunization, tuberculosis prevention, COVID-19, and personal hygiene. ⁴¹¹

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 0

Lesotho does not have a risk communication plan or other strategy to address how messages will reach populations with different communications needs.

In 2017, the World Health Organization’s (WHO) 2017 Joint External Evaluation (JEE) found that while Lesotho did not have a risk communication strategy, the government uses spokespersons from the ministries of communication, health, and agriculture to send risk information to the public via radio, television, newspaper and other media. It also found that there is a system in place for deploying communication officers during public health emergencies, in addition to other informal arrangements. ⁴¹² However, information about these arrangements is not available online and it is unclear whether different communications needs are taken into account. The WHO recommended that Lesotho broadcast risk communications in local languages to maximize reach and that the government diversify communications strategies. ⁴¹³

In 2020, the Ministry of Health released a "Social and Behaviour Change Communication Strategy for Sexual and Reproductive Health and Rights and HIV in Lesotho 2020-21 to 2022-23," which was aimed at improving communications around HIV prevention and HIV-tuberculosis co-infection. It addresses the need for a diverse strategy that embraces many different channels and specifically aims to reach young people. It recommends the production of entertainment education media in the Sesotho language (a local language spoken by the majority of Lesotho's population). ⁴¹⁴

However, there is no evidence that Lesotho has a broader risk communication plan that addresses varying communications needs. No additional evidence of such a plan could be found on the websites of the Ministry of Health or the Ministry of Communications. ⁴¹⁵⁴¹⁶

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

Lesotho does not have a risk communication plan or other strategy that designates a specific position within the government as the primary spokesperson during a public health emergency.

A 2024 paper by a researcher from the National University of Lesotho found that Lesotho’s crisis communications during the COVID-19 pandemic were hampered by ad hoc institutions and unclear mandates, with first the National Emergency Command Center (NECC) and then the National COVID-19 Secretariat (NACOSEC) established under different authorities without a designated spokesperson, leading to duplication, confusion, and an absence of coherent communication plans. Traditional media proved under-resourced and under-trained, driving many residents in Lesotho to rely on unregulated social media channels that amplified misinformation and conspiracy theories. ⁴¹⁸

No additional evidence that any specific position is responsible for serving as the government's spokesperson during public health emergencies could be found on the websites of the Ministry of Health or the Ministry of Communications. ⁴¹⁹⁴²⁰ However, the Ministry of Health's 2022-23 annual report stated that during the 2022-23 fiscal year, the ministry had 88 TV slots, 14 radio slots, 159 social media posts, 6 press conferences, and a number of press releases about health-related topics such as immunization, tuberculosis prevention, COVID-19, and personal hygiene. ⁴²¹

3.5.2 Public health systems communication

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 100

Lesotho's public health system regularly shares information about public health concerns.

Lesotho's Ministry of Health (MoH) operates a Facebook page, where approximately two or three messages are shared monthly about ongoing and acute public health concerns. In April 2025, the Ministry posted a press release to dispel rumors about the unavailability of HIV supplies and treatment services due to the United States government's withdrawal from the country's public health sector, stating that "inaccurate reports have resulted in generalized panic, anxiety and high levels of concern among people living with HIV (PLHIV) on treatment and the general population at large in Lesotho." ⁴²² In the past year, the ministry has also used Facebook to share information about blood cancer, midwifery, the outbreak of an unknown digestive illness in Leribe District, symptoms of diabetes, safe use of medicines, childhood vaccinations, polio, and Mpox. ⁴²³

The MoH also has an account on the social media platform X, but it has not been updated since 2023. ⁴²⁴ The ministry also has a news section on its website, but the last update is from June 2023. ⁴²⁵

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no evidence that senior leaders in Lesotho have shared misinformation or disinformation on infectious diseases in the past two years.

No such evidence could be found on the websites of the Ministry of Health, the Government of Lesotho, the Office of the King, or the Office of the Prime Minister. ⁴²⁶⁴²⁷⁴²⁸⁴²⁹ International and national media outlets also provide no evidence on the subject. ⁴³⁰⁴³¹⁴³²⁴³³

The government of Lesotho has, however, released communications to dispel misinformation about health-related topics. For instance, in April 2025, the Ministry of Health issued a press release to dispel rumors about the unavailability of HIV supplies and treatment services due to the United States government's withdrawal from the country's public health sector, stating that "inaccurate reports have resulted in generalized panic, anxiety and high levels of concern among people living with HIV (PLHIV) on treatment and the general population at large in Lesotho." ⁴³⁴

3.6 Access to communications infrastructure

3.6.1 Internet users

3.6.1a Percentage of households with Internet

Score: 3.17

3.6.2 Mobile subscribers

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 37.51

3.6.3 Female access to a mobile phone

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 100

3.6.4 Female access to the Internet

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 100

3.7 Trade and travel restrictions

3.7.1 Trade restrictions

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

Lesotho has not implemented restrictions on the export/import of medical goods within the past year.

According to the International Trade Organization, import/export restrictions in Lesotho are governed by the Customs and Excise Act (amended in 2021), the Import and Export Control Act of 1984, the Import Restrictions Regulations of 1988, and the Agricultural Marketing Regulations of 1967. ⁴³⁵ The Import and Export Control Act establishes that the Ministry of Finance has the authority to prohibit the import or export of goods into Lesotho if this is in the public interest; however, medical goods are not specifically mentioned. ⁴³⁶ Article 114 of the Customs and Excise Act contains a list of goods which may not be imported; this includes dangerous weapons, unlawful reproductions of copyrighted materials, counterfeit currency, and a number of other goods, but medical goods are not mentioned. ⁴³⁷

No additional evidence could be found on the websites of the Ministry of Finance, Revenue Services Lesotho, the Ministry of Trade and Industry, or the Ministry of Health. ⁴³⁸⁴³⁹⁴⁴⁰⁴⁴¹

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

Lesotho has not implemented restrictions on the export/import of non-medical goods within the past year.

In August 2025, Lesotho's agriculture ministry placed a ban on the import of eggs, potatoes, and cabbage in order to stimulate local production, but there is no evidence that this was related to an infectious disease outbreak. ⁴⁴²

According to the International Trade Organization, import/export restrictions in Lesotho are governed by the Customs and Excise Act (amended in 2021), the Import and Export Control Act of 1984, the Import Restrictions Regulations of 1988, and the Agricultural Marketing Regulations of 1967. ⁴⁴³ The Import and Export Control Act establishes that the Ministry of Finance has the authority to prohibit the import or export of goods into Lesotho if this is in the public interest. ⁴⁴⁴ Article 114 of the Customs and Excise Act contains a list of goods which may not be imported; this includes dangerous weapons, unlawful reproductions of copyrighted materials, counterfeit currency, and a number of other goods. ⁴⁴⁵

No additional evidence could be found on the websites of the Ministry of Finance, Revenue Services Lesotho, the Ministry of Trade and Industry, or the Ministry of Health. ⁴⁴⁶⁴⁴⁷⁴⁴⁸⁴⁴⁹

3.7.2 Travel restrictions

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no evidence that Lesotho has implemented inbound or outbound travel restrictions due to an infectious disease (or any other reason) within the past year.

No evidence of this could be found on the websites of the Ministry of Home Affairs or the Ministry of Health or in local media outlets. ⁴⁵⁰⁴⁵¹⁴⁵²⁴⁵³

During the COVID-19 pandemic, the government of Lesotho restricted all non-essential travel into and out of Lesotho. ⁴⁵⁴

3.7.2b Risk-based approach to international travel-related measures

Score: 0

There is no evidence that Lesotho uses a risk-based approach to international travel-related measures.

The Department of Immigration Services within the Ministry of Home Affairs is responsible for implementing regulations around inbound travel to Lesotho, while the Ministry of Foreign Affairs regulates outbound travel. ⁴⁵⁵⁴⁵⁶

Immigration and inbound travel to Lesotho are governed by the Lesotho Aliens Control Act 1966. This act permits immigration authorities to grant or refuse foreign travelers the right to enter or depart, explicitly empowering them to require a medical certificate "showing [an entrant] to be free from any disease or affliction" and to impose or lift conditions based on "public health, public safety, public order, public morality or fundamental human rights and freedoms," but it does not prescribe a formal, structured risk-assessment process for travel-related measures. Evaluations are made under general health and safety grounds rather than via a codified, risk-based framework. ⁴⁵⁷

In 2018, Lesotho's Constitution was amended with a number of provisions related to citizenship. Specifically, it officially permitted dual citizenship with any other country, outlined the conditions for restoration of Lesotho citizenship, and simplified the process for acquiring Lesotho citizenship by marriage. ⁴⁵⁸ No risk-based considerations are included in this amendment.

According to the Ministry of Health's 2022-2023 Health Sector Annual Joint Review Report (the last publicly available annual report), between April 2022 and March 2023, a total of 52 ill travelers were detected and referred to health facilities at ports of entry across the country. The report also states that a risk-based inspection manual for imported foods had been drafted, but there is no evidence on the websites of the Ministry of Health or the Ministry of Home Affairs that the report is publicly available. ⁴⁵⁹⁴⁶⁰⁴⁶¹

Health System

4.1 Health capacity in clinics, hospitals and community care centers

4.1.1 Available human resources for the broader healthcare system

4.1.1a Doctors per 100,000 people

Score: 3

4.1.1b Nurses and midwives per 100,000 people

Score: 42.04

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 100

Lesotho has a health workforce strategy in place and it has been updated in the past five years.

According to the Lesotho Ministry of Health's 2022-2023 fiscal year report (the last such report that is publicly available), the ministry had endorsed a Human Resource for Health Strategy and Development Plan (2020-2030). The plan is said in the report to provide guidance for setting priorities, inform resource allocation, foster collaboration among stakeholders, and address challenges in Lesotho’s health workforce. The strategy aims to increase Lesotho’s Core Health Worker density, which is below the World Health Organization’s threshold. ⁴⁶² However, this document is not available on the website of the Ministry of Health or of the World Health Organization (WHO). ⁴⁶³⁴⁶⁴

Additionally, in 2004, Lesotho approved its Human Resources Development and Strategic Plan (HRDSP) 2005-2025, which identifies areas of workforce insufficiency and outlines strategies to address them. It includes detailed labor market assessments, projections of staffing needs by cadre and facility type, and clear interventions for training, recruitment, and retention. The strategy focuses on critical shortages in primary care, rural staffing, and specialized cadres such as mental health, laboratory, and pharmacy personnel. It proposes solutions including improved career pathways, expanded training capacity, deployment reforms, and strengthened partnerships with civil society. However, while the document covers the period up to the year 2025, there is no evidence that it has been updated within the past 5 years. ⁴⁶⁵

4.1.1d Health system capacity for essential health services

Score: 0

Lesotho's health system does not have sufficient capacity to deliver essential health services.

Joint External Evaluation of IHR Core Capacities of the Kingdom of Lesotho (2017) scores the country a 1, the lowest possible, in this measure. While trained human resources are available within Lesotho and can be mobilized for risk assessment and response, the mechanisms for requesting and receiving international health professionals are unclear, and should be identified and reviewed to ensure formal mechanisms are in place to mobilize external support in the event of an emergency. Moreover, personnel within Lesotho who have responsibility for emergency response should be encouraged to support other countries’ responses, to gain and share experience with national counterparts.⁴⁶⁶

The World Health Organization's (WHO) 2022 annual report for Lesotho concluded that despite Lesotho’s relatively high government expenditure on healthcare (10.6% of its gross domestic product), the country’s healthcare system is fragile and much of its population is “geographically constrained from accessing health services.” It also noted that Lesotho depends heavily on South Africa for secondary and tertiary healthcare services. ⁴⁶⁷

The delivery of essential health services in Lesotho is also affected by the country’s low health workforce density. In 2023, the World Health Organization (WHO) included Lesotho in its WHO Health Workforce Support and Safeguards List, indicating that the country has a health workforce density below the global median (49 nurses, doctors, and midwives per 10,000 people) and should be prioritized with targeted health personnel development interventions. ⁴⁶⁸ Similarly, a 2022 study of Lesotho's health workforce revealed that the country’s stock of health workers covered only 48% of the need arising from the country’s disease burden. It also found an over-reliance on community workers, which the authors attributed to a "shortage of highly qualified health professionals and the emphasis on task-shifting in the health system". ⁴⁶⁹

According to a survey conducted by Afrobarometer in 2024, most residents of Lesotho (Basotho) express deep concern about the adequacy and affordability of healthcare. Only 2% of Basotho reported having medical aid, with unaffordability cited as the main barrier by 60% of the uninsured. A majority (65%) worry about being unable to obtain or afford care when needed, and half report that they or a family member went without necessary medical treatment in the past year. While 74% of those who accessed public clinics found it easy to get care, most also experienced long wait times (74%), lack of medicines or supplies (62%), poor facility conditions (38%), or absent staff (34%). Despite these challenges, 71% of Basotho believe the government should ensure universal access to health care, and 74% say they trust the Ministry of Health at least somewhat. ⁴⁷⁰

The WHO’s 2024-2027 Country Cooperation Strategy for Lesotho identified a number of challenges facing delivery of essential health services in Lesotho, including inequities in access to essential medicines, weak digital infrastructure, and a health workforce that is not large enough to meet the population’s needs. ⁴⁷¹

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is no evidence that Lesotho has a plan to ensure continuity of essential health services during public health emergencies.

No evidence of such a plan could be found on the websites of Lesotho's Ministry of Health or of the Disaster Management Authority. ⁴⁷²⁴⁷³

According to the World Health Organization's (WHO) 2017 Joint External Evaluation (JEE) report, Lesotho had developed a multi-hazard contingency plan for 2014-2015 that addressed public health hazards but at the time, it had "no national multi hazard public health emergency preparedness plan" ⁴⁷⁵. There is some evidence that this plan had been updated since the JEE; a 2024 paper on disaster risk reduction in Lesotho cites a document titled Lesotho Multi-Hazard Contingency Plan 2020–2023 but does not elaborate on its contents. ⁴⁷⁶ Neither revision of this plan is available on the website of Lesotho's Disaster Management Authority (DMA) or in Lesotho's national legislative database LesLII. ⁴⁷⁷⁴⁷⁸

According to the website of the Global Facility for Disaster Reduction and Recovery (GFDRR), GFDRR supported the development of a Multi-Hazard National Public Health Emergency Preparedness and Response Plan in Lesotho between 2019-2021. ⁴⁷⁹ However, there is no evidence that this document was formally adopted and it is not available on the DMA's website or in the legislative database. ⁴⁸⁰⁴⁸¹

4.1.2 Facilities capacity

4.1.2a Hospital beds per 100,000 people

Score: 31.4

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 100

There is some evidence that Lesotho currently has the capacity to isolate patients with highly communicable diseases in a biocontainment patient care unit or isolation room/unit.

The Botshabelo Hospital for patients with multidrug-resistant tuberculosis in Lesotho's capital, Maseru, is reported to have three isolation wards. However, as the hospital does not have an online presence, the exact capacity of these wards is unknown, and there is no evidence that they can accommodate patients with other communicable diseases. ⁴⁸²

In its annual report covering fiscal year 2022/2023, the Ministry of Health reported that all district-level hospitals had established COVID-19 isolation wards and that there were a total of 368 isolation beds throughout the country. ⁴⁸³ However, there is no evidence on the website of the Ministry of Health or of the World Health Organization that these isolation facilities have since been repurposed to accommodate patients with other communicable diseases. ⁴⁸⁴⁴⁸⁵

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 0

In the past two years, Lesotho has not demonstrated capacity to expand isolation capacity in response to an infectious outbreak, and there is no evidence that the country has developed or updated a plan to expand isolation capacity.

There is publicly available evidence of one hospital that currently has isolation capacity in Lesotho. The Botshabelo Hospital for patients with multidrug-resistant tuberculosis in Lesotho's capital, Maseru, is reported to have three isolation wards. However, as the hospital does not have an online presence, the exact capacity of these wards is unknown, and there is no evidence that they can accommodate patients with other communicable diseases. ⁴⁸⁶

Isolation capacity is not addressed in Lesotho's 2018-2022 National Tuberculosis Strategic Plan. ⁴⁸⁷

Lesotho did scale up isolation capacity in response to the COVID-19 pandemic. In its annual report covering fiscal year 2022/2023, the Ministry of Health reported that all district-level hospitals had established COVID-19 isolation wards and that there were a total of 368 isolation beds throughout the country. ⁴⁸⁸ However, there is no evidence on the website of the Ministry of Health or of the World Health Organization that these isolation facilities have since been repurposed to accommodate patients with other communicable diseases. ⁴⁸⁹⁴⁹⁰

4.2 Supply chain for health system and healthcare workers

4.2.1 Routine health care and laboratory system supply

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 100

There is evidence that Lesotho has protocols for the Ministry of Health to procure laboratory supplies and medical supplies for routine needs.

Within Lesotho's Ministry of Health, the Supply Chain Management Directorate (SCMD) is responsible for ensuring effective procurement processes in the health sector. ⁴⁹¹ According to a 2024 report by the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project, the SCMD primarily plays a coordination role, while the National Drug Service Organization (NDSO) procures, stores, and distributes public health sector goods in accordance with the SCMD's priorities and plans. ⁴⁹² The NDSO oversees a competitive-tender process governed by value thresholds, procurement and adjudication committees, legal review, approved vendor lists, and standardized tender documents, and it references the national treatment guidelines and essential medicines list to align procurement with policy. ⁴⁹³

The NDSO's website has detailed guidelines for the procurement of medical devices, pharmaceutical products, nutrition products, and medical equipment that contain detailed definitions of eligibility, bid submission rules, evaluation criteria, contract award procedures. ⁴⁹⁴⁴⁹⁵⁴⁹⁶

Additionally, the GHSC-PSM provides the government of Lesotho with technical assistance for the acquisition of laboratory supplies and antiretroviral drugs. ⁴⁹⁷

4.2.2 Stockpiling for emergencies

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 33.33

Lesotho does have a stockpile of medical supplies for national use, but there is no overarching public health emergency response plan and no evidence of a strategy to distribute supplies during a public health emergency.

The National Drug Service Organization (NDSO) manages Lesotho's stockpile of public health sector supplies. NDSO is the central warehouse for stocks of medicines, while some supplies are also stored locally in health centers and hospitals for quick distribution to patients. ⁴⁹⁸ The NDSO operates a national warehouse at Mafeteng, located about 45 minutes outside of Lesotho’s capital Maseru. NDSO has an autonomous fleet of vehicles to distribute medications and medical supplies nationwide. The Ministry of Health also stores some vaccines at the ministry’s headquarters in Maseru. According to a 2024 USAID report, many smaller facilities and health clinics suffer from issues such as insufficient storage space, a lack of backup power, poor security infrastructure, and poor record-keeping practices. ⁴⁹⁹

However, there is no evidence on the websites of the Ministry of Health or the NDSO of a plan to distribute medical supplies during public health emergencies. ⁵⁰⁰⁵⁰¹ The World Health Organization's (WHO) 2017 Joint External Evaluation also reported that Lesotho did not have a plan for fast-tracking medical supplies during public health emergencies. ⁵⁰² Also, according to the USAID report, NDSO specifically does not hold buffer stock. ⁵⁰³

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is no evidence that Lesotho has a stockpile of laboratory supplies for national use during a public health emergency.

The National Drug Service Organization (NDSO) manages Lesotho's stockpile of public health sector supplies. NDSO is the central warehouse for stocks of medicines, while some supplies are also stored locally in health centers and hospitals for quick distribution to patients. ⁵⁰⁴ The NDSO operates a national warehouse at Mafeteng, located about 45 minutes outside of Lesotho’s capital Maseru. NDSO has an autonomous fleet of vehicles to distribute medications and medical supplies nationwide. The Ministry of Health also stores some vaccines at the ministry’s headquarters in Maseru. According to a 2024 USAID report, many smaller facilities and health clinics suffer from issues such as insufficient storage space, a lack of backup power, poor security infrastructure, and poor record-keeping practices. ⁵⁰⁵

However, the USAID has reported that the NDSO does not maintain buffer stock/security stock. According to the same report, 87-100 percent of health facilities in Lesotho do hold enough buffer stock to cover 1-1.5 months – but buffer stock is not maintained at the national level. ⁵⁰⁶

There is no additional evidence of a sufficient stockpile of laboratory supplies for emergency use on the websites of the Ministry of Health or the NDSO. ⁵⁰⁷⁵⁰⁸

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no evidence that Lesotho conducts or requires an annual review of the national stockpile to ensure that the supply is sufficient for a public health emergency.

While Lesotho has a national stockpile of medical supplies which is maintained by the National Drug Service Organization (NDSO) at the strategic direction of the Ministry of Health's Supply Chain Management Directorate (SCMD), no buffer/security stock is maintained. ⁵⁰⁹

A 2024 USAID report discusses health sector supply chain forecasting and planning procedures in Lesotho. Forecasting and planning are coordinated by the SCMD in collaboration with the NDSO, development partners such as USAID, and regional supply chain representatives. The forecasting exercise takes place each October; however, USAID noted a "lack of systematic documentation of processes, assumptions, forecasting outcomes, and corrective actions or adjustments" resulting from this process. ⁵¹⁰ USAID notes a high level of maturity of the NDSO's inventory management practices and reports that the agency keeps track of a wide variety of metrics, including Stocked According to Plan (SATP) rates, stock accuracy, stockout rates, order fill rate, wastage from damage, theft, and expiry, order turnaround time, number and duration of temperature anomalies in cold storage facilities, and percentage of incoming batches tested for quality. SATP rates measure how many facilities have supply of a given product that falls between an established minimum and maximum, but this metric does not explicitly assess emergency capacity. ⁵¹¹ There is no evidence of a review process to ensure an adequate supply of emergency medical supplies, and again, the NDSO does not keep buffer stock. ⁵¹²

No evidence of a review process could be found on the websites of the Ministry of Health or the National Drug Service Organization. ⁵¹³⁵¹⁴

4.2.3 Manufacturing and procurement for emergencies

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 0

There is no evidence that Lesotho has a plan to leverage domestic manufacturing capacity to produce medical supplies for national use during a public health emergency. There also is no evidence of a plan to procure medical supplies or expedite medical supplies through points of entry during a public health emergency.

A 2024 USAID report cites an overall "lack of engagement with the private sector to accomplish supply chain goals." ⁵¹⁵ There is some evidence of private sector engagement to produce medical supplies during the COVID-19 pandemic; in 2020, the World Bank reported that the Government of Lesotho was considering leveraging the local textile industry and other private sector actors for the production of personal protective equipment (PPE) and other essential goods. ⁵¹⁶ Lesotho also has a National Medical Oxygen Strategy and Scale-Up Plan, published by the Ministry of Health in 2023. This plan aims to ensure a stable supply of medical oxygen by, among other measures, partnering with regional manufacturers. However, the plan does not address emergency scenarios. ⁵¹⁷ There is no evidence of a plan or agreement to leverage public sector manufacturing capacity during public health emergencies on the website of the Ministry of Health. ⁵¹⁸

There is also no evidence of a plan to procure medical supplies for national use during a public health emergency. Lesotho's National Drug Services Organization (NDSO) is responsible for procuring health supplies under the strategic direction of the Ministry of Health's Supply Chain Management Directorate (SCMD). ⁵¹⁹ However, there is no evidence on either agency's website of an explicit protocol for procuring supplies during a public health emergency. ⁵²⁰⁵²¹. Lesotho's Public Procurement Act, the latest revision of which was published in 2023, states that "a framework agreement may […] be established to ensure preparedness to deal with emergency circumstances" but does not mention public health directly. ⁵²²

Finally, there is no evidence of a plan to expedite medical supplies through points of entry. During the COVID-19 pandemic, the Lesotho Revenue Agency issued guidance to enabled the expedited clearance of relief and essential supplies; it also suspended the collection of customs duties on essential supplies and prioritized post-clearance audits rather than port inspections to facilitate cross-border movement. ⁵²³ However, there is no evidence that these measures were extended beyond the COVID-19 lockdown period. There is no additional evidence of such a plan on the website of the Ministry of Health or of Revenue Services Lesotho. ⁵²⁴

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

There is no evidence that Lesotho has a plan to leverage domestic manufacturing capacity to produce laboratory supplies for national use during a public health emergency. There also is no evidence of a plan to procure medical supplies or expedite laboratory supplies through points of entry during a public health emergency.

A 2024 USAID report cites an overall "lack of engagement with the private sector to accomplish supply chain goals." ⁵²⁵ There is some evidence of private sector engagement to produce medical supplies (but not laboratory supplies) during the COVID-19 pandemic; in 2020, the World Bank reported that the Government of Lesotho was considering leveraging the local textile industry and other private sector actors for the production of personal protective equipment (PPE) and other essential goods. ⁵²⁶ Lesotho also has a National Medical Oxygen Strategy and Scale-Up Plan, published by the Ministry of Health in 2023. This plan aims to ensure a stable supply of medical oxygen by, among other measures, partnering with regional manufacturers. However, the plan does not address emergency scenarios. ⁵²⁷ There is no evidence of a plan or agreement to leverage public sector manufacturing capacity during public health emergencies on the website of the Ministry of Health. ⁵²⁸

There is also no evidence of a plan to procure laboratory supplies for national use during a public health emergency. Lesotho's National Drug Services Organization (NDSO) is responsible for procuring health supplies under the strategic direction of the Ministry of Health's Supply Chain Management Directorate (SCMD). ⁵²⁹ However, there is no evidence on either agency's website of an explicit protocol for procuring supplies during a public health emergency. ⁵³⁰⁵³¹. Lesotho's Public Procurement Act, the latest revision of which was published in 2023, states that "a framework agreement may […] be established to ensure preparedness to deal with emergency circumstances" but does not mention public health directly. ⁵³²

Finally, there is no evidence of a plan to expedite laboratory supplies through points of entry. During the COVID-19 pandemic, the Lesotho Revenue Agency issued guidance to enabled the expedited clearance of relief and essential supplies; it also suspended the collection of customs duties on essential supplies and prioritized post-clearance audits rather than port inspections to facilitate cross-border movement. ⁵³³ However, there is no evidence that these measures were extended beyond the COVID-19 lockdown period. There is no additional evidence of such a plan on the website of the Ministry of Health or of Revenue Services Lesotho. ⁵³⁴⁵³⁵

4.2.3c Mechanism emergency logistics and supply chain management

Score: 0

While Lesotho has a mechanism for supply chain management, there is no evidence of a mechanism that also covers emergency logistics.

The Ministry of Health's Supply Chain Management Directorate (SCMD) is responsible for developing strategies for supply chain management in the health sector, while the National Drug Services Organization (NDSO) is responsible for the procurement, storage, and stockpiling of medical goods. USAID reported in 2024 that the NDSO has an autonomous fleet of vehicles for distribution of medical goods throughout Lesotho. However, there is no evidence on the Ministry of Health's website or that of the NDSO that either agency has a mechanism for coordinating emergency logistics. ⁵³⁶⁵³⁷⁵³⁸

NDSO has also been reported to have an annual work plan and strategic implementation plans, but these documents are not available on the NDSO website. ⁵³⁹⁵⁴⁰ USAID has also reported that there is a procedure for the SCMD to submit unbudgeted supply chain requests to the Ministry of Health during emergencies, but no further information about this procedure is available on the website of the MInistry of Health. ⁵⁴¹

4.3 Medical countermeasures and personnel deployment

4.3.1 System for dispensing MCMs during a public health emergency

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

Lesotho does not have a plan or program for dispensing medical countermeasures for national use during a public health emergency.

Lesotho does have a stockpile of public health supplies at the national level, maintained by the National Drug Service Organization (NDSO), and the Ministry of Health stores some vaccines within cold rooms at the ministry's headquarters in Maseru. However, Lesotho's health authorities do not maintain buffer supply of medical countermeasures. ⁵⁴² There is no evidence on the website of the NDSO or Ministry of Health of a plan for dispensing countermeasures for national use during a public health emergency. ⁵⁴³⁵⁴⁴

In March 2021, Lesotho's Ministry of Health began the launch of its national COVID-19 vaccine campaign with the assistance of the Vaccine Alliance (Gavi), the COVAX Facility, the Coalition for Epidemic Preparedness Innovations, and the World Health Organization. ⁵⁴⁵ However, there is no evidence of a generalized plan for dispensing emergency medical countermeasures.

Lesotho does have non-emergency vaccine rollout programs for a number of diseases, including measles/rubella, poliovirus, human papillomavirus (HPV), HIV, and tuberculosis. ⁵⁴⁶ It also has the Expanded Program on Immunisation Comprehensive Multi-Year Plan (2018-2022), which includes initiatives to increase vaccination coverage, ensure immunization equity, improve the country's vaccine supply and cold chain capacity, and develop a vaccine transportation plan. The plan does not cover public health emergencies. ⁵⁴⁷

4.3.2 System for receiving foreign health personnel during a public health emergency

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 0

There is no evidence of a public plan to facilitate workforce surge during public health emergencies in Lesotho.

Lesotho has non-emergency health workforce strategies. According to the Lesotho Ministry of Health's 2022-2023 fiscal year report (the last such report that is publicly available), the ministry had endorsed a Human Resource for Health Strategy and Development Plan (2020-2030). The plan is said in the report to provide guidance for setting priorities, inform resource allocation, foster collaboration among stakeholders, and address challenges in Lesotho’s health workforce. The strategy aims to increase Lesotho’s Core Health Worker density, which is below the World Health Organization’s threshold. ⁵⁴⁸ However, this document is not available on the website of the Ministry of Health or of the World Health Organization (WHO). ⁵⁴⁹⁵⁵⁰ Additionally, Human Resources Development and Strategic Plan (HRDSP) 2005-2025, which identifies areas of workforce insufficiency and outlines strategies to address them. ⁵⁵¹ Neither document has provisions for emergency workforce surge.

During the COVID-19 pandemic, Lesotho demonstrated some capacity to increase its health workforce in response to a public health emergency. In April 2020, the Ministry of Health employed 94 additional nurses to be deployed across the country. ⁵⁵² The World Bank, through its Lesotho COVID-19 Emergency Preparedness and Response Project, also supported the temporary recruitment of unemployed nurses and doctors to enhance treatment capacity for infected patients. ⁵⁵³

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no evidence of a plan to receive health personnel from other countries to respond to a public health emergency in Lesotho.

A 2021 report by the International Federation of Red Cross (IFRC) concluded that while Lesotho does have a disaster management framework in its 1997 Disaster Management Act, there are no detailed processes for requesting or receiving international assistance during emergencies. There are also no provisions to ensure the freedom of movement, safety, or security of international assisting actors. ⁵⁵⁴⁵⁵⁵ The World Health Organization's (WHO) 2017 Joint External Evaluation (JEE) also reported that the mechanisms for requesting and receiving international health professionals were unclear and not formalized. ⁵⁵⁶

No additional evidence of such a plan is available on the websites of the Ministry of Health or Disaster Management Authority. ⁵⁵⁷⁵⁵⁸

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no evidence of a public plan to redeploy existing health personnel within Lesotho.

Lesotho's 2005-2025 Human Resources Development and Strategic Plan, published in 2004, suggests that redeployment of health personnel (specifically mental health nurses, nurse anesthetists, and nurse clinicians) could help address supply gaps, but it does not lay out a comprehensive redeployment strategy. It emphasizes the need for a new "Posting Policy" to be developed, which would prioritize closing the supply gap at the primary care level and ensure that personnel at more remote facilities are given opportunity to participate in rotations at health facilities in less remote parts of the country. However, there is no evidence on the Ministry of Health's website that such a posting policy has since been developed. ⁵⁵⁹⁵⁶⁰

According to the Ministry of Health's fiscal year 2022-2023 annual review, the ministry has developed a Health Workforce Deployment Policy and Guidelines covering the years 2019-2030. ⁵⁶¹ However, this document is not publicly available on the ministry's website and it is unclear whether it contains provisions to facilitate redeployment of health personnel. ⁵⁶²

4.4 Healthcare access

4.4.1 Access to healthcare

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 50

The right to medical care is included in Lesotho's Constitution, but it is subject to progressive realization.

Article 27 of Lesotho's Constitution (published in 1993, last amended in 2018) is titled "Protection of Health." It states that the country "shall adopt policies aimed at ensuring the highest attainable standard of physical and mental health for its citizens," including the improvement of public health, the creation of conditions to ensure that all citizens have access to medical attention, the prevention, treatment and control of diseases, the improvement of environmental and industrial hygiene, and the reduction of the infant mortality rate. ⁵⁶³

4.4.1b Access to skilled birth attendants (% of population)

Score: 83.82

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 94.35

4.4.1d Coverage of essential health services through universal health coverage

Score: 54.17

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 88.06

4.4.1f Rate of mortality amenable to health care

Score: 74.48

4.4.2 Paid medical leave

4.4.2a Guaranteed paid sick leave

Score: 66.67

Workers in Lesotho are guaranteed paid sick leave, but mental health is not explicitly covered.

According to Article 123 of Lesotho's Labor Code, published 1992, workers are not guaranteed paid sick leave during the first six months of their employment with the same employer. After six months, they become eligible for up 12 days of paid leave within the second six months' continuous employment. After 12 months of continuous employment with the same employer, a worker is entitled to up to 12 days of fully paid sick leave and 24 days of half-paid sick leave during each 12 months' period of continuous employment. Workers are required to present a letter signed by a registered medical practitioner in order to be granted sick leave. The Labor Code does not explicitly mention mental health. ⁵⁶⁴

The same provisions as above are laid out in Article 198 of Lesotho's 2024 Labor Bill. ⁵⁶⁵

4.4.3 Healthcare worker access to healthcare

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

Lesotho's government has not issued a policy, public statement, or legislation committing to provide prioritized healthcare services to healthcare workers.

Part III of Lesotho's Workmen's Compensation Act, 1977, obliges employers to pay medical, surgical, hospital and nursing expenses for work-related injury/disease (with defined transport and appliance costs), and to arrange treatment during temporary incapacity. It does not explicitly mention healthcare workers or public health emergency responders. ⁵⁶⁶

Lesotho also has an Occupational Safety and Health Act, published in 2024, which requires medical surveillance for workers exposed to hazardous chemicals or other dangerous substances. However, it does not contain provisions for prioritized healthcare for these workers. ⁵⁶⁷

The World Bank has provided support to Lesotho in establishing wellness centers for health personnel in settings with a high tuberculosis burden; these wellness centers provide tuberculosis testing and treatment, in addition to support for mental health conditions, physiotherapy, redeployment support, and other services. ⁵⁶⁸

However, no concrete evidence of a policy or public statement to provide prioritized healthcare services to healthcare workers could be found on the websites of the Ministry of Health, the Office of the Prime Minister, or the Government of Lesotho. ⁵⁶⁹⁵⁷⁰⁵⁷¹

4.5 Communications with healthcare workers during a public health emergency

4.5.1 Communication with healthcare workers

4.5.1a Existence of system for communication during a public health emergency

Score: 0

There is no evidence of a system for public health officials and healthcare workers to communicate during a public health emergency.

There is no evidence of such a system on the websites of the Ministry of Health or the Disaster Management Authority. ⁵⁷²⁵⁷³

The Africa Centers for Disease Control and Prevention announced in 2024 that it would invest USD 500,000 towards the establishment of a Public Health Emergency Operation Center in Lesotho, but it is unclear whether this center would facilitate communication between public health officials and healthcare workers. ⁵⁷⁴

The World Health Organization's (WHO) 2017 Joint External Evaluation (JEE) of Lesotho also reported the absence of a formal communication protocol during public health emergencies. ⁵⁷⁵

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is no evidence of a system for public health officials and healthcare workers to communicate during a public health emergency.

There is no evidence of such a system on the websites of the Ministry of Health or the Disaster Management Authority. ⁵⁷⁶⁵⁷⁷

The World Health Organization's (WHO) 2017 Joint External Evaluation (JEE) of Lesotho also reported the absence of a formal communication protocol during public health emergencies. ⁵⁷⁹

4.6 Infection control practices

4.6.1 Healthcare-associated infection (HCAI) monitoring

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 100

There is evidence that Lesotho's national public health system is monitoring for and tracking the number of healthcare associated infections that take place in healthcare facilities.

The World Health Organization's (WHO) 2017 Joint External Evaluation for Lesotho reported that surveillance for HCAI is conducted on a regular basis for high-risk groups and gave Lesotho a score of 3 (out of 5) for "healthcare associate infection (HCAI) prevention and control programmes". ⁵⁸⁰ Prevention of hospital acquired infections is also included as a training need for healthcare workers in the 2016 Infection Control and Waste Management Plan. ⁵⁸¹

However, HCAI surveillance data is not publicly available on the website of the Ministry of Health or of Lesotho's Bureau of Statistics. ⁵⁸²⁵⁸³

4.6.1b Infection prevention and control programme

Score: 100

Lesotho has an infection prevention and control program that is in place nationally.

Lesotho's national infection control and prevention (ICP) framework is documented in the Ministry of Health’s Infection Control and Waste Management Plan, published 2016, and its companion Standard Operating Procedures (SOPs). The ICP framework provides country-wide documentation for the management of infections and healthcare waste. The SOPs are designed for national, district, and local levels and standardize implementation through step-by-step instructions that specify roles, materials, timing, methods, and accountability. The ICP framework covers waste minimization, segregation, handling, storage, transport, treatment and final disposal, quantification, occupational health and safety, hand hygiene, surface decontamination, spillage management, mercury waste, and supervision/monitoring. Facilities are required to include handling, storage, treatment, and disposal of healthcare waste in their risk management plans, coordinated with infection-control staff. ⁵⁸⁴⁵⁸⁵

4.6.1c National plan to ensure a safe environment in health facilities

Score: 100

Lesotho has a plan to ensure a safe environment in health facilities nationally.

A number of policies address the safety of healthcare environments in Lesotho. The Healthcare Waste Management Policy, published in 2010, aims to minimize the adverse impacts of healthcare on the environment through initiatives that cover prevention of pollution, waste minimization and recycling, disposal technologies, and other considerations. ⁵⁸⁶ There is also a Hazardous and Non-Hazardous Waste Management Act, published in 2008, which contains provisions for the generation, transportation, storage, importation, exportation, recycling and disposal of hazardous and non-hazardous waste in healthcare settings. ⁵⁸⁷

The 2016 Infection Control and Waste Management Plan, published 2016, and its companion Standard Operating Procedures (SOPs) also provide country-wide documentation for the management of infections and healthcare waste at institutions of all sizes throughout the country. ⁵⁸⁸

Additionally, in 2023, the Ministry of Health developed National Hand Hygiene Strategy in collaboration with UNICEF. The strategy explicitly addresses health care settings as a priority area for hand hygiene and stresses its importance in preventing the spread of hospital-acquired infections. ⁵⁸⁹

4.7 Capacity to test and approve new medical countermeasures

4.7.1 Regulatory process for clinical trials of unregistered interventions

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 0

There is no evidence that an ethical review is required before beginning a clinical trial in Lesotho.

Article 44 of Lesotho's Medicine Control Bill, published in 2019 and revised in 2022, outlines the requirements for the conduct of clinical trials in the country. It states that a clinical trial may be conducted using a group of human beings or a group of animals. The Lesotho Medicines and Medical Devices Control Authority is responsible for monitoring clinical trials to ensure that participants are safe and has the right to suspend or stop clinical trials if it considers it necessary. ⁵⁹⁰

In reviewing applications for clinical trials, the Authority is to consider whether the trial will provide relevant information relating to the efficacy of the medicine or medical device being tested, but there is no requirement for a comprehensive ethical review process. However, within 30 days of completion of a clinical trial, manufacturers are required to provide the Authority with details on the findings of the trial in terms of ethical considerations. ⁵⁹¹

No additional evidence of a requirement for pre-clinical trial ethical reviews could be found on the website of the Ministry of Health. ⁵⁹² The Medicines and Medical Devices Control Authority does not have an online presence.

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

There is no evidence of an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics or epidemics in Lesotho.

Clinical trials are regulated by Lesotho's Medicine Control Bill, published in 2019 and revised in 2022. Article 44 of the bill outlines the requirements for the conduct of clinical trials in the country. It states that a clinical trial may be conducted using a group of human beings or a group of animals. The Board of Lesotho's Medicines and Medical Devices Control Authority is responsible for monitoring clinical trials to ensure that participants are safe and has the right to suspend or stop clinical trials if it considers it necessary. The law does not contain provisions for fast-tracking clinical trials for unregistered MCMs or recognizing the results of clinical trials from elsewhere. However, it does more generally permit the sale of unregistered medicines or medical device with written authorization from the Board (but no reference is made in the law to an expedited process or to public health emergencies). ⁵⁹³

There is no additional evidence of a process for expediting clinical trials or for mutual recognition of clinical trials on the website of the Ministry of Health; the Medicines and Medical Devices Control Authority does not have an online presence. ⁵⁹⁴ The World Health Organization's (WHO) Joint External Evaluation for Lesotho also concluded that there is "no protocol in place that enables Lesotho to use non-registered treatments or vaccines in the event of an emergency". ⁵⁹⁵

4.7.2 Regulatory process for approving medical countermeasures

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

There is a government agency responsible for approving new medical countermeasures (MCM) for humans in Lesotho.

Lesotho's Medicines and Medical Devices Control Authority was established by decree in 2023 (the Lesotho Medicines and Medical Devices Control Authority Act). The functions of the Authority as named in the act are to regulate the manufacture, import and export, storage, distribution, sale and use of medicines and medical devices and to ensure that medicines and medical devices meet safety and quality standards. The Authority is governed by a Board, which comprises the Ministry of Health's Head of Pharmaceutical Services, a medical practitioner, four pharmacists, a representative of the Director of Livestock Services, the head of the Ministry of Health's legal department, a radiation physicist, and a diagnostic radiographer. ⁵⁹⁶ Per this act, the Board of the Medicines and Medical Devices Control Authority is responsible for approving and monitoring clinical trials for new medical products in Lesotho. The Board's members were appointed in 2024 by the Minister of Health. ⁵⁹⁷ Neither the Authority nor its Board have an online presence or a section on the Ministry of Health's website. ⁵⁹⁸

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is no evidence of an expedited process for approving medical countermeasures (MCM) for human use or recognition of approval decisions taking place elsewhere during public emergencies in Lesotho.

The Lesotho Medicines and Medical Devices Control Authority Act, published in 2023, contains a section on "harmonization of regulatory requirements and activities." This section states that the Ministry of Health is responsible for facilitating the harmonization of Lesotho's medical quality, safety, and efficacy standards with international technical guidelines developed by entities such as the World Health Organization (WHO). It also states that the Authority shall "take such measures that may ensure mutual recognition of regulatory decisions". However, no specific procedure for this recognition is provided in the act, and no reference is made to public health emergencies. ⁵⁹⁹

No additional evidence of an expedited process for approving MCM could be found on the website of the Ministry of Health. ⁶⁰⁰ The Medicines and Medical Devices Control Authority does not have an online presence.

During the COVID-19 pandemic, the World Bank reported that Lesotho's government had put in place a plan for an expedited regulatory pathway for the approval of COVID-19 vaccines. ⁶⁰¹ The exact mechanism of this pathway is not publicly available on the Ministry of Health's website. ⁶⁰²

Commitment to International Norms

5.1 IHR reporting compliance and disaster risk reduction

5.1.1 Official IHR reporting

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Lesotho has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁶⁰³

5.1.2 Integration of health into disaster risk reduction

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 0

Epidemics and pandemics are not integrated into Lesotho's national risk reduction strategy, and there is not a standalone national disaster risk reduction strategy for epidemics and pandemics.

Lesotho's National Disaster Risk Reduction (DRR) Policy was published in 2011 by the Disaster Management Authority. It identifies core action areas – risk identification and assessment, education and knowledge management, risk reduction and development, and disaster preparedness and emergency response – along with cross-cutting issues (capacity, gender, corruption, HIV/AIDS), resource mobilization, institutional arrangements, stakeholder roles, and monitoring and evaluation. Sector provisions include integrating DRR into poverty reduction, climate adaptation, health (safe hospitals and health facilities), protection of critical infrastructure, land-use/building codes, and environmental management. ⁶⁰⁴

Biological hazards, defined as "[processes] or [phenomena] of organic origin or conveyed by biological vectors, including exposure to pathogenic microorganisms, toxins and bioactive substances," are mentioned in the policy's "Terminology" section but they are not covered elsewhere. Epidemics and pandemics are not explicitly mentioned. ⁶⁰⁵

Epidemics and pandemics are also not integrated into Lesotho's Disaster Management Act, which was published in 1997. ⁶⁰⁶

5.2 Cross-border agreements on public health and animal health emergency response

5.2.1 Cross-border agreements

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 100

There is evidence that Lesotho has cross-border agreements with neighboring countries and membership in regional groups with regards to public health emergencies.

Lesotho is a member country in the East, Central, and Southern Africa Health Community (ECSA-HC). The ECSA-HC is an intergovernmental health organization which promotes cooperation, collaboration, research, capacity building, policy development and advocacy in health throughout the region. The ECSA-HC directs the Strengthening Pandemic Preparedness (SPP) Project, which is financed by the World Bank. Components of this project include support for the development of event-based surveillance (EBS) and integrated disease surveillance in member countries, the expansion of the network of field epidemiologists, the strengthening of surveillance systems in member countries, the expansion of capacities at points of entry, surveillance of antimicrobial resistance, capacity-building for laboratory-based surveillance, and other initiatives related to public health emergency preparedness. ⁶⁰⁷

As a Member State of the African Union, Lesotho is part of the Africa Centers for Disease Control and Prevention's (Africa CDC) Southern Africa Regional Collaboration Center, which also includes Angola, Botswana, eSwatini, Malawi, Mozambique, Namibia, South Africa, Zambia, and Zimbabwe. ⁶⁰⁸ Africa CDC has coordinated activities such as the training of African Volunteers Health Corps (AVoHC) members, who are trained to respond to public health emergencies across the continent. ⁶⁰⁹ In 2024, Africa CDC coordinated the training of 50 AVoHC responders in Lesotho. ⁶¹⁰ However, this does not necessarily mean that there are specific agreements in place in the event of a public health emergency.

Lesotho also belongs to the Southern African Development Community (SADC), a regional economic community comprising 16 member states across the southern part of the continent. ⁶¹¹ SADC has a Disaster Risk Reduction Unit which is responsible for coordinating regional preparedness and response programs for cross-border hazards and disasters. ⁶¹² SADC member states are also parties to the Protocol on Health 1999, which obligates countries to coordinate regional efforts on epidemic preparedness. ⁶¹³

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

There is evidence that Lesotho has a Memorandum of Understanding with neighboring countries with regards to animal health emergencies, but there are gaps in its implementation.

In March 2024, the Southern African Development Community (SADC) signed a memorandum of understanding (MoU) with the World Organization for Animal Health (WOAH). The parties to the MoU agreed to cooperate in the areas of animal health (including transboundary animal diseases, zoonoses, and emerging infectious diseases), animal welfare, antimicrobial resistance, aquatic animal health and biosecurity, wildlife health, food safety, biothreat reduction, economics of animal health, and animal health systems in a One Health context. The parties agreed to keep each other informed and seek each other's expertise and observations with regards to these issues. As a member state of the SADC, Lesotho is a party to this MoU. ⁶¹⁴ However, there is no evidence on the website of the WOAH or on the website of Lesotho's Ministry of Agriculture and Food Security that any actions have ever been taken under this MoU, or of any further agreements with regards to cross-border cooperation on animal health emergencies. ⁶¹⁵⁶¹⁶

5.3 International commitments

5.3.1 Participation in international agreements

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Lesotho has signed and ratified the Biological Weapons Convention (BWC).

Lesotho signed the BWC in 1972 and ratified it in 1977. ⁶¹⁷

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 100

Lesotho has submitted confidence building measures for the Biological Weapons Convention (BWC) in the past three years.

Lesotho submitted its first confidence building measure (CBM) for the BWC in 2024. However, it is not publicly available in the BWC-CBM database. ⁶¹⁸

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Lesotho has provided the required United Nations Security Council Resolution (UNSCR) 1540 report to the Security Council Committee.

Lesotho’s submission to the 1540 Committee, dated 15 January 2014, transmits its national report prepared under paragraph 4 of resolution 1540 (2004), affirms support for the resolution, and notes creation of a Technical Committee to oversee implementation; it states Lesotho does not develop, acquire, manufacture, possess, transport, transfer or use nuclear, chemical or biological weapons or their delivery systems, nor support non-State actors to do so, and lists international conventions it has signed/ratified/acceded related to counter-terrorism and non-proliferation. ⁶¹⁹

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 25

5.3.2 Voluntary memberships

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Lesotho is not a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction, the Australia Group, or the Proliferation Security Initiative. ⁶²⁰⁶²¹⁶²²

5.4 JEE and PVS

5.4.1 Completion and publication of a JEE assessment and gap analysis

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 0

Lesotho has not completed a Joint External Evaluation (JEE) in the last five years.

Lesotho's last JEE was conducted in 2017. ⁶²³ There is no evidence on the website of the World Health Organization (WHO) of a more recent JEE. ⁶²⁴

5.4.2 Completion and publication of a PVS assessment and gap analysis

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

Lesotho has not completed and published a Performance of Veterinary Services (PVS) assessment in the last five years.

No evidence could be found on the website of the World Organization for Animal Health (WOAH). ⁶²⁵ However, WOAH reports that Lesotho has completed an initial PVS evaluation, a PVS gap analysis, and has implemented PVS legislation. ⁶²⁶

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

Lesotho has not completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years.

According to the World Organization for Animal Health, Lesotho's last PVS gap analysis was completed in 2011.

5.5 Financing

5.5.1 National financing for epidemic preparedness

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 100

There is evidence that Lesotho has allocated national funds to improve capacity to address pandemic/epidemic threats within the past three years.

The government of Lesotho's 2024-2025 "Budget at a Glance: Draft Budget Book 2024/25" shows capital allocations for a number of epidemic/pandemic prevention-related line items in the 2023-2024 and 2024-2025 budgets, including scaling up TB prevention interventions (281,894,757 loti / USD 15.9 million in 2023-24), increasing human papillomavirus (HPV) vaccination rates (60,480 loti / USD 3,415 in 2024-25), and establishing community-based leprosy diagnosis, treatment, and care services (2,670,253 loti / USD 150,778 in 2023-24). ⁶²⁷ No additional evidence of national funds being allocated to address pandemic/epidemic threats could be found on the website of the Ministry of Finance of Lesotho. ⁶²⁸

5.5.2 Financing under JEE and PVS reports and gap analyses

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

Lesotho has not completed a Joint External Evaluation (JEE), a National Action Plan for Health Security (NAPHS), or a national GHSA Roadmap over the past five years.

Lesotho's last JEE was conducted in 2017. ⁶²⁹ There is no evidence on the website of the World Health Organization (WHO) of a more recent JEE. ⁶³⁰

In 2023, it was reported that the government of Lesotho had completed a multi-sectoral resource mapping exercise to identify resources for the implementation of the NAPHS. ⁶³¹ However, there is no evidence on the website of the Ministry of Health that the NAPHS was adopted or is currently in effect. ⁶³²

Lesotho has not completed a GHSA Roadmap over the past five years. ⁶³³

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

Lesotho has not completed and published a Performance of Veterinary Services (PVS) assessment in the last five years.

No evidence could be found on the website of the World Organization for Animal Health (WOAH). ⁶³⁴ However, WOAH reports that Lesotho has completed an initial PVS evaluation (2007), a PVS gap analysis (2011), and has implemented PVS legislation (2013). ⁶³⁵

5.5.3 Financing for emergency response

5.5.3a Emergency public financing during a public health emergency

Score: 100

Lesotho has a special emergency public financing mechanism and funds which the country can access in the face of a public health emergency.

Lesotho has a statutory Contingencies Fund under the Public Financial Management and Accountability Act, 2011, which the Minister of Finance may draw on for "urgent and unforeseen" needs, with annual appropriations set by Parliament; the FY2024/25 Draft Budget Book shows a standing 300,000,000 loti (USD 16.9 million) allocation to this fund. ⁶³⁶⁶³⁷ Additionally, Lesotho has a statutory Disaster Management Fund established by the Disaster Management Act, 1997, financed by government appropriations and donations and used for expenses of the Disaster Management Authority; the Act defines "emergency" to include events requiring government action "to save lives, protect property and public health and safety." ⁶³⁸

Lesotho was formerly eligible to access the World Bank's Pandemic Emergency Financing Facility, which closed in April 2021. ⁶³⁹

Lesotho is also eligible for support from the World Bank Group's International Development Association (IDA). ⁶⁴⁰

5.5.4 Accountability for international commitments to address epidemic threats

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that Lesotho has requested support to improve capacity to address pandemic/epidemic threats over the past three years.

In October 2024, Lesotho's Minister of Health Selibe Mochoboroane authored a letter addressed to the Pandemic Fund Secretariat urging the organization to continue financing the Pandemic Fund. The letter cites the Fund's crucial role in financing domestic pandemic response measures and notes that the country's commitments to pandemic preparedness are underscored by its consistent co-investments. ⁶⁴¹ Additionally, in 2025, the Ministry of Health signed a Letter of Intent with Gavi, the Vaccine Alliance, to secure direct funding and public financial management capacity-building support. ⁶⁴²

There is no evidence on the websites of Lesotho's Ministry of Finance or Ministry of Health that the country has supported other countries' capacity to address pandemic or epidemic threats. ⁶⁴³⁶⁴⁴

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that Lesotho has requested financing/technical support from donors to improve the country's domestic capacity to address epidemic threats in the past three years, but no evidence that it has provided other countries with financing or technical support to improve capacity to address epidemic threats.

In October 2024, Lesotho's Minister of Health Selibe Mochoboroane authored a letter addressed to the Pandemic Fund Secretariat urging the organization to continue financing the Pandemic Fund. The letter cites the Fund's crucial role in financing domestic pandemic response measures and notes that the country's commitments to pandemic preparedness are underscored by its consistent co-investments. ⁶⁴⁵ Additionally, in 2025, the Ministry of Health signed a Letter of Intent with Gavi, the Vaccine Alliance, to secure direct funding and public financial management capacity-building support. ⁶⁴⁶

Global Health Security Tracking also reports that Lesotho received USD 15 million in funds for capacity-building (including Joint External Evaluation core capacities) and COVID-19 related funds. ⁶⁴⁷

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 100

Lesotho has fulfilled its full contribution to the World Health Organization (WHO) within the past two years.

The most recent WHO Statement of Account for Lesotho, published December 2024, states that Lesotho had an assessed contribution of USD 5,740 which was received by the WHO in May 2024. The statement shows that Lesotho does not have an outstanding balance for this period. Lesotho also fulfilled its full assessed contribution each year from 2020 to 2023. ⁶⁵⁰

5.6 Commitment to sharing of genetic & biological data & specimens

5.6.1 Commitment to share data and specimens in emergency/non-emergency research

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is no evidence that Lesotho has a publicly available plan for sharing genetic data, specimens, or other biological materials that goes beyond influenza.

No such plan is publicly available on the websites of the Ministry of Health, the Ministry of Communications, Science and Technology, the Ministry of Agriculture and Food Security, or the World Health Organization. ⁶⁵¹⁶⁵²⁶⁵³⁶⁵⁴

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no public evidence that Lesotho has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) framework in the past two years.

The World Health Organization (WHO) has not reported any non-compliance by Lesotho with the requirements of the PIP framework. ⁶⁵⁵⁶⁵⁶⁶⁵⁷

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no public evidence that Lesotho has not shared pandemic pathogen samples during an outbreak in the past two years.

The World Health Organization (WHO) has not reported any failures by Lesotho share pandemic pathogen samples during the past two years. ⁶⁵⁸

Risk Environment

6.1 Political and security risk

6.1.1 Government effectiveness

6.1.1a Policy formation

Score: 50

6.1.1b Quality of bureaucracy

Score: 25

6.1.1c Excessive bureaucracy/red tape

Score: 25

6.1.1d Vested interests/cronyism

Score: 50

6.1.1e Corruption

Score: 37

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 0

6.1.2 Orderly transfers of power

6.1.2a Orderly transfers of power

Score: 75

6.1.3 Risk of social unrest

6.1.3a Risk of social unrest

Score: 0

6.1.4 Illicit activities by non-state actors

6.1.4a Risk of terrorism

Score: 100

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 25

6.1.5 Armed conflict

6.1.5a Presence or risk of armed conflict

Score: 75

6.1.6 Government territorial control

6.1.6a Government territorial control

Score: 100

6.1.7 International tensions

6.1.7a International tensions

Score: 25

6.2 Socio-economic resilience

6.2.1 Literacy

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 95.95

6.2.2 Gender equality

6.2.2a UNDP Gender Inequality Index score

Score: 32.57

6.2.3 Social inclusion

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 23.22

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4 Public confidence in government

6.2.4a Public confidence in government

Score: 100

6.2.5 Local media and reporting

6.2.5a Robust, open, diverse local media and reporting

Score: 100

6.2.6 Inequality

6.2.6a Gini coefficient

Score: 55.1

6.3 Infrastructure adequacy

6.3.1 Adequacy of road network

6.3.1a Adequacy of road network

Score: 50

6.3.2 Adequacy of airports

6.3.2a Adequacy of airports

Score: 25

6.3.3 Adequacy of power network

6.3.3a Adequacy of power network

Score: 25

6.4 Environmental risks

6.4.1 Urbanisation

6.4.1a Urban population (% of total population)

Score: 79.33

6.4.2 Land use

6.4.2a Change in forest area (percentage points)

Score: 76.33

6.4.3 Natural disaster risk

6.4.3a Natural disaster risk

Score: 25

6.5 Public health vulnerabilities

6.5.1 Access to quality healthcare

6.5.1a Total life expectancy (years)

Score: 13.21

6.5.1b NCD mortality rate

Score: 0

6.5.1c Population aged 65+

Score: 83.51

6.5.1d Tobacco use (% of adults)

Score: 9.36

6.5.1e Level of adult obesity (%)

Score: 55.43

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 34.98

6.5.2 Access to potable water and sanitation

6.5.2a Access to potable water

Score: 77.97

6.5.2b Access to at least basic sanitation facilities

Score: 47.93

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 0

6.5.3 Public healthcare spending levels per capita

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 15.81

6.5.4 Trust in medical and health advice

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50

Citations

Kingdom of Lesotho. 2021. "National Action Plan on Antimicrobial Resistance 2021–2026". [source]
Kingdom of Lesotho. 2021. "National Action Plan on Antimicrobial Resistance 2021–2026". [source]
Kingdom of Lesotho. 2021. "National Action Plan on Antimicrobial Resistance 2021–2026". [source]
Ministry of Health of the Kingdom of Lesotho. [source].
Government of Lesotho, Ministry of Agriculture, Food Security and Nutrition. [source].
Andom AT, Fejfar D, Yuen CM, Ndayizigiye M, Mugunga JC, Mukherjee JS. 2023. "The Impact of COVID-19 on Tuberculosis Program Performance in the Kingdom of Lesotho." Trop Med Infect Dis. [source].
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