Organizational Summary

Summary About Lesotho Boston Health Alliance (LeBoHA)

Organazational Summary.

In the Mountain Kingdom of Lesotho, the burden of disease is exceptionally high. Among the 2 million people, HIV infects 23% of adults, and the rate of TB is second highest in the world at 724 cases per 100,000 people and the rate of maternal death is the highest in the region(554/100,000). Now non-communicable diseases are affecting health. Confounding this, in the early 2000’s, the number of physicians was only 1/3 of the African average. There were only 130 physicians in the country; only 30 were from Lesotho, and only a few worked in in the rural districts outside the capital of Maseru.

With no medical school in the country, talented Basotho students were leaving their native country to attend medical school abroad, and rarely returning home. Additionally, the few who did return faced adverse working conditions, including assignment to remote mountainous areas where they would be responsible for a wide range of clinical problems for which they were unprepared; profound professional isolation; poorly managed hospitals, lack of supplies and medicines, low salaries, and a lack of opportunities for teaching, research, and career growth.

In the early 2000’s, LeBoHA recognized that while many medical students were not returning home, each year there was a core group who would come back to care for their families and communities and serve their country during its time of need. We that recruiting them home would require creating new, high-quality educational opportunities for clinicians and healthcare managers.

Based on their assessment of the many short-lived global health initiatives of the time, LeBoHA concluded that achieving sustainable change in Lesotho would require a long-term commitment to strengthen the country’s primary healthcare system, collaborating closely with in-country partners.

In 2007, to address these multiple challenges, the partnership between Boston University School of Medicine and Lesotho Ministry of Health was established; Lesotho Boston Health Alliance was formed with the mission to:

To improve management, policy, planning, and clinical capacity in the Lesotho health sector by strengthening health professional education and professional development with a focus on district hospitals and primary health care.

Guided by this model of local partnerships and long-term commitment, LeBoHA’s successful approach to financing programs is to use external grant funds to launch programs, and then, as they prove themselves, to transfer costs to government—at a cost the government can afford.

The effectiveness of these strategies is illustrated by the following key milestones:

  • 2007, LeBoHA created the Lesotho Medical Students Association, which functions in part to actively recruit students home.
  • In 2008, LeBoHA launched a four-year post-graduate specialty-training program in Family Medicine, the first physician-training program ever established in Lesotho.
  • In 2009, LeBoHA initiated Lesotho’s first competency-based nursing and midwifery in-service training program. Our nursing policies and procedures manual is now the national guideline of nursing practice.
  • In 2015, LeBoHA’s specialty training program was awarded higher education accreditation -- the first in its country’s history. The Ministry of Health then assumed all salary and educational costs of the program.
  • In 2019, the Ministry of Health required all students finishing medical school abroad to return home for internship training. They asked LeBoHA to run the new National Medical Internship Program, which has now enrolled over 153 interns.
  • In 2021, the postgraduate program was reaccredited in alignment with the Lesotho qualifications framework, allowing LeBoHA to confer a Master’s of Medicine in Family Medicine , the regionally recognized certification for medical specialization.

LeBoHA’s health system strengthening efforts also include:

  • Partnering with civil society entities (e.g., Lesotho Medical Association, Lesotho Nurses Association, Lesotho Medical, Dental and Pharmacy Counsel) to identify, prioritize and address health issues with funding from the European Union.
  • Supporting the education of health professionals from Lesotho who commit to stay and work in their home county using funds from a $1.5 M BUSM endowment.
  • Teaching 23 Problem-Solving for Better Health® workshops since 2004, training 772 health professionals to solve problems in their everyday work with minimal additional funds in partnership with the Dreyfus Health Foundation.
  • Editing and publishing the Lesotho Medical Journal for over 16 years that has helped create of a culture of scholarship in the health sector.
  • Imagine you are 10 years into the future but this time it’s different.
  • Constructing the Postgraduate Medical Campus including an academic Center, library, administration building, and a dormitory with funds from the USAID.

These programs have reversed many of the factors that led to health workers leaving the country that were present when LeBoHA began work. There are now opportunities for specialty training preparing them for the work they have to do. There is continuing professional education and support, teaching and research, and a career trajectory that offers an opportunity for professional advancement. The postgraduate specialty-training program graduates recognized as specialists and consultants.

In this environment of learning, scholarship and support, there are measurable improvements in the health system.
  • When LeBoHA’s Postgraduate and Medical Internship programs are combined, there are now more doctors in LeBoHA-led training programs -- than there were in the entire country in 2005.

  • To date, all 45 graduates of the two programs remain in the country. This increase in locally trained doctors contributes to equitable health care services in the country.

  • Doctors trained in LeBoHA programs are now working in health professional teams in 7 of the ten Districts of the country. For example, in the rural district of Mokhotlong, a Family Medicine consultant works with a FM trainee, internship graduate, intern trainee, and nurses, community health workers and District Health Management Team officials providing improved availability and quality of health services to the people in the Mountain Kingdom.

The LeBoHA model to train health professionals in a District Hospital environment is highly replicable, and could be a model for healthcare delivery in other low-income countries

Awards: In 2022, LeBoHA received the:

  • UN Interagency Task Force and the WHO Special Programme on Primary Health Care Award announced at the UN General Assembly.
  • Society of Teachers of Family Medicine Innovation Award.
What is next for LeBoHA?

LeBoHA is partnering with the Ministry of Health to expand Medical Specialty Training to include obstetrics and gynecology, surgery, psychiatry, internal medicine and pediatric training.

For a list of all LeBoHA publications, please visit LeBoHA website LeBoHA Website .
For more information, please contact Brian Jack MD, LeBoHA President or Elizabeth Nkabane Nkholongo, LeBoHA Executive Director