2. Health Indicators Population = 1.8 Million Annual growth rate = 1.9%. The life expectancy at birth = 41.2 The Infant Mortality Rate (IMR) 94/1000 HIV prevalence rate = 23% HIV prevalence among pregnant women 27% ANC 1 st visit 92% Focused ANC 70%

3. Health indicators cont.. The Maternal Mortality Ratio (MMR) 1155 PMTCT coverage 84% Facility Delivery 62% Home delivery 38% PNC within 48hrs 55% CPR 47%

4. Lesotho Policy Background Lesotho does not have a specific universal HIV and SRH linkages and integration policy or strategy. Lesotho’s policy response to HIV and SRH is captured in various independent policy documents. SRH and HIV are vertically programmed. There has been a mapping exercise of SRH and HIV tools in 2012 that will inform the review of such policies. Although there is bilateral programming of SRH/HIV, both invite each other during the development or review of the policies and budget.

5. National HIV Policies Lesotho National Health and Social Welfare Policy 2011 provides the national framework for addressing health issues and identifies HIV, STI,TB; and SRHR/FP as priority health issues. National HIV and AIDS Policy 2006 and National HIV and AIDS Strategic Plan 2006-2011, provide the overall framework for the country’s HIV response. Health Sector Policy on Comprehensive HIV Prevention 2010, aims to integrate HIV prevention activities into all activities of the Lesotho health-care system. The policy commits to linkages and integration of HIV&AIDS with poverty reduction strategies including a broader focus on SRH.

6. National SRH policy National Reproductive Health Policy 2008 commits to ensuring the integration of HIV & AIDS into SRH. Lesotho National Adolescent Health Policy 2006 aims to protect the health, development and rights of all adolescents in Lesotho. Adolescents Health Standards –2012 draft document addresses SRH and HIV in broader manner. SRH draft strategic plan- addresses both SRH and HIV (2011-2016)

7. SRH Policies Cont.. Lesotho Obstetric Record (LOR)- integrates ANC, Delivery, PNC and HIV e-MTCT Plan (2011 – 2016) -has integrated MNCH and HIV. ANC, FP, Ca Cx,STI and PMTCT guidelines- are integrated ANC, delivery and postnatal registers- are integrated CHW Training Manual- includes all essential package of care. Patient Tracking Tool- used by CHW to track all lost to follow clients (HIV infected,TB,ANC etc)

8. Key challenges The available policies, strategies, guidelines and tools are not fully integrated. Donor funding mainly focuses on HIV alone and do not accommodate other programs e.g. SRH

9. Way Forward MOH is in the phase of reviewing both the SRH and HIV documents to incorporate the recommendations of the assessment. Although countries feel that having a stand alone policy for integration is a waste of time and funds, there is need to have one integrated policy for SRH and HIV to address some burning issues.

10. Conclusion Bringing SRH and HIV together will reduce the costs, save patient time, enhance scarce human resource and addresses infrastructural problems.

11. thank you KHOTSO PULA NALA