PIH Lesotho: Bo-Mphato Litšebeletsong Tsa Bophelo

PIH Lesotho’s mental health program started in 2017 with screening for common mental health conditions among patients with multidrug-resistant tuberculosis (MDR-TB) and the integration of an early childhood development (ECD) intervention. This ECD intervention was adapted from Peru’s CASITA program into an existing continuum of facility and community-based primary care in a poor, mountainous area of Mohale’s Hoek, Lesotho. Through this program, mothers who receive post-natal care are screened, treated for depression, and referred to the district hospital as needed. Following the success of the ECD program, screening and mental health services for common mental health conditions were scaled up across PIH Lesotho’s health facilities. 

Between 2019-2021, the MVC helped support the integration of mental health services into primary health services at all PIH Lesotho supported facilities, including referrals for MDR-TB patients from around the country to the PIH-run MDR-TB program. The monitoring, evaluation, and quality of services have improved, including an updated mental health register, contextually refined mental health indicators, the utilization of a mental health dashboard, and the systemic collection of patient-level data for the first time via CommCare.   

"We cannot separate treatment of mind and body" -Dr Melino Ndayizigiye (Clinical Director for Bo-mphato Litsebeletsong tsa Bophelo)

In 2020, at the invitation of the Ministry of Health, the PIH Lesotho team served as the lead author and partner for the country's first national mental health policy and strategic plan as part of the MOH’s Technical Working Group. The policy and strategic plan received support from PIH's Global Policy and Partnership, Global Mental Health, and Clinical Planning and Financing teams. If approved, the policy will result in new staff, stuff, spaces, and systems for mental health care that decentralize services for the roughly 20% of people who live with mental, neurological, and substance use conditions.  

PIH has integrated an early childhood development intervention into an existing community based primary health care platform called the Casita program. Mothers attending post-natal care at the health center are screened for depression; those diagnosed with depression receive basic care and those diagnosed with severe depression are referred to the district hospital for further management.

Most recently, the team has been working closely with the MOH to reform the mental health program in Berea district, the non-PIH supported district where the country’s COVID-19 unit is located. They are integrating mental health services into primary care as a model for other districts across the country. PIH Lesotho’s mental health program supports the training of Berea health center nurses and conducts training for site directors and nurses on crisis response elements as part of the complementary Grand Challenges Canada Project. In addition, the team developed innovative staff wellness, peer support, and crisis response programs that include clinical and social support, wellness centers, PFA, counseling, trainings, and expanded human resource capacity. 

• Standardize and formalize basic psychological and medication management 
• Establish and strengthen integrated mental health services at PIHL rural initiative supported facilities and Berea health centers 
• Leverage lessons learned Berea as point of reference to reform three other PIH- supported districts across Lesotho  
• Train nurses to include psychoeducation into their general health education and outreach 
• Strengthen monitoring, evaluation, and quality systems for mental health 
• Support the government to establish affordable, integrated, and decentralized mental health services 
• Strengthen mental health data use by nurses and other stakeholders through provision of data feedback from MEQ team 

•  Lesotho Mental Health Innovation Network