Lesotho achieves sustainable financing for procurement of TB drugs

17 February 2014 - Lesotho/Geneva - Lesotho has become one of the first lower middle income countries from the African region to be able to make a transition into self-financing for the procurement of adult first-line drugs for tuberculosis (TB) without further dependence on a grant from the Global Drug Facility (GDF).

The small mountainous country has been able to achieve this milestone because of political commitment at the highest levels and intensive work by staff in the national tuberculosis programme (NTP). This has been accomplished despite the heavy burden that both TB and HIV put on their health systems and budgets.

In a population of 1.8 million, in 2012, HIV/AIDS and TB constituted major public health problems where approximately 23% of the adult population is infected with HIV and there is a 75% TB/HIV co-infection rate. In a country with such high TB/HIV co-infection, proper management of drugs becomes complex and requires adequate training, skills and staff dedication, which became the cornerstones of the Lesotho TB control programme.

The government demonstrated its support for the initiative by committing 100% of the resources needed for the procurement of drugs from its national budget starting 2014. Full responsibility for TB drugs for adults will now rest with Lesotho as initially envisioned in 2008.

It began in 2007, when Lesotho received the first year of a three-year grant from GDF to buy first-line drugs for adults. A year later in 2008, the Ministry of Health (MoH) committed to an increase of the governmental contribution to TB drugs corresponding to an additional 20% every year, though direct procurement with GDF which started in April 2009, to complement the grant support. GDF made consistent advocacy efforts during this period and provided technical assistance.

The MoH also demonstrated commitment to securing quality-assured anti-TB drugs through continued engagement with GDF and negotiations to obtain a waiver on open tendering, single source procurement and pre-payment. This allows the MoH to use GDF’s direct procurement service and avoid the open market for TB drugs, minimizing vulnerability to procuring drugs of questionable quality. GDF supplies quality-assured drugs at internationally competitive prices with the aim of ensuring good treatment outcomes.

The health and TB services in the Lesotho include 10 administrative districts, 18 hospitals providing TB diagnosis and treatment services including quarterly reports on notification and treatment outcomes and 216 health centres involved in patient diagnosis, treatment and follow up, with the support of community health workers. The NTP operates according to a Public-Private Mix approach and has Memorandum of Understandings with at least 18 private clinics that diagnose and treat TB patients free of charge since they are supplied with free first-line TB drugs and consumables such as sputum jars. The NTP collaborates and coordinates a number of partners including nongovernmental organizations and private clinics. In addition to the procuring drugs from GDF, Lesotho also operates a "pull" system that provides buffer stock in all districts.

Lesotho has the fourth highest TB incidence in the world, estimated to be 630 per 100 000 populations in 2012.