Sudden reductions in US assistance earlier this year created chaos within the country's healthcare system. A recently finalized five-ye...
Sudden reductions in US assistance earlier this year created chaos within the country's healthcare system.
- A recently finalized five-year health financing agreement aimed at ensuring consistent HIV and TB treatment has been established between the United States and Lesotho, following President Donald Trump's significant reduction in aid earlier this year.
- Over 1,500 healthcare professionals were impacted, with 60% of Lesotho's HIV counselors losing their positions following the sudden termination of USAID and PEPFAR financial support.
- The U.S. Embassy states that the new pact ensures shared financial support for frontline personnel and critical medical supplies.
- Implementation is scheduled to begin in April of next year.
A five-year collaborative funding agreement between the United States and Lesotho aims to bring back stability to a healthcare system that was severely affected by sudden reductions in U.S. aid, resulting in the termination of numerous frontline staff and the closure of essential HIV programs.
In a statement released on Tuesday, Jessica Tesoriero, a spokesperson for the US Embassy in Maseru, mentioned that the new bilateral agreement will provide "joint funding for frontline healthcare workers" and guarantee ongoing purchase of critical HIV and public health supplies.
The agreement will also maintain the nation's disease-monitoring and data-tracking systems, which were on the verge of collapse after the interruption of USAID and PEPFAR funding earlier this year.
Tesoriero mentioned that the memorandum of understanding, which expands on PEPFAR's 18-year collaboration in Lesotho that enabled the country to attain "outstanding achievements in the battle against HIV/AIDS," aims to guide the nation toward "a robust, independent, and sustainable health system" by merging U.S. assistance with enhanced government leadership.
The contract will be signed in December, with execution planned for April 2026.
The agreement comes from discussions with a top-level American delegation headed by Deputy Assistant Secretary for Health Policy and Diplomacy Mamadi Yilla. Senior officials from the US Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) were also involved.
Lesotho's Health Minister Selibe Mochoboroane and Acting Minister of Finance and Development Planning Ntoi Rapapa headed the country's delegation. Faith-based groups offering critical care in Lesotho and representatives from The Global Fund also met with the delegation.
As part of the agreement, the United States will offer technical support while Lesotho takes on increasing control over key aspects of its healthcare system. This involves achieving a series of performance standards that both parties have mutually agreed upon.
Health system weakened by reductions
The recent agreement comes after several months of instability caused by US President Donald Trump issuing executive orders that halted foreign assistance for 90 days.
The action immediately stopped funding that supported approximately 1,500 healthcare professionals, such as doctors, nurses, lab technicians, and counselors. The health department could not stop widespread layoffs.
According to UNAIDS, as of March 2025, 72% of PEPFAR funding had been stopped or ended, leading to 804 positions being lost. By June, at least 652 frontline staff had been dismissed, including 60% of the nation's HIV testing counselors.
The financial collapse also significantly reduced the health budget. Dr Tapiwa Turambiswa, who oversees national HIV programs, stated that 93% of USAID support and 6% of CDC funding had been eliminated, causing total external aid to drop from approximately R1.4-billion to R600-million.
The effects were swift and serious. The number of HIV tests dropped from 11,702 in August 2024 to 9,054 in April 2025. A lack of counselors led to many tuberculosis patients, who should be tested for HIV, no longer receiving the screening. (Lesotho has one of the highest rates of TB in the world, with 664 cases per 100,000 people, and approximately half of these patients also have HIV).
Prevention initiatives were closed down, including the M212-million (R1 = M1) USAID-supported SECURE project (focused on condom distribution and medical male circumcision). The M168-million Bophelo Bo Botle program, which aided over 120,000 individuals receiving ARVs, was discontinued.
Numerous additional losses occurred in areas such as mental health assistance, basic medical care, drug oversight, and illness monitoring frameworks.
Despite Mochoboroane's public assertion that Lesotho could manage with a financial shortfall of R181-million, the extensive service closures and large-scale layoffs exposed significant weaknesses.
Tesoriero stated that the new agreement signifies a revival of a cooperative framework "grounded in mutual accountability," featuring combined financial contributions and U.S. technical assistance aimed at maintaining essential services and fostering lasting resilience.
For the thousands of Basotho who rely on HIV testing, treatment, TB checks, and basic medical care, the agreement, despite being vague, marks the first sign of stability following months of doubt.
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