38 ICU beds; up from 10 in 2021; 30 clinicians receive short-term critical care training; 47 health care providers attend basic emergency training.

With its mountainous terrain and use of donkeys and horses as primary modes of transport, Berea Hospital nurse Sello Ramakanate says the consequent high incidence of traumatic brain injuries in Lesotho is compounded by limited critical care, pushing up deaths rates.

Now, however, thanks to collaboration between the government and World Health Organization (WHO) and other partners, the number of intensive care unit (ICU) beds has almost quadrupled, from 10 to 38, since 2021.

50-year-old Susan Lineo, who was admitted into the ICU for drug-resistant Tuberculosis at Lesotho's only hospital for people with this advanced form of the disease, says, “When I came here, I was weak but when I got admitted in the ICU and started treatment, I feel a sense of life again. I am grateful that we have this facility in place to cater for people like me. The doctors and nurses here have been good to me.”

The COVID-19 pandemic highlighted this gap, with most health facilities lacking designated high-care beds, let alone ICUs. But it also presented an opportunity to develop critical care capacity for pandemic preparedness and health system strengthening into the future.

In March 2020, the country’s only 10 ICU beds were at the Queen 'Mamohato Memorial Hospital in Lesotho’s capital city, Maseru. A donation from a bank in Lesotho then added a further five at Maluti Adventist Hospital, 80 kilometres east of Maseru.

But it still was not enough, and Lesotho’s Health Ministry reached out to WHO for technical support to build its emergency and critical care capacity, establish oxygen production plant and build human resource capacity.

“With financial support from the Global Fund, WHO led an assessment to identify the gaps. The consequent recommendations were made based on the anticipated caseload for future COVID-19 waves, and building a resilient health system beyond the pandemic,” explains Dr Richard Banda, WHO Representative to Lesotho.

WHO’s provision of standards served as a basis for the creation of the ICUs, including how to address issues of infrastructure, equipment, human resources, diagnostics, medication and consumables and developing local guidelines. Two national strategies emerged from the process, the National Oxygen Scale-up Strategy, Emergency and Referral Policy, and the Critical Care Strategic Plan, with WHO providing technical assistance to mobilize funding to implement these guidelines.

To support human resource development, WHO provided short-term critical care training for 30 clinicians, while 47 care providers underwent basic emergency training. All the trainings are WHO-certified, and accredited either by the Africa Institute of Emergency Medicine or the European Society of Intensive Care Medicine.

The World Bank supported the establishment of two ultra-modern eight-bed ICUs at Mafeteng and Berea district hospitals. They are equipped with ventilators, piped oxygen and truncation systems, providing a convenient and safe system of delivering oxygen to patients.

The two ICUs serve Lesotho’s northern and southern regions, as first referral ICUs. They are currently 70% functional, providing treatment to an average three patients per week between February and June 2023.

Dr Senate Mathaha, a medical officer at Mafeteng Hospital, welcomes the development. “The new unit will alleviate the care burden of trauma and diabetes patients, those with obstetric and HIV-related complications, and the like. Taking care of ICU patients requires a lot of special skill, on top of dedication and meticulous attention to detail,” he says.

With 20 more ICU beds being created by the World Bank, the total number is expected to increase to 58 by the end of 2023.