Millennium Development Goals
Status Report 2013
Summary
KINGDOM OF LESOTHO
Millennium Development Goals
Summary Report
2013
CONTENTS:
1.
2.
3.
4.
5.
6.
7.
8.
9.
MDGs at a Glance.............................
MDG 1...............................................
MDG 2...............................................
MDG 3...............................................
MDG 4...............................................
MDG 5...............................................
MDG 6...............................................
MDG 7...............................................
MDG 8...............................................
Millennium Development Goals - Status Report - Summary
2
3
7
10
13
16
20
25
29
Page 1
MDGs at a Glance
Goal
1. Eradicate extreme
poverty and hunger
2. Achieve Universal
primary education
3. Eliminate gender
disparity at all levels.
4. Reduce child Mortality.
5. Reduce Maternal
Mortality.
6. Combat HIV and AIDS
and TB.
7. Ensure environmental
sustainability
8. Develop global
partnership for
development.
2015 Target
Reduce by half the proportion of
people living on less than 1.25
dollars a day
Achieve full and productive
employment for all
Reduce by half the proportion of
people suffering from hunger
Ensure that all children are able to
complete primary education
Gender equity in primary
education.
Gender equity in secondary
education and tertiary
Gender equity in the economy.
Gender equity in the government
and politics
Reduce by two-thirds child
Mortality rate
Reduce by three-quarters maternal
Mortality rate
Halt and begin to reverse spread of
HIV and AIDS
Halt and begin to reverse incidence
of TB.
Halve the proportion of people
without safe drinking water and
sanitation
Reverse loss of environmental
resources
Develop a conducive environment
for trade and investment
Make available new technology in
cooperation with the private
sector.
Provide affordable access to
essential drugs.
Millennium Development Goals - Status Report - Summary
Progress
Overall Assessment
Off Track
Off Track
Off-Track
Off Track
On Track
On Track
On Track
Off Track
On Track
On Track
On Track
Off Track
Off Track
Off Track
Off track
Slow
progress
Slow
Progress
Slow Progress
Slow
Progress
Slow Progress
Slow
Progress
Slow
Progress
On Track
Slow Progress
Slow
Progress
Page 2
Goal 1
Eradicate Extreme Poverty and
Hunger
Millennium Development Goals - Status Report - Summary
Page 3
Overview
Lesotho has a biggest challenge in reducing
poverty, hunger and income inequality.
Currently, Lesotho cannot produce enough food
to meet domestic demands and a larger
proportion of rural population is still caught in
poverty due to high rate of unemployment.
Decline in agricultural productivity and inflation
are also contributing to high poverty levels.
TARGET 1: Reduce by half the proportion of people living on less than 1.25 dollars a day
Indicators
1995
2003
2011
2015
Proportion of people below the national poverty line (%)
66.61
56.61
57.3
29
Poverty gap index (%)
37.85
28.97
28.7
17
GINI index
0.57
0.52
0.53
Trend Analysis
Most of Basotho still live in poverty with very
low incomes that are insufficient to acquire their
daily basic needs. The proportion of households
below the poverty line was 57.3%1 in 2011
increasing from 56.61% in 2003. Poverty gap
index slightly decreased from 28.97 in 2003 to
28.7 in 2011. On the other hand, the degree of
inequality in households’ incomes (measured by
Gini coefficient) has increased from 0.522 in 2003
to 0.53 in 2011 showing increasing disparities
between the rich and the poor.
There are challenges that Lesotho faces in an
attempt to eradicate poverty. These include
among others, continued decline in remittances
especially as a result of retrenched Basotho
1
2
workers from South African mines, lack of job
opportunities for Basotho, decline in agricultural
production, rising commodity prices and low
participation of women in economic activities as
female headed household (36%) are more
vulnerable to hunger than male-headed
households.
Response to these challenges has been
consistent
with
the
following
projects/programmes, amongst others, having
been implemented: Joint Programme on
Economic Growth and Development to
accelerate shared and sustainable economic
growth and Support to Financial Inclusion in
Lesotho to improve and expand access to
sustainable financial services in urban and rural
areas.
.
Households Budget Survey 2011
Households Budget Survey 2003
Millennium Development Goals - Status Report - Summary
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TARGET 2: Achieve full and productive employment for all
Indicators
2003
2008
2011
2015
Unemployment rate (%)
23.4
25.3
25.3
15
29
34.5(2
006)
11.8
Proportion of vulnerable employment in total employment (%)
Trend Analysis
Lesotho is faced with high unemployment rate
which has persistently hovered around 25% for
the past decade. There are factors that
contributed to the high rate of unemployment
and these include among others inadequate
export diversification (the textile industry
dominates the economy, contributing almost
90%3 of manufacturing jobs), especially in the
manufacturing sector, which creates insufficient
employment opportunities and lack of training
on entrepreneurial skills especially among youth.
Vulnerable employment on the other hand,
which comprises unpaid family workers and the
self-employed, has declined from 29% in 2003 to
11.8% in 2011. Lesotho was faced with a major
decrease in the proportion of self-employed
workers in total employment from 25.4 % in
2003 to 8%4 in 2011. Meanwhile, the proportion
of unpaid family workers in total employment
has consistently hovered around 5%. However,
differences in survey methodologies render
inter-year comparisons difficult for this indicator.
Unemployment is very severe among youth, as a
result the Government of Lesotho together with
Development Partners have intervened through
‘Promotion of Youth Employment Towards
Poverty Reduction Program’ which focuses on
labour market information, policy environment,
education system and entrepreneurial mindset,
access to resource and promoting effective social
dialogue.
Fig 1.1 : Unemployment Rate from 1995
40
35
30
25
20
15
10
5
0
1995
1997
1999
2003
2008
2011
Unemployment Rate
Source: HBS (2003), Census (2006), ILFS (2008), LDS (2011)
3
BoS, Statistical Yearbook 2010.
4
Lesotho Demographic Survey 2011
Millennium Development Goals - Status Report - Summary
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.TARGET 3: Reduce by half the proportion of people suffering from hunger
Indicators
2004
2009
2012
Prevalence of underweight children under 5 years
19.8
13.2
-
Proportion of stunted children under 5
38.2
39.2
-
34(2003)
18.8
27.3
Proportion of population that is food insecure
2015
29
Trend Analysis
Chronic malnutrition among young children is a
health concern in Lesotho. The percentage of
underweight children has declined from 19.8%5
in 2004 to 13.2%6 in 2009. This decrease in
underweight children can be attributed to the
implementation of short and long term food
security and nutrition intervention programmes
such as encouraging home garden food
production, home-based income generating
activities and supplementary feeding. Stunting
has however increased from 38.2% in 2004 to
39.2% in 2009. This level of stunting is
considered well above the emergency
international threshold. Despite efforts made to
address this problem, stunting still remains one
of the key challenges facing children in Lesotho.
During the period 2006 - 2009, Lesotho
experienced declining levels of food production
due to drought. However, the level of production
increased in 2009/2010 leaving 10.7%7 of the
total population in need of food assistance. It
then started to decline in 2010/11 due to heavy
rains that resulted in major floods; therefore the
farming sector suffered major losses on crops
and contributed to loss of seasonal employment
opportunities. In the same year, drought plagued
the planting season (August-October) therefore
many farmers planted late or not at all. In the
lowlands up to 60% of fields were left fallow8
hence the area planted declined from 238,524
ha in 2010 to 144,278 ha in 2011.9 Consequently,
Lesotho Vulnerability Assessment Committee
(LVAC) estimated that 39% of the population
(726,000 people) would require food assistance
in 2012/13.
Fig. 1.2: Proportion of Population Requiring Food Assistance
50
38.7
40
30
29.5
28.8
27.3
24
18.8
20
13.1
10.7
10
0
2006
2007
2008
2009
2010
2011
2012
2013
Source: USAID FFP-OFDA Food Security Assessment (2012)
7Lesotho
5Lesotho
Demographic Health Survey 2004
6Lesotho Demographic Health Survey 2009
Vulnerability Assessment Committee 2008
FFP-OFDA Food Security Assessment, May 2012.
9MAFS/BoS, Lesotho Crop Forecasting Report 2011-2012.
8USAID
Millennium Development Goals - Status Report - Summary
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Goal 2
Achieve Universal Primary
Education
Millennium Development Goals - Status Report - Summary
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Overview
Education has been a core priority for the
Government of Lesotho for a long time and has
been devoted significant resources. Owing to
these huge investments in education, Lesotho
has been progressing well towards achieving
universal access to education. At present,
Lesotho is one of the countries with the highest
literacy in the region.
TARGET: Ensure that, by 2015, children everywhere, boys and girls alike, are able to complete a full
course of primary schooling.
2000
2004
2009
2012
2015
(Goal)
Literacy rate of 15-24 year-olds,
women and men (%)
N/a
M: 82.5
F: 96.1
M: 87.4
F: 98.2
M: 87.4
F: 98.2
(2009)
100
Percentage of pupils starting
grade 1 who reach last grade of
primary (%)
N/a
61.2
(2005)
62.8
65.5
100
Net enrolment ratio in primary
education (%)
82
M: 78.7
F: 85.3
83
M: 81
F: 86
80.9
M: 78.6
F: 83.2
82.1
M: 79.6
F: 82.6
100
Indicator
Trend Analysis
In 2000, the Government of Lesotho introduced
Free Primary Education (FPE), which greatly
improved access to primary education. This led
to a significant increase in the number of
children enrolling in primary schools, as
indicated by an increase in Net Enrolment Rate
(NER) from 60.2% in 1999 to 82% in 2000. Total
enrolments continued to rise until 2003,
indicated by a growth of NER from 82% in 2000
to reach a peak at 85% in 2003. However, since
2004, enrolments started to decline and have
been falling steadily since then. To curb this
problem, in 2010, the Government passed the
Education Act of 2010, making primary
education not only free, but also compulsory.
This not-withstanding, net enrolment rates
continued to decline gradually from 81.8% in
2010 to reach 81.1% in 2012. This partially
reflects the additional costs of education,
including school books and uniforms, which
many families struggle to afford. Furthermore, as
a result of the HIV/AIDS pandemic, there is an
increasing trend of children dropping out of
school to assume responsibility in the household,
especially caring for the family. Whilst access to
education has improved and many children have
enrolled in primary schools in Lesotho, as
indicated by a NER that is sustained above 80%,
there are pockets of disadvantaged children who
are out of school, consisting mainly of herd-boys,
learners with disabilities, orphans and other
vulnerable children, who constitute around 20%.
The downward trend in NER indicates slow
progress towards the attainment of 100% NER
goal in 2015.
To address these challenges, Government
provides bursaries and grants to vulnerable
children and households and is continuing with
the school feeding programme amongst other
initiatives.
Lesotho has one of the highest literacy rates in
sub-Saharan Africa – 87.4% for males and 98.2%
for females – so is on track to attain this MDG
indicator.
Net Cohort Survival Rate (NCSR) at primary level
has also improved significantly over this period.
In 2006, it stood at 40.9%, indicating that only
41% of children enrolled in Grade 1 in 2000
reached Grade 7 in 2006. Although this rate has
Millennium Development Goals - Status Report - Summary
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been fluctuating, overall it has been improving
and it increased to 65.5% in 2012. This implies
that two-thirds of children enrolled in Grade 1 in
2006 reached Grade 7 in 2012. It is worrisome
though, that one third did not reach Grade 7, as
others repeated or dropped along the way.
Lesotho has made significant progress in access
indicators at primary level. High political support
has meant that the Education Sector has
continued to get around 20% of the annual
budget. Even during the recent global meltdown
when resources were limited, and when
Government changed in 2012 this high level of
budget allocation was sustained. Nevertheless,
the progress is too slow and unless the
Education Act, 2010 is enforced to bring all
disadvantaged children in school, Lesotho is
unlikely to meet MDG Goal 2 in 2015 as reflected
in Figure 2.1 below.
Fig. 2.1: Net Enrolment Ratio in Primary Education,
1990-2015 Actual and Desired Trends
100
90
80
70
60
50
40
1990
1995
2000
Male
2005
Female
2010
2015
Total
Source: MoET, Education Statistics Bulletins 2001, 2012
Millennium Development Goals - Status Report - Summary
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Goal 3
Promote Gender Equality and
Empower Women
Millennium Development Goals - Status Report - Summary
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OVERVIEW
Lesotho is performing well in its efforts to bridge
the gender gap. In 2011 the World Economic
Forum’s gender equality ratings ranked Lesotho
9th in the world. It is one of the few countries in
Sub-Saharan Africa ensuring equal access to
education. The ratio of females to males
particularly in secondary and higher education is
too high indicating that there is inequality in
access to education.
The country strives to promote equal
opportunities for women, men, girls and boys so
that development efforts may exert positive
impact on all gender issues. Nevertheless, the
Africa Peer Review Mechanism Report notes that
the primacy accorded cultural beliefs and
practices as articulated in Section 18(4) (c) of the
Constitution
entrenches
gender-based
discrimination and inhibits full development of
human rights culture regardless of gender.
Target: Eliminate gender disparity in primary and secondary education preferably by 2005 and at all levels
by 2015
Indicator
2001
2003
2007
2008
2010
2011
2012
2015
Female-male ratio in
primary education
101
100
97.8
97.6
96.4
105
104
100
34.4
42.6
-
42.5
-
54.4
56.1
50
10.6
17
22.9
22.9
22.9
25.3
30
128
127
131
134
136
136
133
100
118
104
107
112
123
146
146
100
Share of women in nonagricultural wage
employment
Percentage of seats
held by women in
parliament 10
Female-male ratio in
secondary education
Female-male ratio in
tertiary education
TREND ANALYSIS
Lesotho has attained gender balance in primary
education implying almost equal numbers of
males and females in school. The statistics
reflect that between the years 2000 and 2003
there was a marginal gender imbalance in
favour of females, that is more girls than boys
enrolled in primary school. In the year 2004, the
situation changed until the year 2012 when
results show more males than females enrolling
in primary school. However, the situation is
different in secondary school, where more
females still enrol more than males and this
inequality experienced in secondary school
remains a concern in the country.The girl-boy
ratio in secondary school initially fell from
22.9
149/100 in 1990 to a low of 126 in 2004, but it
has now crept back up to 136. Furthermore, the
female-male ratio for tertiary education has
hovered around 110 females per 100 males
during the past decade. The impact of this pattern
is evident in long-term literacy and educational
outcomes. Likewise, in tertiary level, the female
enrolment is higher than that of the males except
for the Lerotholi Polytechnic which has a higher
male enrolment. According to the 2009 LDHS,
97% of women (aged 15-49) are literate
compared to only 80% of men. Moreover, 52% of
women havea secondary or higher education,
while only 40% of males have achieved that
distinction.
Millennium Development Goals - Status Report - Summary
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Source: Education Statistics Reports 2001, 2003, 2003-2007, 2009, 2010, 2011, 2012
The share of women in formal wage employment
in the non-agricultural sector has been high with
an increase from 34% (2001) to 43% (2003 and
2008). The percentage continued to rise until it
exceeded target of 50% in 2011 reaching 54.4%
and 56.1% in 2012. Despite the progress
achieved, women Chief Executive Officers and
managers are still rare. Women occupy only 23%
of the economic decision-making positions in
government.Therefore, there is need to reform
laws and customs that hinder female economic
development.
Lesotho has achieved slow but progressive
improvement with respect to gender equality in
Parliament. The proportion of women in
Lesotho’s Senate has fluctuated around 30%
since 1998 elections while female representation
in the lower house has steadily increased. The
total representation of women in Parliament has
increased from 10.6% in the 1998 elections to
25.4% in 2012. Lesotho is within reach of the
MDG target of 30% representation. Currently,
the proportion of women in Cabinet is 21.7%. In
2005 the government made a proactive effort to
ensure female representation by reserving 30%
of all constituencies for only women contestants.
Figure 3.2: Share of women in wage employment in the nonagricultural sector
1990-2015 Actual and Desired Trends
60
50
40
30
20
2001
2003
2005
2007
2009
Trend
2011
2013
2015
Target
Sources: 2001 LDS, 2002/03 HBS, 2008 ILFS, 4th CMS 2010-2011, 3rd CMS 2011-2012
Millennium Development Goals - Status Report - Summary
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Goal 4
Reduce Child Mortality
Millennium Development Goals - Status Report - Summary
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Overview
The population of Lesotho has historically had
better health than many sub Saharan African
states. However, increasing poverty and high
prevalence of HIV and AIDS has made families
more vulnerable to ill health amongst other
challenges. As one of the most vulnerable
groups in the country, many children have been
mostly affected by these challenges and these
have led to high rates of child mortality.
TARGET: Reduce the under-five mortality rate by two-thirds
Indicators
2001
2004
2009
2011
2015
Under Five Mortality Rate(per 1,000 live births)
113
113
117
43
37
Infant mortality Rate(per 1,000 live births)
81
91
91
94
27
71.3
74.7
69.6
-
100
Percentage of 1 year-olds immunized against measles
Trend Analysis
One in every nine children born in Lesotho dies
before reaching his or her fifth birthday. The
proportion of children who die before their fifth
birthday remained constant at 113 deaths per
1000 live births during the 2001-2004 period. It
however increased to 117 deaths per 1000 live
births between 2004 and 2009, but has
decreased to 43 deaths per 1000 live births in
2011. Infant mortality has been increasing during
the same period (2001- 2009) and has further
increased to 94 deaths in 2011. Deaths occurring
in the neonatal period (0-28 days) account for
40% of under-five mortality and deaths during
the postnatal period (child birth to 6 weeks)
account for 38%11. The greatest challenge to
reducing child and infant mortality is a weak
health care system coupled with poor family and
community health practices. Even though there
are a number of programmes12 to address child
mortality,
11LDHS,
2009.
Major programmes include the Integrated Management
of Childhood Illnesses strategy (IMCI), Infant and Young
Child Nutrition Programmes. Expanded Programme on
Immunization and the ‘Reaching Every District (RED)’
initiative
12
implementation has been slow and ineffective
due to separate operational plans with weak
integration. Figures 4.1 and 4.2 illustrate the
actual and desired trends of infant and under
five mortality rates.
The Government of Lesotho has not been
passive in its attempts to halt child mortality. The
health sector’s programmes being implemented
aim to ensure the survival and development of
children through basic health services specifically
Prevention of Mother to Child Transmission
(PMTCT), nutrition and treatment of common
childhood
diseases
and
immunization.
Immunization against measles is equally
important, as it is the leading cause of mortality
among vaccine-preventable childhood diseases.
The universal immunization coverage against
measles has been hindered by insufficient
transport, inaccessibility of health centres and
inadequate skilled personnel. The immunization
coverage increased from 71.3% to 74.7% during
the 2001-2004 period. It however declined to
69.6% in 2009. Inadequate transport, insufficient
skilled personnel and frequent staff turnover are
some of the key factors that have contributed to
Millennium Development Goals - Status Report - Summary
Page 14
low coverage performance. Moreover, the
decentralization of health services is not yet fully
functioning, and districts still depend on the
central level
mobilization.
planning
and
resource
Figure 4.2 Infant Mortality Rate
2000-2015 Actual and Desired Trends
Fig. 4.1: Under-Five Mortality Rate
2000-2015 Actual and Desired Trends
140
120
100
80
60
40
20
0
for
100
80
60
40
20
2001 2003 2005 2007 2009 2011 2013 2015
Actual Trend
Path to Goal
0
2000 2002 2004 2006 2008 2010 2012 2014
Trend
Source: LDS (2001, 2011) and LHDS (2004, 2009)
Millennium Development Goals - Status Report - Summary
Path to Goal
Source: LDS (2001, 2011) and LHDS (2004, 2009)
Page 15
Goal 5
Improve Maternal Health
Millennium Development Goals - Status Report - Summary
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Overview
Lesotho’s maternal mortality ratio is one of
the highest in the region despite the
considerable efforts taken by Government
together with different stakeholders. Though
there has been some improvements in other
maternal health indicators, there is still more
work to be done in delivering a state where
every pregnancy is safe. The improvement
of these indicators raises a question over the
quality of maternal health services – the
expectation is that these improvements
should be translated into a reduction in
maternal deaths.
TARGETS 1:Reduce by three quarters the maternal mortality ratio
Indicator
2001
2004
2009
Maternal mortality ratio (per 100,000
births)
Proportion of births attended by skilled
health personnel
2011
2015
419
762
1,155
1143
90
60.0
55.0
61.5
-
80
Trend Analysis
Figure 5.1 Maternal Mortality Rate
1990 - 2015 Actual and Desired Trends
1400
1200
1000
800
600
400
200
0
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
The Maternal Mortality Ratio (MMR) has
increased from 762 deaths per 100,000 live
births in 2004 to 1,155 deaths per 100,000
live births in 2009. This increase was
followed by a slight decline to 1143 per
100,000 births in 2011. Using the 2004
baseline, the Government of Lesotho set a
new target to 300 deaths per 100,000 live
births by 2015 against the global target of 90
per 100,000 (derived from the 1990 baseline
of 370 per 100,000 births). As it can be noted
in figure 5.1 below, Lesotho is highly unlikely
to meet this target unless accelerated
measures are undertaken. Figure 5.2
provides a highlight on the causes of
maternal deaths in Lesotho.
Actual Trend
Path to Goal
Source:Trends in Maternal Mortality: 1990-2008WHO/UNICEF/UNFPA/WB; LDHS (2004,2009) and LDS
(2001,2011)
Millennium Development Goals - Status Report - Summary
Page 17
Fig. 5.2: Causes of Maternal Deaths
Others
10%
Ectopic Pregnancy
3%
Postpartum Sepsis
34%
Hemorrhage
7%
Pre-eclampsia/
Eclampsia
12%
Obstructed/
Prolonged Labour
14%
Abortion
Complications
20%
Source: EmoC 2005
Many women, especially in the mountains of
rural Lesotho, die of causes that could be
prevented if they had access to antenatal
care, emergency obstetric care, and skilled
delivery assistance. With regard to safe
deliveries, there has been a slight increase in
the proportion of births attended by trained
health personnel from 55% in 2004 to 61.5%
in 2009. Though the progress has been very
slow, it is possible that by 2015, 80% of
births shall be attended to by skilled health
personnel given some efforts that have
already been taken.
Government of Lesotho has implemented a
number of policies to curb these high rates
of maternal deaths. These include the
adoption of the MDG Accelerated
Framework (MAF) in 2011. While there are
other initiatives such as the National
Reproductive
Health
Policy
(2009)
refurbishment of health centres with
improved maternal health facilities and
integrated HIV and AIDS and reproductive
health services, MAF will assist in employing
evidence based information on utilizing high
impact solutions to address the obstacles
and impediments to achievement of this
goal. Despite these endeavours, insufficient
infrastructure and skilled health personnel
across the country, more especially in the
rural areas, have remained some of the key
challenges towards meeting Goal 5.
Millennium Development Goals - Status Report - Summary
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TARGET 2: Achieve, by 2015, universal access to reproductive health
Indicator
Contraceptive prevalence rate, married women,
15-49
Adolescent (15-19) birth rate
Antenatal care coverage (at least 1 visit)
Antenatal care coverage (at least 4 visits)
Unmet need for family planning
2001
2004
2009
2015
36.1
37
47
80
85.2
-
20.2
90.0
69.6
30.9
19.6
92.0
70.4
23.0
100
Trend Analysis
The contraceptive prevalence rate slightly
increased from 36.1% in 2004 to 37% in
2004.It further improved to 47% in 2009
showing a 10 percentage point increase.
Although this is a significant increase as
compared to an increase between 2001 and
2004, it is unlikely that 80% target will be
reached for 2015. On the other hand, the
coverage of Antenatal Care (ANC) for women
that attend at least one ANC visit improved
from 90% in 2004 to 92% in 2009. The
coverage is lower for women that attend at
least four ANC visit. In 2009, the coverage
increased slightly to 70.4% from 69.6% in
2004. At this rate of coverage, the 2015
target is unlikely to be achieved as shown in
Figure 5.3 below.
Fig. 5.3: Antenatal Care Coverage (at
least one visit)
120
100
80
60
40
20
0
2001 2003 2005 2007 2009 2011 2013 2015
Actual Trend
In terms of family planning, the proportion
of unmet needs for family planning
decreased by 26% from 30.9% in 2004 to
23% in 2009 suggesting that it is unlikely that
all family planning needs shall be met by
2015. This indicator reveals that more
investment should be channeled towards
improving family planning services as
opposed to demand creation.
Despite showing a decline, trends in
adolescent
birth
rate
have
been
unsatisfactory. There were fewer adolescent
births in 2009 (19.6%) than in 2004 (20.2%)
representing only a 1.4% decrease. This
decline is very low given that teenage
pregnancy is a major health concern because
it is associated with higher maternal child
mortality and morbidity and carries high
risks,
such
as
pregnancy
induced
hypertension, obstructed or prolonged
labour, and unsafe abortion. Younger
mothers are much less likely to receive
antenatal care. Moreover, teen pregnancy
adversely impacts long-term wellbeing, as
young mothers are less likely to continue
their
education
and
find
decent
employment.
Path to Goal
Source: LDHS 2009 and 2004; EMICS 2000
Millennium Development Goals - Status Report - Summary
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Goal 6
Combat HIV & AIDS and
Tuberculosis
Millennium Development Goals - Status Report - Summary
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Overview
HIV and AIDS has been acknowledged as
one of the foremost constraints to attaining
all MDGs. The epidemic hinders child and
maternal health, undermines economic
productivity, and impacts educational
outcomes of Orphaned and Vulnerable
Children (OVCs). Lesotho currently has the
third highest HIV prevalence rate in the
world.
Target 1:Halt and begin to reverse spread of HIV and AIDS.
Indicators
2004
2005
2007
HIV Prevalence among
population aged 15-24
11.3
M: 6.0
F: 15.4
-
-
Adults (15-49) with multiple
partners in the past year
M: 30.4
F: 11.0
-
-
Condom use among adults
during last high-risk sex
M: 38
F18.7
-
-
Proportion of population aged
15-24 years (youths) with
comprehensive correct
knowledge of HIV and AIDS
HIV+ pregnant women
receiving ART for preventing
MTCT
2009
9.3
M: 4.2
F: 13.6
M:
21.9
F: 6.4
M:
50.5
F: 38.5
M: 18.4
F: 25.8
-
-
M:
28.7
F: 38.6
2
5
25
40
2010
2011
2012
2015
-
-
-
-
-
-
-
-
-
M: 80
F: 70
-
-
-
85%
43
51
52
97
Trend Analysis
Lesotho has registered a reduction in the
HIV prevalence among youth (15 – 24) from
11.3% in 2004 to 9.3% in 2009. On the other
hand, prevalence among adults (14-49
years) naturally stabilized around the year
2000 and is currently at 23%13. Although
HIV infection is pronounced in nearly every
socio-demographic
and
geographic
subpopulation,
its
impact
is
not
homogenous. Women have a higher
infection rate than men – 27% versus 18%14.
HIV prevalence in urban areas is 27.2%,
13
14
LDHS, 2009.
Ibid.
when compared to that of rural areas at
21.1%. The increased urban prevalence may
be attributed to a number of factors
including rural urban migrations where
most people settle in informal settlements
and vulnerability to HIV is increased when
they exhibit higher risk taking behaviours
such as transactional sex. This does not
withstand the fact that people with
comprehensive knowledge had been
increasing. The proportion of the population
aged 15-24 years with comprehensive
correct knowledge of HIV and AIDS was
25.8% among females in 2004 and 18.4% for
Millennium Development Goals - Status Report - Summary
Page 21
males in the same year and increased to
38.6% for females and 28.7% for males
respectively in 2009.
In terms of prevention of HIV transmission
from mother to child, the proportion of HIV
pregnant women receiving antiretroviral
treatment for preventing Mother to Child
Transmission (MTCT) has increased steadily
from 2% in 2004 until it reaches 52% in
2012. It is worth noting that this proportion
has been increasing slower during the 20092012 period despite having shown
significant increases since 2004 until 2009.
With regard to behavioural change, condom
use among adults during last high-risk sex
and adults with multiple partners, there has
been a slight improvement. Condom use
among adults has slightly improved from38
to 50.5 in and 41.9 to 38.5 amongst men
and women respectively during 2004-2009
period but remains low and static. In
addition to this, there has also been a
decline in the number of adults, both
female and males, with multiple partners.
Though there is a decrease in the numbers
of Adults (15-49) with multiple partners in
the past year, these figures are still a
concern. Despite increase in comprehensive
knowledge about HIV and AIDS, evidence
has shown that Multiple and Concurrent
Partnerships (MCP) remains the main driver
of HIV. This calls for focus specifically on
raising awareness about the risks of MCP in
prevention strategies and in messaging
efforts, such as Behaviour Change
Communication (BCC).
The Government of Lesotho together with
its Partners has undertaken a number of
efforts to prevent new infections and
provide care for those who live with HIV and
AIDS. These include voluntary testing and
counseling, Prevention of Mother to Child
Transmission (PMTCT), provision of
antiretroviral and the development of the
national HIV prevention strategy (2011–
2016).
Fig. 6.1: HIV prevalence among adults (15 - 49 years) 1990-2015 Trend
30
25
20
15
10
5
0
1990
1995
2000
2005
2010
2015
Sources: WHO and 2009 LDHS
Millennium Development Goals - Status Report - Summary
Page 22
TARGET 2: Achieve by 2010, universal access to treatment for HIV and AIDS for all those who
need it.
Indicators
Adult Antiretroviral
coverage
Child Antiretroviral
coverage
2004
2005
2007
2009
2010
2011
2012
2015
4
16
24
48
59
58
59
80
1
11
24
19
22
24
80
Trend Analysis
The country developed an ambitious scaleup plan and to accelerate uptake of ART to
meet universal access targets. The
proportion of the adult population in need of
life saving antiretroviral who have access to
antiretroviral drugs increased from 16% in
2005 to 59% in 2012. The proportion of
children receiving antiretroviral drugs
remains very low at 24% in 2012. There has
also been a rapid scale up of the ART
program with the number of adults and
children receiving Highly Active Antiretroviral
Treatment (HAART) from 4,678 in 2005 to
93,553 in 2012.
TARGET 3: Begin to reverse the incidence of Tuberculosis and other diseases.
Indicators
(1990)
Baseline
2007
2008
2009
2010
2011
TB Prevalence/100 000 pop
249
421
513
410
408
411
TB Deaths/100 000 pop
31
83
91
90
85
94
47
(1995)
67.9
74
70
69
74
Proportion of tuberculosis
cases detected and cured
(success rate %)
2015
85
Trend Analysis
The number of TB cases notified per 100,000
of population rose from 249 in 1990 to 513
in 2008 and declined to 411 in 2011. At this
rate, it is unlikely that the target of less than
300 cases per 100,000 of population by 2015
shall be achieved. Considerable progress has
however been made regarding treatment of
TB cases. The proportion of TB cases that
have been successfully treated has increased
from 47% in 1995 to 74% in 2011. The target
of 85% successful treatment of TB cases is
likely to be achieved by 2015. However, the
number of deaths due to TB as measured by
TB deaths per 100,000 of population has
increased from 83 deaths per 100,000 of
population to 91 between 2007 and 2008. It
Millennium Development Goals - Status Report - Summary
Page 23
declined to 90 in 2009 and further to 85 in
the subsequent year. The latest figure of
2011 shows a worsening case of an increase
to 94 deaths per 100,000 of population.
Despite promising levels of TB treatment
success rate, the HIV/TB infection together
with the growing numbers of Multi-Drug
Resistance (MDR) TB remains a challenge. In
response, Lesotho will train more health
workers on collaborative TB/HIV care,
support the district level TB/HIV technical
working groups, and work towards response
harmonization with other SADC countries. It
will also engage more private practitioners
as partners in implementing of the TB/HIV
strategy.
Millennium Development Goals - Status Report - Summary
Page 24
Goal 7
Ensure Environmental Sustainability
Millennium Development Goals - Status Report - Summary
Page 25
Overview
Strong environmental management is essential
for long term sustainable development and
poverty reduction. Environmental degradation
and climate change issues are particularly critical
for Lesotho because its economy is dependent on
subsistence, rain-fed agriculture and natural
resource exports. Lesotho’s planning path hinges
on environmentally sensitive activities such
as mining, large infrastructure, the garment
industry, and agriculture. Key areas of
concern include land degradation, water,
sanitation, biodiversity, climate change,
energy, and environmental governance.
TARGET 1: Integrate the principles of sustainable development principles into policies and programmes
and reduce of environmental resources and biodiversity
indicators
2001
2004
2009
2011
Total biomass for Cooking
66
62.3
51.3
53.93
Total biomass for heating
67.1
-
57.5
51.7
1.37%
1.40%
1.44%
1.63%
Endangered Species
-
-
-
3
Protected land area
-
-
-
0.4
636000
-
-
805000
0.35
-
-
0.43
Forestry coverage
CO2 Emissions, total (tonnes)
CO2 per capita (tones)
Trend Analysis
Biomass is the dominant form of energy in
Lesotho being used by 53.93% of households for
cooking needs and 51.7% for heating needs.
Further analysis shows that consumption of
biomass is higher in rural areas. In 2011, 71.3%
of rural households used wood as the primary
fuel for cooking compared to 8% in urban areas
and the disparity is similar for cooking not
withstanding that small area covered by forest.
Since 2000, forest area has remained very small
but has slightly increased from 1.37% to 1.63% of
total land area in 2013.
The International Union for Conservation of
Nature (IUCN) Red List specifies only one animal
species in Lesotho as critically endangered – the
Maluti minnow – while two are endangered
(white-tailed mouse and long-toed tree frog) and
11 others are vulnerable to extinction. Republic
of South Africa and Lesotho partnered in 2001 to
create the Maloti-Drakensberg Transfrontier
Conservation and Development Program, which
incorporated 5170 km2 on the Lesotho side,
including Sehlabathebe National Park. Other
areas include Ts’ehlanyane National Park (56
km2) in the North, the Bokong Reserve (19.7 km2)
and Lets’eng-la-Letsie (4.34km2) following its
recognition by the Ramsar Convention in 2004.
As one of the small economies, Lesotho is not a
large CO2 emitter. The First National
Communication to the UN Framework
Convention on Climate Change reports 636,000
metric tonnes of emissions (not including land
use change and forestry) for 1994 – all from the
energy sector15. This figure steadily increased to
805,000 in 2000.
15
Ministry of Natural Resources, National Report on
Climate Change, April 2000.
Millennium Development Goals - Status Report - Summary
Page 26
Figure 7.2: Forestry Coverage in Lesotho
Fig 7.2 Biomass Consumed in Tonnes
800000
750000
700000
650000
600000
550000
500000
450000
400000
2003 2004 2005 2006 2007 2008 2009 2010
Wood
Source: FAO 2010
Shrubs
Dung+Crop Waste
Source: 2011 Lesotho Environment and Energy Statistics Report,
Department of Energy 2013
TARGET 2: Halve the proportion of households without sustainable access to improved drinking water
and sanitation.
Indicator
2001
2004
2009
2011
2015
Proportion of household with improved
water
Proportion of household with improved
sanitation
80.6
(1995)
55.8
78.9
82
91
24
50.9
24
55
62
Trend Analysis
In 2011, 82% of households were using an
improved drinking water source, with major
regional disparities. Roughly 91% of urban
households versus 74% of rural households use
safe water sources16. Also, 32% of rural
households must travel more than 30 minutes to
access safe water compared to 11% for urban
families. About 55% of households are using an
improved sanitation facility – 26% and 22% for
urban and rural areas, respectively.17 It appears
that urban sanitation coverage has drastically
declined, which can be explained both by inter-
16
17LDHS,
LDHS, 2009.
Millennium Development Goals - Status Report - Summary
2009.
Page 27
year differences in data collection and ruralurban migration
From analysis of the two targets above, it is
apparent that Lesotho’s primary challenge is
Land degradation which is mostly driven by
heavy reliance on biomass and poor agricultural
practices. This poor land management practices
causes sedimentation and impact on river ecosystems and water quality since land and water
are integrated systems.
To address the above mentioned challenges the
government of Lesotho with Millennium
Challenge Cooperation, World Bank and other
Bilateral Donors has financed the Metolong Dam
and water supply programme which are
envisaged to increase access of water also in
connection with sanitation MCC and EU have
provided funding for VIP latrine construction and
various water and sanitation projects
respectively. With regard to protected area and
wetlands the Government of Lesotho has
embarked on Rehabilitation and Restoration of
Wetlands at 3 Pilot areas.
Fig. 7.3 Proportion of Households with Improved Water
100
90
80
70
60
50
Urban
Rural
Source: LDHS 2009, LDHS 2004, LDS 2001
Fig. 7.4 Proportion of Households with Improved Sanitation
60
50
40
30
20
10
Total
Urban
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
0
Rural
Sources: 2009 LDHS, 2004 LDHS, 2001 LDS, CMS 2011
Millennium Development Goals - Status Report - Summary
Page 28
Goal 8
Global Partnership for Development
Millennium Development Goals - Status Report - Summary
Page 29
Overview
Goal 8 addresses the way developed countries
can assist developing countries in achieving the
MDGs through development assistance, market
access, foreign investment, and access to
critical technologies and innovation. Total net
ODA comprises grants or loans to developing
countries for economic and social development
from Organization for Economic Cooperation
and Development (OECD), Development
Assistance Committee (DAC) members.
TARGET 1: Address the special needs of least developed countries
Indicators
2000
2005
2008
2010
2011
Net ODA to Lesotho – total (USD millions)
37
67.49
143.8
256
264.58
Net ODA to Lesotho – per capita (USD)
20
36
118
121
Net ODA to Lesotho – as a proportion of GNI
3.76%
3.63%
6.74%
10.04%
9%
Proportion of ODA allocated to social services
60.4%(2002)
81.80%
87.64%
91.12%
-
Trend Analysis
Net ODA to Lesotho from all donors (including
multilateral institutions) more than doubled in
2010 to $256 million ($118.01 per capita) which is
10% of GNI. In 2011, net ODA to Lesotho only
increased to $265 million($120.6 per capita)
which is 9% of GNI. However, Assistance is still far
below the commitment of 0.7% of GNI made by
development partners and the UN at the 2005
Gleneagles Summit reflecting that Donors are
regressing on their ODA commitments to least
developed countries. Therefore, overall ODA will
likely decrease and stabilize at normal levels in
subsequent years.
Another indicator under target one is the
proportion of ODA allocated to Social services
which has steadily increased over the past
decade from 60% in 2002 to over 90% in 2010. A
high proportion allocated to social services is
indicative of the inclusiveness of ODA for all
segments of the population and ensures the use
of donor funding for basic human development in
education, primary health care, nutrition, and
water and sanitation.
Figure 8.1: Net Official Development Assistance to Lesotho
1990-2011
300
250
200
150
100
50
ODA to Lesotho (current USD, millions)
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
0
ODA to Lesotho (constant 2011 USD, millions)
Source: OECD
Millennium Development Goals - Status Report - Summary
Page 30
TARGET 2:Develop an open, rule-based, non-discriminatory trading and financial system
Indicators
2000
Proportion
of
exports
to
developed countries admitted
11%
free of duty
Proportion of ODA allocated to 6.66%(20
build trade capacity
02)
Foreign Direct Investment into
224.47
Lesotho (million maloti)
2005
2008
2010
2011
2012
100%
100%
100%
100%
100%
3.16%
1.05%
0.32%
-
-
482.2
1583.53
1274.64
1422.24
1593.69
Trend Analysis
Due to duty-free and quota-free access to the
U.S. through Africa Growth and Opportunity Act
(AGOA) and free trade agreements with the EU,
SACU and SADC, 100% of exports to developed
economies have been admitted free of duty
since 2002. Passing of AGOA has spurred a
booming textile sector in Lesotho, creating
thousands of jobs. Exports constituted 43% and
46.8% of the GDP in real prices in 2010 and 2011
respectively.
With regard to aid for trade, ODA to Lesotho has
focused on infrastructure, agriculture, trade
policy and regulation, industrial development
and tourism. The proportion of ODA allocated for
trade capacity has fallen considerably from 9% in
2003 to less than 1% in 2010 due to increased
funding towards HIV and AIDS programmes
amongst other reasons.
The global financial crisis triggered a decline in
FDI from M5383.53m in 2008 to M1274.64m in
2010. In 2011 and 2012 FDI increased to
M1422.24m and M1593.69m18 respectively as a
result of a number of initiatives such as the
development of industrial infrastructure. To
attract FDI, efforts are already being taken by
LNDC with support of the Southern Africa Trade
Hub to diversify markets. Continued investment
in industrial infrastructure and the Metolong
water project should also attract further FDI.
Figure 8.2: Net Foreign Direct Investment (million maloti)
2000
1500
1000
500
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
18Central
Millennium Development Goals - Status Report - Summary
Bank of Lesotho
Page 31
TARGET 3: Make new technologies available, especially information and communications
Indicators
2000
2005
2008
2010
2011
2012
2013
Fixed telephone lines per 100 people
Mobile subscribers per 100 people
Internet users per 100 people
1.13
0.35
0.22
2.08
11.19
2.84
2.53
25.67
4.05
2.05
41.62
4.45
2
53.62
2
70
3
84
13
Trend Analysis
There has been a significant penetration of
communication services in Lesotho, particularly
with respect to mobile networks. The sector has
realized increased subscription for both voice
and internet services, increased coverage and
wider choice of communication services which
contribute towards bridging the digital divide.
Teledensity for mobile telephony has increased
exponentially from around 1% in 2000 to 84% in
March 2013 (figure 8.10). On the contrary, the
growth of fixed telephony has largely remained
stagnant with teledensity at 3% in March 2013
compared to 1% in 2000. This stagnation in fixed
telephony is characteristic of most developing
countries.
Like in most African countries, penetration on
Internet access and services in Lesotho has
progressed very slowly. Exorbitant prices, slow
and unreliable connectivity have been the key
factors that hindered Internet penetration.
However, this is bound to change now that
Lesotho sources international bandwidth
through the East African Submarine System
(EASSy) project. Participation in this project was
intended to bridge the digital divide through
introduction of cheaper and high capacity
bandwidth connectivity. The Lesotho Internet
Exchange Point (LIXP) has also been established
to address high costs of internet connectivity.
The facility is intended to enable improved
domestic speeds, efficient use of international
bandwidth, reduced costs and make savings on
foreign exchange.
Figure. 8.10: Lesotho ICT Access,
2000-2012
80.00
60.00
40.00
20.00
0.00
2000 2002 2004 2006 2008 2010 2012
fixed telephone lines per 100
mobile lines per 100
internet users per 100
Sources: Lesotho Communications Authority;
International Telecommunications Union
A herd boy at the cattle post near USF tower Semena
(ThabaTseka) on his mobile phone, he can now keep in
touch with the Herd Owner and police in cases of
disaster and stock theft.
Millennium Development Goals - Status Report - Summary
Page 32
TARGET 4: Provide affordable access to essential drugs in developing countries
Indicator
2007
2010
Availability of essential medicines
74%
77.7%
Trend analysis
Lesotho is committed to “making available to its
population safe, effective, good quality,
affordable medicines in both Public and private
sector” as stated in the National Medicines
Policy. It is in this context that in November
2009, a nationwide study on the availability,
procurement, distribution and use of a selection
of medicines in Lesotho was conducted. As
shown in Table 8.1 below, the results of the
survey revealed 77.7% average availability of
essential medicines at hospitals.This represents
an increase of 3.7% from the 74% availability
during the 2007 survey. However Access to
essential medicines is affected by availability of
the medicines at health facilities, their
affordability, as well as the distance to the
facility.
Table 8.1: Medicine Access in Lesotho
2007
2010
Availability of Indicator Medicines (All)
74%
77.7%
Availability of Indicator Medicines (GoL)
74.5%
80.3%
Availability of Indicator Medicines (CHAL)
74.7%
74.7%
Overall Availability of TB medicines
78%
80.7%
Overall Availability of STI medicines
78%
79%
-
69.6%
7
17
-
13
-
23
40%
57.7%
-
143.7
HOSPITALS
Overall Availability of ARVs
Average Out-of-Stock days for Indicator Medicines (All
Hospitals)
Average Out-of-Stock days for Indicator Medicines (GoL
Hospitals)
Average Out-of-Stock days for Indicator Medicines (CHAL
Hospitals)
HEALTH CENTERS
Availability of Indicator Medicines
Average Out-of-Stock days for Indicator Medicines
Source: MOHSW, 2010 Medicine Access Survey
Millennium Development Goals - Status Report - Summary
Page 33