The Healthcare System in Lesotho: What a French National Should Know

Lesotho’s health system is under the authority of the Ministry of Health. The France Diplomatie pages consulted for this guide describe health infrastructure as weak, which complicates care in the event of an accident, and do not detail the split between public, faith-based and private facilities; the World Health Organization does not give the detail either on its page devoted to the country.

On funding, the WHO reports health expenditure of about 120 US dollars per capita, or more than 12% of GDP. This ratio should be set against a GDP per capita of less than 1,000 US dollars according to France Diplomatie and says nothing about the availability of care in a specific facility.

For an expatriate, the practical consequence is clear: Lesotho is surrounded by South Africa, which offers more complete care facilities, and the insurance must provide for this referral. The page guide to healthcare systems offers a comparison method.

The pages read for this guide describe no compulsory national health insurance accessible to expatriates: cover rests on direct payment, employer arrangements and insurance contracts. The conditions of access for a foreigner to public facilities, including the fees charged, should be confirmed with the Ministry of Health and each facility.

Lesotho is not on the CLEISS list (the French liaison centre for international social security) of States bound to France by a social security agreement: the Carte Vitale opens no rights and only the seconded employee keeps the French scheme, reimbursed on French rates according to Assurance Maladie (the French national health insurance).

France Diplomatie indicates that the French embassy covers none of these costs and that in any case there is no French embassy in Lesotho. See healthcare reimbursement in Lesotho.

France Diplomatie gives a precise instruction: in a serious emergency, it is strongly advised to go directly to South Africa; if this journey is impossible, go to the Queen Mamohato / Tsepong hospital in Maseru rather than a private clinic. It also asks you to check that the insurance covers transport from Lesotho to South Africa, as well as the care received in that country.

No local emergency number is published on the health page. Before departure, save the numbers of your assistance provider and those of the Consulate General in Johannesburg. On the spot, identify the quickest route to the border post and check its opening hours: not all border posts are open 24 hours a day.

An evacuation takes place in several stages: stabilisation on site, the assistance provider’s decision, medically supervised transport and admission to a South African facility; the guide medical repatriation describes the steps. At the border, the stay in South Africa is generally limited to seven days for those entering by road from Lesotho, a point to anticipate for a medical stay.

France Diplomatie recommends taking only the strictly necessary medicines, in their original packaging, with a prescription giving the names in international non-proprietary names, checking that they are authorised in Lesotho and never buying medicines on the street, because of the risk of counterfeits.

For a chronic treatment, a stock for several months when settling in and a discussion with a local doctor about the available equivalents limit the risk of running out; South African pharmacies near the border are a solution to check with the insurer.

Dental and optical care fall under insurance contracts and the CFE (Caisse des Français de l’étranger, the French social security fund for expatriates); see expat health insurance.

The French vaccination schedule must be up to date (diphtheria, tetanus, poliomyelitis, whooping cough, measles). Depending on the length and conditions of the stay, France Diplomatie additionally cites yellow fever (certificate required only when arriving from a country with a risk of transmission), hepatitis A and typhoid fever, hepatitis B for frequent or long stays, tuberculosis for children under 15, rabies for young children and rural stays, and mpox in the event of risky exposure.

The diseases flagged are typhoid fever, hepatitis A, mpox, rabies and tuberculosis, which is treated with several antibiotics for several months; prevention relies on BCG, early detection and complete treatment. HIV prevalence is 25%, the second-highest rate in the world: risky behaviour should be avoided and a doctor consulted as soon as possible after exposure. The France Diplomatie page does not mention malaria.

Natural hazards add to health risks: snow from June to October, thunderstorms and lightning from November to February, intense heat, drought. Plan for large quantities of drinking water, hike only where shelter is quickly accessible and stay informed of weather bulletins.

Drink only sealed water, sealed drinks or water made drinkable. Wash or peel fruit and vegetables well, cook meat, fish and eggs thoroughly, avoid raw vegetables, shellfish and cold buffets, and wash your hands frequently.

Against mosquitoes: covering clothing, skin repellents, mosquito nets and protection of the home, removal of stagnant water. Other precautions: favour reliable transport, avoid driving at night, swim only in supervised areas, do not touch or feed animals, wear closed shoes and consult a doctor quickly after a bite or sting.

Mountain hiking deserves medical preparation: weather conditions that can change quickly, thunderstorms and lightning that claim victims every year, intense heat and the need for large quantities of water. France Diplomatie advises setting out only with accessible shelter, reporting any long-duration departure to the honorary consul and reporting to village chiefs before spending the night.

For children, up-to-date vaccination, BCG for under-15s on a prolonged stay and rabies vaccination for young children in rural areas should be discussed with a doctor. For a chronic illness, check before departure the continuity of treatments, the availability of medicines and the insurer’s coverage, taking into account the history to be declared; see medical questionnaire and history.

France Diplomatie describes a contract covering all medical costs, hospitalisation and medical repatriation as imperative: without it, access to care may be refused, even in a life-threatening emergency. Three routes exist: the CFE, with membership before departure or within three months of settling in for immediate cover; international first-euro insurance, with direct payment and evacuation; the protection of a secondment.

The comparison is made on the coverage area, hospitalisation ceilings, maternity, evacuation to South Africa and the medical questionnaire; see coverage area.