Electronic medical records scale-up in Lesotho
Strengthening lifesaving HIV/AIDS and TB services in Lesotho, with experiences some of the highest rates for these diseases in the world, is essential to reduce global exposure to the suffering and deaths caused by these preventable and treatable conditions. This project assists local Lesotho structures, across all levels of government, to strengthen data systems to effectively plan, resource, implement, and monitor the provision of lifesaving HIV and TB health services.
The work entails supporting the Government of Lesotho (GoL), particularly the Ministry of Health (MOH), to develop and implement user-friendly and cost-effective digital-health tools that allow health workers to collect, analyze, and use data for better and enhanced patient outcomes at the point of care. It also allows for improved decision making that has a direct impact on managing health services effectively at facility level. These tools are essential in managing HIV and TB proactively as they assist to prioritize patient care, track patients through the health system, identify service gaps, allocate scarce resources, and ensure resources are utilized efficiently.
The project reinforces local in-country ownership, strengthening GoL’s management of its extensive response to HIV and TB without long-term dependence on donor funding. By enabling responsive digital systems that are embedded within local public health structures, the project helps to ensure that lifesaving HIV and TB health services are scaled and sustained beyond the project funding cycle, ensuring maximal return on PEPFAR investments.
HISP South Africa was selected to lead this initiative to support digital system architecture, interoperability, training, and analytics for HIV case surveillance and programme monitoring.
Primary Goal
To strengthen lifesaving HIV/AIDS and TB services in Lesotho through the revitalisation and integration of Lesotho’s national digital health systems to support the improvement of HIV case surveillance, patient monitoring, and programme performance
Strategic Objectives
- Scale up electronic medical records (EMRs) and patient tracking across all 10 districts
- Design and deploy an HIV case surveillance system to monitor newly diagnosed cases
- Develop national data standards and architecture for digital health integration
- Strengthen DHIS2-based systems for improved programme reporting and analytics
- Build capacity for data use, quality improvement, and governance within the MOH
Key Components and Implementation Approach
- EMR Scale-Up (OpenMRS/Bahmni): Supporting facility-level digital systems to track HIV clients across testing, ART initiation, and follow-up. Ensuring offline functionality and clinical decision-support tools are embedded within the system.
- Case Surveillance System Development: Designing and rolling out a tracker-based HIV case surveillance module, enabling near real-time tracking of new HIV diagnoses, linked to care and treatment services.
- Interoperability Architecture: Strengthening the national digital health enterprise architecture, including alignment with DHIS2, HPRS, lab systems, and national patient identifiers using open standards and interoperability layers.
- Data Use Capacity Building: Developing dashboards, job aids, and supervision tools for facility, district, and national staff. Supporting data quality improvement and use in routine decision-making and performance reviews.
- Sustainability and Handover: Embedding change management, national governance, and mentoring structures to transition systems ownership to the Ministry of Health and local implementing teams
Achievements to Date
- National EMR configuration aligned with ART programme workflows
- Case surveillance metadata package developed and piloted in priority districts
- HIV dashboards prototyped for real-time programme tracking
- Data exchange pathways established between EMR, DHIS2, and lab systems
- Capacity-building framework rolled out to support local ownership and scale
Strategic Impact
- Real-time patient visibility across the HIV cascade, improving linkage and retention
- Better programme monitoring through dashboards and automated indicator reporting
- Improved HIV case detection and surveillance with digital-first tracking
- National interoperability foundation laid for future digital transformation
- Sustainable systems anchored in MOH-led governance and country ownership