When a high school teenager visited a clinic at Ha Koali, in Berea district, for treatment of a Sexually Transmitted Infection (STI), the Nursing Officer at the clinic offered her counselling and information on family planning, including the newly introduced self-injection depo –Sayanna Press. Ever since, the girl is now using Sayanna Press as her family planning method of choice.

By providing counselling and information services to the teenager besides treating the STI, the Nursing Officer, Ms ‘Makatleho Rapapa provided integrated Sexual Reproductive Health Care services to her as recommended under 2Gether4SRHR program, a regional intervention whose goal is to improve the sexual and reproductive health and rights of all people, but with a particular focus on adolescent girls, young people and key populations in the Eastern and Southern Africa (ESA) region.

Integration of services requires that health-care providers have the knowledge and skills to provide an appropriate basic package of services and to refer patients for other necessary services that are not provided at that site, just as the Nursing Officer did. “The fact that she had an STI showed that she was already doing sex. Therefore, during counselling I showed her different types of contraceptives and she opted for Sayanna Press. She preferred it as she would not have to visit the health facility regularly and therefore would not have to miss school and would not have to ask her parent to visit the health facility regularly,” she pointed out.

In Quthing district, integrated services are offered mostly during community outreaches. According the District’s Public Health Nurse Ms ‘Mateboho Mothupi, 80 percent of the population in Quthing works in South Africa so during the outreaches, they are given the full package as they come to Lesotho seasonally. “We provide the full package including cervical cancer screening and HIV testing and counselling, besides provision of different types of contraceptives. We also refer cases of Sexual Gender Based Violence(SGBV). Just recently we referred a 12-year-old HIV positive girl who had a mental illness, whose father was aware of the SGBV done to her by a friend,” she stated. In Quthing, the other challenge is that most people have to walk long distances before they can reach a health facility, hence the need for the community outreaches.

In Butha-Buthe district also, Lesotho Planned Parenthood Association (LPPA) starts the outreach, done once a month at ‘Moteng with a health talk. There is also HIV testing and counselling, cancer screening, COVID19 vaccination and family planning services.

Rethabile (not real name), heard about self-injection depo (Sayana Press) during the health talk and decided there and then to inject, through the assistance of the health care providers. “I will come for the next dose after three months, if by then they realise that I can be able to inject myself, then they will give me the next doses to inject myself,” she said adding, “It is not even painful. I am going to encourage others to also use it.”

The rationale for integration is to increase the effectiveness and efficiency of the health system and to meet people’s needs for accessible, acceptable, convenient, client centred comprehensive care. In Lesotho, UNFPA, the United Nations Population Fund leads implementation of 2Gether4SRH program in collaboration with UNAIDS, UNICEF and WHO. The program combines strategies and activities according to the strengths and comparative advantages of the four participating UN agencies, providing catalytic support to the government and civil society and communities to scale up quality integrated Sexual Reproductive Health and Rights/HIV and Sexual Gender Based Violence services for all people, especially adolescent girls, young people and key populations.

UNFPA has capacitated journalists in Lesotho on reporting about Sexual and Reproductive Health and Rights with particular focus on 2Gether4SRHR program and integration of SRHR, HIV and SGBV services, so that they can raise awareness among the population about the program and SRHR issues and also report consistently and factually. The journalists were also taken on a tour of health facilities to observe first hand provision of integrated services.

Lesotho is one of five countries implementing 2Gether4SRHR program funded by the Swedish International Development Cooperation Agency (SIDA).