ComBaCaL - Community-Based chronic disease Care Lesotho: A 5-year implementation research programme to tackle non-communicable diseases in rural Lesotho

Non-Communicable Diseases (NCDs) such as diabetes and high blood pressure are the number one cause of death and disability globally. More than 75% of premature NCD-related deaths occur in low- and middle-income countries. A programme mainly funded by the Swiss Agency for Development and Cooperation aims to tackle NCDs in Lesotho, building on long-term experience in HIV/AIDS chronic disease care.

In many sub-Saharan African countries, including Lesotho, NCDs have overtaken infectious diseases as the major burden of disease. Lesotho has successfully managed to reduce HIV transmission and AIDS-related deaths due to a decentralized HIV testing and care strategy. A key attribute of this strategy was the involvement of community lay health workers (LHWs) to guarantee access of testing and treatment to the rural population.

Building on this experience, ComBaCaL (Community Based chronic disease Care Lesotho) aims at improving NCD care through training in prevention, screening, diagnosis and care at both the health centre and community level. Starting in two rural districts of Lesotho, the programme first focuses on high blood pressure and diabetes. It will then be scaled-up beyond the initial programme area and widen its scope to include mental health disorders. LHWs - who are mostly women - are employed by a social enterprise, enabling them to acquire entrepreneurial skills and set up small businesses.

The programme has been jointly developed by a consortium led by the Swiss NGO SolidarMed together with the Swiss TPH, the National University of Lesotho, the Lesotho Ministry of Health, and a community member. Further collaborators include the University of Zurich (Department of Informatics) and an eHealth start-up from Lesotho.

Innovative eHealth-assisted community-based care

ComBaCaL trains LHWs to provide NCD prevention, screening and diagnosis and evaluates in a large-scale, cluster-randomized trial, what aspects of NCD care can safely and effectively be shifted to LHWs. A locally developed eHealth application with smart clinical algorithms assists LHWs, allows supervision by clinic staff, and efficiently links the data to the health facility.

Multidisciplinary implementation research

A baseline NCD prevalence and morbidity survey marks the start of the programme, followed by a multi-phase cluster randomized controlled trial framed by qualitative and health economy research. ComBaCaL offers several junior scientists from Lesotho and Switzerland the opportunity to complete Master and PhD degrees. Thanks to the collaboration between the University of Zurich and the University of Lesotho, the programme also includes capacity building in the field of eHealth.

More information

Project website:

SolidarMed News and press release

Swiss TPH News

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Selected projects at this location:

Involved Regions: Africa
Involved Countries: Lesotho

Project Facts