Lesotho: Tapping Local Leaders and Caregivers, Book Sharing to Improve Children’s Nutrition, Education, and Health

 {Photo credit: BLC staff/MSH.}Chief Motleleng of Thabang village shares a book with his four-year-old grandson, Tsoanelo.Photo credit: BLC staff/MSH.

Lesotho is the only independent state in the world that lies entirely above 1,000 meters, and Mokhotlong is the highest of the country’s ten districts. Mokhotlong’s extreme climate and terrain pose significant challenges to children’s nutrition, development, and well-being. Rugged mountains, some impassible by vehicle, and frequent snow cover during the winter months limit access to health services, education, and a balanced diet.

While these conditions can exacerbate existing health and development challenges, the social bonds and protection networks inherent to the Basotho culture and incorporated into formalized governance systems enhance livelihoods and support within the district. Mokhotlong’s cultural wealth is well represented in the local chieftainship. The chief has an essential and wide-ranging leadership role in Basotho villages, from quelling disagreements among community members to writing letters of concurrence for orphans and vulnerable children (OVC) to access birth certificates and child support grants.

The US Agency for International Development (USAID)-funded Building Local Capacity for Delivery of HIV Services in Southern Africa Project (BLC), in collaboration with local civil society organization GROW and research partner Stellenbosch University, is leading implementation of the Lesotho Mphatlalatsane Project, a component of USAID’s three-year OVC Special Initiative. The Mphatlalatsane Project, meaning “early morning star” in Sesotho, seeks to integrate HIV testing and treatment services, nutrition, and positive parenting practices for children aged 1-5 years into rural communities in Lesotho. The interventions include delivering book-sharing, nutrition, and health messages to caregivers and preschool children to provide holistic support for children’s minds and bodies at the most critical point of their development.

The critical role of Chief Motleleng

GROW introduced the Mphatlalatsane Project to Khumamang Motleleng, the chief of Thabang, a village just outside the urban center of Mokhotlong. He was impressed by the project, agreeing to have the pilot conducted in Thabang Preschool, and even providing the field team with an office to conduct the book-sharing and health and nutrition sessions. Chief Motleleng set a strong example by participating in the sessions with his four-year-old grandson, Tsoanelo. His presence and participation encouraged other male family members to take part in the activities with the young children. More than 70 caregivers – about 1 in 10 being grandfathers, fathers, or uncles – attended sessions with their children in four preschools throughout Mokhotlong Urban Council.

Chief Motleleng shared:

I learned about good health, hygiene, taking a child to the clinic for growth monitoring, and that children have to eat well and healthy. I also learned that I have to give children love and education.

Establishing a book culture

It is challenging to find books appropriate for small children in rural districts, and caregivers often underestimate the value or best ways of sharing books with young children.

Chief Motleleng related his grandson’s enthusiasm for the initiative:

He is so determined: each time I get home, he asks me for [the latest book] and to share it with him. So I take a book with me all the time to share with him.

The Mphatlalatsane Project seeks to develop a systemic change in the culture of book-sharing within families and communities. The book-sharing intervention is not only popular among the children: curious community members regularly observe the sessions. Teachers from nearby schools and community caregivers have requested book-sharing mentoring, and health messaging sessions in their schools and homes.

Expanding reach

BLC and partners conducted the pilot intervention in four Mokhotlong Urban center preschools from May 4 through June 12, 2015.  The positive response and demonstrated community ownership of the pilot has encouraged the Mphatlalatsane Project team to explore ways to share the programming with nearby preschools in the same district (Mokhotlong Urban), while working to kick off the full-scale project in two other community councils.

Transportation, however, may be a challenge, notes Chief Motleleng: “The majority of villages around here do not have roads.” Recognizing this, the project intervention teams have been trained to ride horses to reach the most remote villages.

BLC’s experience with the pilot project has reinforced the lesson that engaging champions like Chief Motleleng can galvanize an entire community to invest in the future of their children. It is role models and local thought leaders that will have the greatest influence on ensuring the sustainability and long-term impact of the Mphatlalatsane Project after the research is complete, and to shift the developmental, health, and educational trajectory of the country’s children.  

The Mphatlalatsane Project is one component of the USAID-funded and directed OVC Special Initiative that is working to integrate community-based social programming with clinical services to improve the survival, growth, and development of OVC in three countries (Lesotho, Swaziland, and Zimbabwe). To provide evidence for an effective and sustainable early childhood care and development (ECCD) model, the Lesotho Mphatlalatsane Project will be evaluated by a randomized control trial, while it reaches more than 1,000 caregiver/child pairs from 2015 to 2017. BLC, led by Management Sciences for Health (MSH), is collaborating with USAID/PEPFAR, the Government of Lesotho, local civil society organization GROW, and Stellenbosch University in South Africa to develop, implement, and evaluate the Lesotho Mphatlalatsane Project, including implementation of the randomized control trial.

*All quotes translated from Sesotho