The role of state and non-state actors in the sustenance of the expanded program on immunization (EPI) in Lesotho, Southern Africa

This study takes cognizance of the lingering crisis and politics in governing health sector system in sub-Saharan Africa. It articulates the role of the state and civil society groups in primary health provisioning and investigates the questions “how”, “what”, “why” and “who” that matter in Lesotho, where 83 percent of the population live in rural areas. The study utilized secondary clinical data at the national level as the basis for analysis which involved a lengthy desktop analysis of the Expanded Program on Immunization (EPI) clinic data and records. Data sources indicate that Lesotho’s primary health care system is grassroot-oriented in implementation, with a very functional community health and voluntary health worker system. Close collaboration was also found to exist between the state organs and the Christian Health Association of Lesotho (CHAL) across the entire platform of health care delivery. The study identified the existence of some peculiar socio-environmental factors such as poor coordination, suspicion and communication gaps - among others - which are impeding the progress of the EPI in spite of the cordial relationship which exists between the state and other stakeholders/role-players.