KHANYANE, Lesotho – The weight of poverty can be measured in more than just a lack of material possessions. For Mabafula Ntšihlele, a mother of ten in a remote corner of Lesotho, it meant her children were excluded from basic healthcare – a reality brought into sharp focus during a nationwide measles and rubella vaccination campaign last October. The story of her family, living in a single-room clay house nestled in the Fothane Hills, illustrates the often-invisible barriers that prevent vulnerable populations from accessing even free public health services.
Ntšihlele’s struggle wasn’t a matter of refusing care, but a simple inability to afford the associated costs. A medical booklet, required for vaccinations, cost approximately $1.50, and the roundtrip bus fare to the nearest health facility, Motebang Hospital, was around $1.60. These seemingly small sums proved insurmountable for a family surviving on sporadic work and barely enough food to get by. The situation highlights a critical issue within Lesotho’s healthcare system: access isn’t solely about availability, but too affordability and dignity.
The family came to the attention of health officials during the nationwide measles and rubella vaccination campaign, launched by Minister of Health Selibe Mochoboroane with a directive to village health workers: ensure no child is left unvaccinated. Khanyane village health worker Makoetle Koetle, taking the directive seriously, reported Ntšihlele’s family after noticing her under-five children hadn’t appeared at the village vaccination point. “Children experience pain when they see other children receiving services while they are excluded,” Koetle explained, recognizing the emotional toll of being left behind.
’Mamoferefere Zim, the manager of nursing services at Motebang Hospital, responded to the report. Despite the difficult journey – crossing a stream and navigating forested paths – Zim reached the family’s home and was struck by the depth of their need. She found four children under five, none with medical booklets, and a household struggling to secure even a single meal. Ntšihlele’s husband voiced no objection to vaccination, and Zim arranged for the children to receive the necessary immunizations, including a BCG vaccine for the newborn.
But Zim’s response extended far beyond simply administering vaccines. Recognizing that poverty was the root cause, she facilitated the provision of medical booklets and appealed to colleagues for assistance. The response was overwhelming, with civil servants donating food, clothing, blankets, and even a bed for the family. “The response went beyond the call of duty and helped restore the family’s dignity,” Zim said. The family had even requested consideration for permanent sterilization, a reflection of their desperate circumstances.
The case underscores a broader challenge within Lesotho’s health system, as Zim observed: “Often, we focus on delivering services, yet people fail to access them because they cannot afford to come.” She emphasized that the cost of poverty extends beyond monetary limitations, encompassing the need for transportation, sustenance while waiting for care, and basic necessities like diapers and clean clothing. “At the clinic, the cost of poverty becomes visible,” she stated.
Ntšihlele now expresses renewed confidence in her ability to access healthcare for her children. “I always wanted my children to be vaccinated. Now that they have medical booklets, I will borrow money for transport to Motebang Hospital if I have to,” she said. She credits the nurses and village health workers not only for the medical care but also for the broader support they provided, including taking photographs of her home to solicit further assistance from the community.
The nationwide measles-rubella vaccination campaign, which ran from October 20-24, 2025, with follow-up efforts from October 25-27, aimed to reach 196,308 children aged 0-59 months across Lesotho with multiple interventions, including measles-rubella vaccine, oral polio vaccine, Vitamin A, and deworming tablets, according to the World Health Organization Regional Office for Africa.
While the immediate crisis facing Ntšihlele’s family has been addressed, the underlying issues of poverty and access to healthcare remain. The focus now shifts to ensuring the continued routine vaccinations for her children and addressing the systemic barriers that prevent other families from receiving the care they need. The story serves as a potent reminder that public health is inextricably linked to socioeconomic well-being, and that true access requires more than just the availability of services.
If you or someone you know is struggling with poverty or food insecurity, resources are available. Contact your local social services agency or a charitable organization for assistance.
