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The story of Physiotherapy in Lesotho

Physiotherapy skills in the training of village health workers in Lesotho

In Lesotho, there are currently (as of 2026) around 10 qualified physiotherapists and 22 physiotherapy assistants working in hospitals as well as around 160 village health workers operating in the communities. However, given the vast distances, limited transport options, widespread poverty and scarce human resources, many people do not have regular access to physiotherapy treatment. To improve care, particularly in remote villages, specific physiotherapy training courses for village health workers were introduced for the first time in 2014 at Paray Hospital in Thaba-Tseka. The programme was developed and implemented with the support of the NGO Physio in Lesotho, Switzerland.

The aim of these courses is to provide village health workers with simple and safe basic skills for caring for people with chronic illnesses, disabilities and those who are bedridden. This enables patients to benefit from simple therapeutic measures, exercise and targeted support even at home. A dedicated handbook was developed for the training sessions and translated into the national language, Sesotho. The training sessions take the form of one-day workshops and are repeated regularly. This allows for different aspects of home care to be explored in greater depth over the years. A particularly important component is the exchange of experiences: the village health workers bring specific cases from their villages and receive expert guidance and practical advice. Several hospitals have adopted the initiative over the years, including St Joseph’s, Scott, Mamohao, Tebellong and Seboche Hospital. Currently, the courses are held regularly, particularly at Paray Hospital and Seboche Hospital.

Around 80 active Village Health Workers are involved at each of these two locations.

There is also a link to the physiotherapy department at the hospital between training days. The Village Health Workers can contact the physiotherapy assistants working there if they have any questions. In the case of patients requiring long-term support – for example, following a stroke resulting in hemiplegia or in the case of a disability– contact is established with the relevant village health worker even before the patient is discharged from hospital. This allows for the preparation of further care at home. Experience to date shows that this model is an important and effective complement to physiotherapy care at village level. Regular training sessions and ongoing professional exchange are crucial to this. Both Paray Hospital and Seboche Hospital would like to offer the training sessions even more frequently in future, where possible.

At other participating hospitals, the ‘Physio Skills in Home-Based Care’ programmes are currently held less regularly. Their implementation there depends in particular on the available financial and human resources.

„Physio in Lesotho“ supports this practical model so that physiotherapy knowledge reaches places where professional therapy is only available to a limited extent: directly to

people in their villages.

VHW booklet , PDF

VHW booklet in Sesotho, PDF

Training for Physiotherapy Assistants in Lesotho

Physiotherapy provision in Lesotho faces significant staffing challenges. By 2026, there will be just ten qualified physiotherapists and 22 physiotherapy assistants working in hospitals across the country.

Given the limited financial and human resources, physiotherapy has long been given low priority within the healthcare system. At the same time, there is a clear and growing need for physiotherapy services in both state-run facilities and mission hospitals. The current number of qualified professionals is far from sufficient to meet the actual demand for care. Physiotherapy support is required, amongst others, for people following accidents, patients with eurological conditions or disabilities, people with respiratory conditions, and children with physical impairments. Against this backdrop, physiotherapy assistants play a central role in ensuring comprehensive basic care across the region.

A tradition of training dating back to 1981

The continous training of staff in the field of basic physiotherapy has a long tradition in Lesotho. As early as 1981, Paray Hospital began specifically training nursing assistants in basic physiotherapy knowledge and practical skills. From this hospital-based upgrade training, the professional profile now known as a physiotherapy assistant gradually developed. In the 1980s, numerous mission hospitals sent staff to Paray Hospital for relevant training, including the hospitals in Seboche, St James, St Joseph, Scott, Maluti and Tebellong. At the same time, towards the end of the 1980s, further training programmes were also established in public hospitals, delivered by qualified physiotherapists at the Queen Elizabeth II Hospital in Maseru.

In 1987, a collaboration began between Paray Hospital and the Queen Elizabeth II Hospital.

Subsequently, numerous one-week upgraded training courses were held for staff from various institutions. Following a prolonged pause in further training activities between 1995 and 2008, thebprogramme was relaunched in 2008 at Paray Hospital in collaboration with the Swiss NGOb‘Physio in Lesotho’. Since then, multi-day training courses for beginners as well as for experiencedbphysiotherapy assistants have been offered on an ongoing basis, usually annually. Staff from all public, private and church-run or missionary hospitals in Lesotho were invited to these courses.

The training courses are regularly well attended, with around 15 to 20 participants. Supplementary in-house training sessions have also been held at Seboche Hospital, amongst other places. Since the programme was resumed in 2008, around 30 further training and advanced courses for physiotherapy assistants have taken place.

The next nationwide course is scheduled for November 2026 at Paray Hospital, Thaba Tseka.

National significance and urgent need for action

This continuing professional development programme, which has been in place for over four decades, demonstrates that physiotherapy assistants in Lesotho are not a new or short-term solution, but rather a professional role that has evolved since 1981 and is firmly established within the healthcare system. Throughout this development, staff from virtually all relevant hospital structures across the country have been involved.Given the very limited number of qualified physiotherapists and the simultaneous rise in demand for care, promoting this existing but as yet officially unrecognised professional role will become even more important in the future. Physiotherapy assistants represent a vital resource for making basic physiotherapy services available outside the few specialised centres. It is therefore necessary to specifically strengthen their training, continuous professional development, professional support and institutional recognition. Without the further expansion of this professional group, the existing gap in care provision risks widening further due to the growing shortage of skilled staff and resources.

A leading role in this development is currently being played in particular by Paray Hospital and the Swiss NGO Physio in Lesotho, which jointly promote and deliver nationwide continuing professional development programmes. Furthermore, a specific handbook on basic physiotherapy in hospital settings has been developed as the basis for a standardised and practice-oriented training programme. It supports physiotherapy assistants in their daily work and helps to ensure fundamental quality standards in physiotherapy care.

Attempts were made in the past to organise a recognised training programme at a state-run training centre, but these could not be realised due to financial constraints.

Basic reference booklet, PDF

Physiotherapy skills in the care of older people in Lesotho

For several years now, there have been small care homes in Lesotho for elderly and solitary people. Many of these are affiliated with church organisations and are run by religious people in collaboration with local carers. The team usually includes a qualified nurse or a member of staff with nursing experience, as well as a doctor who is consulted as and when required. As there is a limited number of qualified physiotherapists in Lesotho, imparting basic practical knowledge to local carers is of great importance. The NGO Physio in Lesotho has therefore, upon request, delivered training courses on the basics of physiotherapy in the care of older people at four facilities.

The focus is on simple measures that can be easily implemented in everyday life: maintaining and promoting mobility, regular exercise, fall prevention, and managing common complaints such as painful joints, swollen legs or breathing difficulties. Equally important is the prevention of complications arising from prolonged bed rest. Facilities in Hlotse, Pitseng, Maseru and Qacha’s Nek have been able to expand their care services thanks to these training sessions and continue to receive support from ‘Physio in Lesotho’.

Particularly given the limited staff and financial resources in Lesotho, well-trained local carers can make a significant difference. Many basic physiotherapy measures can be safely taught with clear guidance and integrated into the daily care routine. This enables the mobility,independence and well-being of older people to be improved using relatively simple means.Where a specific physiotherapy assessment or treatment is required, outpatient physiotherapy is utilised, where available, or a referral to a nearby hospital is arranged for further rehabilitation.

This work builds on the many years of physiotherapy experience gained by Physio in Lesotho at Paray Hospital in Thaba-Tseka. The knowledge developed there is now also being shared outside the hospital.

The growing challenge of neurological rehabilitation in Lesotho

The number of patients with stroke has been rising in Lesotho for years. Despite increased prevention efforts in primary healthcare, the need for treatment remains high. At the same time, traumatic brain injuries resulting from road traffic accidents or acts of violence, as well as HIV/AIDS-related disorders of the central and peripheral nervous systems, place additional demands on neurological care. Many of these patients have moderate to severe limitations in their independence. Early, targeted physiotherapy and rehabilitation can play a crucial role in helping them regain basic functions, prevent complications and reduce long-term disabilities.

The crucial phase: early neurological rehabilitation

In rehabilitation, a distinction must be made between intensive early rehabilitation and medium- to long-term support. Village Health Workers based in the villages play a vital role in providing this longer-term care. However, a particular challenge arises in the early phase following a stroke or other neurological damage. The number of patients requiring treatment is rising, whilst staffing resources in physiotherapy are limited. At the same time, patients are often discharged from hospital after just a few days. As many affected individuals do not yet have sufficient access to structured rehabilitation at home, a crucial window of opportunity for early neurological rehabilitation may be lost. Yet the first few weeks in particular are of great importance for functional recovery.

For patients with moderate to severe impairment, sufficient time should therefore, wherever possible, be set aside for targeted rehabilitation in hospital. Before discharge, basic skills such as sitting independently or with support, standing up and walking with assistance should be mastered as securely as possible. In cases of additional impairments, such as speech disorders or difficulties with planning and executing movements, longer-term and interdisciplinary rehabilitation is often required. Neurological physiotherapy requires continuity. Neurological physiotherapy is a specialised form of treatment and requires regular therapy tailored to the individual. Where continuous treatment by physiotherapists or physiotherapy assistants is not possible, selected exercises can be carried out with the support of family members following careful instruction. This requires thorough training and regular professional supervision. Access to outpatient rehabilitation also remains a challenge. Repeated journeys to hospital entail considerable costs for many families and are, in some cases, barely affordable.

Funds have therefore been set up at Paray Hospital and Seboche Hospital to help patients in particular need with their transport costs.Shared responsibility for better care.

Improving neurological rehabilitation is therefore a high priority in the annual continuing professional development of hospital-based physiotherapy assistants. It is equally important to raise awareness amongst decision-makers, doctors and nursing staff. Despite existing efforts, providing appropriate care for neurological patients, particularly following a stroke, remains a major challenge. Sustainable improvements require a shared commitment across several levels: sufficient time for early rehabilitation, well-trained specialist staff, close collaboration between healthcare professions, and better options for follow-up care after discharge from hospital.

Early neurological rehabilitation is not a supplementary measure, but a crucial component of effective stroke care.

Booklet in Sesotho, PDF

Booklet in English, PDF

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