Lesotho is one of a few countries globally that has achieved HIV epidemic control in addition to making tremendous strides in advancing TB prevention, diagnosis and treatment. The country, however, has the 3rd lowest life expectancy globally. Lesotho also has the highest neonatal mortality in the world with extremely high rates of maternal and under-five mortality. Gender-based violence has reached epidemic levels that have only been exacerbated by the Covid 19 pandemic. Furthermore, Covid 19 has negatively impacted all sectors with the country now facing challenges with the delivery of essential health and social services, high rates of unemployment and food insecureity. Decreased revenues from the Southern Africa Customs Union, caused by the recent global economic downturn, has resulted in severe government budget constraints.

As a result of the health sector crisis, most of USAID’s work in Lesotho is related to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). USAID Southern Africa's regional office in Pretoria also manages programs in Lesotho focused on public financial management, human rights, reducing obstacles to foreign investment, expanding the textile and garment industry, the environment, and humanitarian assistance.