A 2009 Demographic and Healthy Survey reported that system-wide problems in the health sector contribure to Lesotho's worsening outcomes in health. The first is low utilization of health facilities, due to the poor (perceived and actual) quality of services. Service quality is not only undermined by the lack of equipment and a poor referral system between health centers and hospitals, but also by an inadequate number of healthcare workers. Moreover, it remains off track to meet the Millennium Development Goals (MDG's) 4 (reducing child mortality) and 5 (improving maternal health). According to a 2012 health report on Lesotho:
The average annual percentage decline in Maternal Mortality Ratio between 1990 and 2010 was only 0.9%, far less than the 5.5% needed to be “on track” towards achieving MDG 5.
Equally, the under-five mortality rate was estimated to have only decreased slightly from 89 in 1990 to 86 deaths per 1,000 live births in 2011.
Lesotho has the third highest HIV adult prevalence rate in the world at 23%.
Life expectancy at birth has declined from 60 years in 1992 to 50 years in 2014.
To support the Ministry of Health in reaching better maternal and child health, HealthNet TPO implements a Perfomance Based Financing (PBF) project in Lesotho. This project ended in 2018