Remarks by Deputy Chief of Mission Keisha Toms Boutaleb at the Project ECHO Launch 

Virtual Address, August 27, 2021:

Lumelang bo-‘M’e le Bo-Ntate, 

Please allow me to start by paying my respects to

His Majesty King Letsie III,

The Right Honorable the Prime Minister,

Honorable members of His Majesty’s cabinet, especially the Minister of Health, Honorable Semano Sekatle,

Their Excellencies Heads of Diplomatic Mission and International Organizations,

Ladies and Gentlemen,

Good morning, 

I am delighted to join you virtually for today’s launch of the Project Extension for Community Health Outcomes, or ECHO, Model.  In the midst of the COVID pandemic, now, more than ever, we need solutions and technological innovations that will allow us to provide the essential health services needed for our communities, while protecting them and keeping them safe.  Allow me to congratulate and thank the Ministry of Health for moving beyond the Southern Africa Regional ECHO by establishing its very own Project ECHO.  

Project ECHO is a unique tele-health platform that can connect remote clinical sites with central specialists using a collaborative model of medical education and care management that capacitates clinicians everywhere to provide quality services to more people, right where they live.  Project ECHO is not just about another telecommunication system.  It is meant to improve access to best-practice care to the underserved.  It empowers local experts and health providers.  And it provides a platform for experiential, case-based learning that is interactive, collaborative, and most of all, collegial.  In this regard, Project ECHO is transformative.  It can transform the way health care mentorship and knowledge are delivered to reach communities.   

Honorable Minister Sekatle, thank you for your leadership.  I applaud you and the Government of Lesotho for embracing this ground-breaking initiative.  

As already highlighted, Project ECHO transforms the way health care mentorship and knowledge are delivered, with an aim to reach more people in rural and underserved communities. This low-cost, high impact intervention is done through the application of the ECHO learning loop – linking interdisciplinary specialist teams with multiple primary care providers through teleECHO programs.  Developed in 2003 at the University of New Mexico, Project ECHO is designed to serve rural settings where patients lack access to medical experts and have a limited ability to seek specialty care.  Since ECHO’s development, the U.S. Centers for Disease Control, or CDC, has been a technical partner with the University of New Mexico, providing both funding and technical guidance for implementing various ECHO models across many countries.  In early 2020, following CDC Zambia’s proposal to support Southern Africa’s Regional ECHO as part of the integrated HIV, Tuberculosis, and COVID-19 response, CDC Lesotho approached the Ministry of Health, which agreed to join the Regional ECHO initiative.  

I want to thank my CDC Lesotho colleagues for introducing Project ECHO to the Ministry of Health in January 2020.  Moreover, the CDC has supported the establishment of the Southern Africa Regional ECHO with a regional hub based in Zambia and national sub-hubs in five southern African countries.  Lesotho was among these five countries, which also include Botswana, eSwatini, Malawi, and Mozambique.  Fostering a collaborative approach of the South-to-South sharing, Lesotho has been a key beneficiary of the bi-weekly COVID-19 ECHO sessions delivered using a regional adopted curriculum. With technical assistance from the University of Mexico and ECHO-India, Lesotho’s national, district, hub-based site-level staff, and PEPFAR staff have received the ECHO immersion training.  Following today’s launch of Lesotho’s own ECHO model, I encourage the Ministry to adopt the successful practices we have seen in other ECHO participating countries.  This includes a regular review of the progress, the sharing of experiences, and the prioritization of topics of interest. 

The Kingdom of Lesotho is better positioned when compared to many ECHO countries in the region in terms of the hub equipment coverage.  The next phase will include equipping and expanding the number of spokes, increasing utilization of the platforms, and scaling up various ECHO models, including COVID, tuberculosis, advanced HIV disease, cervical cancer, maternal health, and mental health services.  I am grateful to the Global Fund for supporting the Ministry of Health by recruiting key personnel – such as an ECHO coordinator, chief training facilitator, and information technology specialist, to support the implementation of this important initiative.  

For the past 18 months since the start of the COVID pandemic, PEPFAR has committed to HIV program continuity and adapting them to ensure that prevention and treatment services are offered in way that is safe for both providers and recipients.  Project ECHO affords an opportunity for essential HIV services to continue.  Trainings, mentorship, and specialist care can now be accessible to remote facilities through an active learning environment that minimizes risks.  With ECHO already reaching Ministry of Health staff, we are expecting an improvement in quality of services provided to patients, facilitated via on-line teaching, case presentations, and sharing of clinical experiences.  

The United States government and other global policymakers are recognizing the potential of ECHO to expand workforce capacity exponentially to treat more patients faster using existing resources.  At a time when health care systems are under mounting pressure to do more without spending more, this is critical.  Our pledge to support ECHO in Lesotho is part of the U.S. government’s larger commitment to capacity building aimed at strengthening Lesotho’s health care system and the health care providers who work within it.  Additionally, U.S. government resources were provided by the CDC and the U.S. Agency for International Development to procure ECHO equipment through its implementing partners ICAP and JHPIEGO.  This has allowed coverage for 18 hub sites, including centers for excellence like Sankatana and Baylor, and 17 spoke sites at health centers.  In the future, it is my hope that the Ministry of Health will focus on expanding the reach of the ECHO platform to more health facilities, thereby ensuring that remote areas of the Kingdom will have access to quality services.    

Allow me to close by again congratulating Minister Sekatle, Ministry of Health staff, my U.S. government colleagues, and our health implementing partners for today’s tremendous step forward in strengthening the Kingdom of Lesotho’s national health system.  Your outstanding work, enthusiasm, and unwavering support have assisted in this great achievement.  Thank you for your excellent collaboration as we move forward to the next level.  United We Stand.  Lets’oele le beta poho!

Kea Leboha.  

Khotso. Pula. Nala.