Fabian Räber

Community Based Chronic Care Lesotho (ComBaCaL) is a collaborative program between Lesotho and Switzerland dedicated to developing, testing, and sharing innovative solutions to enhance chronic disease care in remote settings in low- and middle-income countries.

At the core of ComBaCaL is the concept of Community Health Workers (CHWs) supported by a digital clinical decision support system, enabling them to provide treatment for selected conditions in remote areas with limited access to clinics.

In phase 1, we empowered CHWs to independently prescribe and manage treatment of uncomplicated hypertension and type 2 diabetes. This approach was effective in large cluster-randomised trials.

In the current phase 2, the focus has expanded to integrated care packages addressing a wider range of conditions, including HIV, sexual and reproductive health, and health services for children under five. The aim of this phase is to prepare ComBaCaL for scale.

For detailed information and a comprehensive list of our publications, visit: www.combacal.org.

In settings such as Lesotho, where young women face enormous HIV and sexual and reproductive health (SRH) challenges, novel and accessible spaces to complement traditional health facilities are urgently needed. HIV- and pregnancy-related complications are still the leading cause of death among young women in high HIV prevalence settings in Southern Africa. 

Hair salons may offer a safe, accessible, trusted community space to engage young women and address barriers related to HIV/SRH.

In a first step, we concluded an innovative cross-sectional survey – co-designed and conducted in collaboration with citizen scientists – and gathered data among 100 hair stylists and 300 clients across Lesotho. The findings were complemented by qualitative research, narrative storytelling and a video documentary.

In a next step, we are designing and implementing a pilot to evaluate a first HIV/SRH service intervention at a few hair salons in Lesotho.