The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) Lesotho Nutrition and Health System Strengthening Project (P170278) EASTERN AND SOUTHERN AFRICA | Lesotho | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2021 | Seq No: 5 | ARCHIVED on 19-Oct-2023 | ISR57219 | Implementing Agencies: Kingdom of Lesotho, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 25-Jun-2021 Effectiveness Date: 19-Aug-2021 Planned Mid Term Review Date: 08-Jul-2024 Actual Mid-Term Review Date: Original Closing Date: 30-Jun-2026 Revised Closing Date: 30-Jun-2026 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The objective is to increase the utilization and quality of key nutrition and health services and improve selected nutrition behaviors known to reduce stunting. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Community-Based Health and Nutrition Services:(Cost $14.80 M) District level health system strengthening:(Cost $8.00 M) Strengthen Government Stewardship, Project Management, and M&E:(Cost $3.60 M) Contingency Emergency Response Component Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial Implementation Status and Key Decisions The project was launched on April 28, 2022 by His Majesty King Letsie, Prime Minister and World Bank Representative. The project is supporting community-based health and nutrition services which includes the provision of a package of nutrition-specific interventions targeted towards women, children and adolescents and district level health system strengthening. The project has three components: (i) community-based health and nutrition services; (ii) district level health system strengthening; and (iii) strengthen government stewardship, project management and M&E. To date, (i) the first rounds of quality improvement assessments for district hospitals and health centers have been conducted; (ii) nearly 6,000 adolescents have been reached with the comprehensive sexuality education (CSE) package; and (iii) village health worker kits (medical and non-medical) have been procured. Next immediate steps include (i) rolling out the training of VHWs across districts; and (ii) disbursing Quality Improvement Grants to the district hospitals and health centers. 10/19/2023 Page 1 of 7 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial Substantial High Macroeconomic Substantial Substantial Substantial Sector Strategies and Policies Substantial Substantial Substantial Technical Design of Project or Program Substantial Substantial Substantial Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Substantial Substantial Environment and Social Moderate Moderate Moderate Stakeholders Moderate Moderate Moderate Other -- -- -- Overall Substantial Substantial Substantial Results PDO Indicators by Objectives / Outcomes To increase the utilization and quality of key nutrition and health services. IN01321918 ►Women ages 15-49 who took iron tablets for 90+ days during the pregnancy of the most recent birth (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 51.00 51.00 51.00 66.00 Date 31-Dec-2018 30-Mar-2023 30-Jun-2023 08-Oct-2025 The actual status will be reported after the LDHS has been conducted. Comments: IN01321956 ►Adolescents ages 15-19 currently using a modern contraceptive method in selected districts (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 45.20 45.20 45.20 50.00 Date 31-Dec-2018 30-Mar-2023 30-Jun-2023 08-Oct-2025 10/19/2023 Page 2 of 7 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) The actual status will be reported after the LDHS has been conducted. Comments: To improve selected nutrition behaviors known to reduce stunting IN01321920 ►Children ages 6-23 months with minimum dietary diversity (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 23.00 23.00 23.00 28.00 Date 31-Mar-2020 30-Mar-2023 30-Jun-2023 08-Oct-2025 The actual status will be reported after the LDHS has been conducted. Comments: IN01321958 ►Children under 6 months exclusively breastfed. (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 59.00 59.00 59.00 67.00 Date 31-Mar-2020 30-Mar-2023 30-Jun-2023 08-Oct-2025 The actual status will be reported after the LDHS has been conducted. Comments: Improve quality of selected health services IN01321919 ►Women with institutional deliveries (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 89.40 89.40 89.40 92.00 Date 31-Dec-2018 30-Mar-2023 30-Jun-2023 08-Oct-2025 The actual status will be reported after the LDHS has been conducted. Comments: IN01321957 ►Health facilities certified as Level 2 or above with quality rating system (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 50.00 Date 30-Nov-2020 30-Mar-2023 30-Jun-2023 08-Oct-2025 This indicator is linked to the assessment of the health facilities receiving the Quality Improvement Grant. Comments: This will be reported after the health facility assessments (round 4 and 8) are conducted. Intermediate Results Indicators by Components 10/19/2023 Page 3 of 7 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) Community-based health and nutrition services IN01321959 ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 383,957.00 700,000.00 Date 31-Dec-2019 30-Mar-2023 30-Jun-2023 08-Oct-2025 This indicator will be reported after related project activities are implemented (e.g., training of VHWs, Quality Improvement Grants). The same applies to the sub-indicators. The baseline should be zero. Comments: Activities have not started. The value should be the sum of the two sub-indicators. This indicator will be revised in the restructuring. IN01321963 People who have received essential health, nutrition, and population (HNP) services - Female (RMS requirement) (Number, Corporate Supplement) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 204,593.00 347,000.00 IN01321966 Number of children immunized (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 20,458.00 43,000.00 Date 31-Dec-2019 30-Mar-2023 30-Jun-2023 28-Feb-2025 IN01321967 ►Villages benefitting from nutrition and health services package. (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 4,000.00 Date 31-Dec-2018 30-Mar-2023 30-Jun-2023 08-Oct-2025 The status of this indicator will be reported after the VHWs are trained. Comments: IN01321969 ►Adolescents (ages 15-19) reached with comprehensive sexuality education by a peer educator (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 5,961.00 160,000.00 Date 31-Dec-2019 30-Mar-2023 30-Jun-2023 08-Oct-2025 District Level Health System Strengthening IN01321960 ►Newborns breastfed within first hour of delivery (Percentage, Custom) 10/19/2023 Page 4 of 7 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) Baseline Actual (Previous) Actual (Current) End Target Value 82.10 82.10 79.00 87.00 Date 31-Dec-2018 30-Mar-2023 30-Jun-2023 08-Oct-2025 IN01321964 ►Pregnant women screened for anaemia before 36 weeks of gestation (percentage of 1st ANC visits) (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 77.10 77.10 76.00 85.00 Date 31-Dec-2018 30-Mar-2023 30-Jun-2023 08-Oct-2025 IN01321970 ►Facilities that have presented their Quality Improvement Plan for the semester (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 85.00 Date 29-Jan-2021 30-Mar-2023 30-Jun-2023 08-Oct-2025 Strengthening stewardship functions and project management IN01321961 ►Referral guidelines developed and adopted (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 08-Oct-2020 30-Mar-2023 30-Jun-2023 08-Oct-2025 IN01321962 ►Annual food and nutrition multisectoral steering committees meetings held (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 1.00 0.00 4.00 Date 31-Dec-2019 30-Mar-2023 30-Jun-2023 08-Oct-2025 IN01321965 ►Creation and utilization of recurrent MOH budget line for quality and bonus grant financing (Yes/No, Custom) Baseline Actual (Previous) Actual (Current) End Target Value No No No Yes Date 26-Jun-2020 30-Mar-2023 30-Jun-2023 15-Dec-2023 The process of creating of recurrent MOH budget line for quality and bonus grant financing is yet Comments: commence. 10/19/2023 Page 5 of 7 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) IN01321968 ►Number of focus group discussions at the community level to record various perceptions about the project (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 0.00 0.00 10.00 Date 27-May-2021 30-Mar-2023 30-Jun-2023 23-Jun-2026 Activity has not started Comments: Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P170278 IDA-69310 Effective USD 22.00 22.00 0.00 8.13 12.40 40% P170278 TF-B5884 Effective USD 4.40 4.40 0.00 1.83 2.57 41% Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date P170278 IDA-69310 Effective 25-Jun-2021 19-Jul-2021 19-Aug-2021 30-Jun-2026 30-Jun-2026 P170278 TF-B5884 Effective 29-Jun-2021 19-Jul-2021 19-Aug-2021 28-Feb-2025 28-Feb-2025 Cumulative Disbursements 10/19/2023 Page 6 of 7 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) Restructuring History Level 2 Approved on 14-Jun-2023 Related Project(s) There are no related projects. 10/19/2023 Page 7 of 7