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 | IBRD/IDA | Investment Project Financing (IPF) | FY 2021 | Seq No: 8 | Archived on 11-Apr-2025 | ISR03108 Implementing Agencies: Ministry of Health 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 25-Jun-2021) 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 Development Objective been changed since Board Approval of the Project Objective? No 2. COMPONENTS Name Community-Based Health and Nutrition Services:(Cost 14,800,000.00) District level health system strengthening:(Cost 8,000,000.00) Strengthen Government Stewardship, Project Management, and M&E:(Cost 3,600,000.00) Contingency Emergency Response Component:(Cost 0.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Moderately Unsatisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Moderately Satisfactory Overall Risk Rating Substantial Substantial 4. KEY ISSUES & STATUS Apr 11, 2025 Page 1 of 8 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) 4.1 Implementation Status and Key Decisions T The project was launched on April 28, 2022, by His Majesty King Letsie, the Prime Minister, and the World Bank's Country Representative. The project supports community-based health and nutrition services, including the provision of a package of nutrition-specific interventions targeted towards women, children, and adolescents, as well as 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) strengthening government stewardship, project management, and M&E. To date: (i) The fourth, second, and third rounds of quality improvement assessments for health centers, district hospitals, and District Management Health Teams, respectively, have been conducted. (ii) Over 19,300 adolescents have been reached with at least one health and nutrition topic within the comprehensive sexuality education (CSE) package. (iii) The MoH has completed the training of all the country’s 8,363 village health workers (VHWs) on the delivery of health and nutrition services at the community level, in line with the MoH’s new strategy of an “Integrated People-Centered Approach of Providing Health Services.” Moreover, intensive supportive supervision and mentorship of the VHWs by the trainers are currently ongoing and will continue until April 30, 2025. The project also supported the Lesotho Demographic and Health Survey and the Ministry of Health's Annual Joint Review. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 07 - 11 Nov Proposed Rating 25 Jun 2021 2024 Political and Governance Substantial High 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 Apr 11, 2025 Page 2 of 8 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) Stakeholders Moderate Moderate Moderate Overall Substantial Substantial Substantial Apr 11, 2025 Page 3 of 8 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes To increase the utilization and quality of key nutrition and health services. Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Women ages 15-49 who took 51.00 Dec/2018 63 30-Jun-2024 63 31-Jan-2025 66.00 Jun/2026 iron tablets for 90+ days during the pregnancy of the most recent birth (Percentage) Adolescents ages 15-19 45.20 Dec/2018 53 30-Jun-2024 64 31-Jan-2025 50.00 Jun/2026 currently using a modern contraceptive method in selected districts (Percentage) To improve selected nutrition behaviors known to reduce stunting Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Children under 6 months 59.00 Mar/2020 61 30-Jun-2024 61 31-Jan-2025 64.00 Jun/2026 exclusively breastfed. (Percentage) Improve quality of selected health services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Women with institutional 89.40 Dec/2018 85.30 30-Jun-2024 85.30 31-Jan-2025 92.00 Jun/2026 deliveries (Percentage) Apr 11, 2025 Page 4 of 8 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) Health facilities certified as 0.00 Nov/2020 59 30-Jun-2024 87 31-Jan-2025 50.00 Jun/2026 Level 2 or above with quality Comments on Total 173 hf of which 151 were certified as level 2 or above. rating system (Percentage) achieving targets 6.2 Intermediate Results Indicators by Components Community-Based Health and Nutrition Services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year People who have received 0.00 Dec/2019 841,620 30-Jun-2024 1,077,658 31-Jan-2025 950,000.00 Jun/2026 essential health, nutrition, Comments on Consistent with Corporate Scorecard “Millions of people receiving quality health, nutrition, and population (HNP) achieving targets and population services” services (Number) Number of Village Health 0 Nov/2024 0 30-Nov-2024 0 31-Jan-2025 76 Jun/2026 Nutrition Committees Comments on This will be measured once the NGO firm is engaged to sensitize local leadership. Established and Functional achieving targets (Number) Adolescents (ages 15-19) 0.00 Dec/2019 14,581 30-Jun-2024 19,330 31-Jan-2025 23,500 Jun/2026 reached with comprehensive sexuality education by a peer educator (Number) District level health system strengthening Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Pregnant women screened 77.10 Dec/2018 77 30-Jun-2024 77 31-Jan-2025 85.00 Jun/2026 for anaemia before 36 weeks of gestation (percentage of 1st ANC visits) (Percentage) Apr 11, 2025 Page 5 of 8 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) Facilities that have presented 0.00 Jan/2021 10 30-Jun-2024 100 31-Jan-2025 85.00 Jun/2026 their Quality Improvement Plan for the semester (Percentage) Creation and utilization of No Jun/2020 No 31-Mar-2024 No 31-Jan-2025 Yes Jun/2026 recurrent MOH budget line for quality and bonus grant financing (Yes/No) Strengthen Government Stewardship, Project Management, and M&E Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Referral guidelines No Oct/2020 No 31-Mar-2024 Yes 31-Jan-2025 Yes Jun/2026 developed and adopted (Yes/No) Annual food and nutrition 0.00 Dec/2019 1 30-Jun-2024 2 31-Jan-2025 4.00 Jun/2026 multisectoral steering committees meetings held (Number) Number of focus group 0.00 May/2021 0.00 30-Jun-2024 19 31-Jan-2025 30 Jun/2026 discussions at the community level to record various perceptions about the project (Number) Apr 11, 2025 Page 6 of 8 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) 7. DATA ON FINANCIAL PERFORMANCE 7.1 Cumulative Disbursements 7.2 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed TF-B5884 Effective 4.40 4.40 0.00 4.40 0.00 100.00 % IDA-69310 Effective 22.00 20.41 0.00 13.80 6.90 66.67% 7.3 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing IDA-69310 Effective 25-Jun-2021 19-Jul-2021 19-Aug-2021 30-Jun-2026 30-Jun-2026 Apr 11, 2025 Page 7 of 8 The World Bank Implementation Status & Results Report Lesotho Nutrition and Health System Strengthening Project (P170278) TF-B5884 Effective 29-Jun-2021 19-Jul-2021 19-Aug-2021 28-Feb-2025 30-May-2025 8. KEY DATES Key Events Planned Actual Approval 25-Jun-2021 25-Jun-2021 Effectiveness 19-Aug-2021 19-Aug-2021 Mid-Term Review No. 01 08-Jul-2024 01-Jul-2024 Operation Closing/Cancellation 30-Jun-2026 9. RESTRUCTURING HISTORY Restructuring Level 2 Approved on 12-Jun-2023 Restructuring Level 2 Approved on 23-Dec-2024 10. ASSOCIATED OPERATION(S) There are no associated operations Apr 11, 2025 Page 8 of 8