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  • Closed Compact Report:  Closed Compact Report: Lesotho Compact
  • October 2015

Health Sector Project

  • $122,398,000Original Compact Project Amount
  • $143,650,195Total Disbursed

Estimated Benefits

Estimated Benefits for the Health Sector Project
Time Estimated Economic Rate of Return (ERR) over 20 years Estimated beneficiaries over 20 years Estimated net benefits over 20 years
At compact closure 5.2 percent 752,003 $-53,613,000

Estimated benefits corresponds to $143.65 million of project funds, where cost-benefit analysis was conducted.

Project Description

The crisis in human health resources is a major issue in Lesotho, as in the rest of southern Africa. This has the potential to severely hamper the country’s efforts to reduce poverty and promote economic growth. The country faces difficulties retaining nurses and clinicians due to poor working conditions and greater career opportunities offered outside the country. Lesotho has one of the highest HIV/AIDS prevalence rates in the world—more than one of every five adults in Lesotho is HIV-positive, according to United Nations figures. Because only half of Basotho women give birth at medical facilities, there is also no way to ensure they are taking appropriate precautions to avoid spreading HIV, leading to infection in many newborns. Combining the efforts of the Government of Lesotho, the President’s Emergency Plan for AIDS Relief (PEPFAR) program and other donors, the objectives of the Health Sector Project were to mitigate the negative economic impacts of poor maternal health, HIV/AIDS, tuberculosis and other diseases. The U.S. Agency for International Development and the Centers for Disease Control and Prevention, working through PEPFAR, supported complementary public health policies, expanded HIV/AIDS prevention and care, strengthened the country’s health management information systems, and coordinated ongoing training for nurses. During the compact, PEPFAR expanded its program to prevent mother-to-child transmission of HIV/AIDS to each of Lesotho’s 10 districts and to increase the number of health centers at which it works.

The MCC-funded project was designed to strengthen the country’s health care system and its ability to deliver quality services by:

  • renovating health centers in order to help those centers achieve a common standard;
  • improving infrastructure in 14 outpatient departments and providing management training to support the extension of anti-retroviral therapy services;
  • constructing and equipping a new National Reference Laboratory and training staff in Maseru, and building dormitories and staff residences at Lesotho’s National Health Training College;
  • constructing a dedicated, central facility for collecting and processing blood, which included a mobile blood collection vehicle, storage equipment and collection units;
  • increasing capacity for nurse training and improving district-level health care human resource management; and
  • improving occupational health and safety and medical waste management practices.

By compact end, 14 outpatient health departments, the National Reference Laboratory, a National Blood Transfusion Center, and student and staff lodging at the training college were renovated and equipped. The number of blood units collected yearly by mobile collection units increased 124 percent from 3,381 to 7,593, and nearly 200 health practitioners were trained in infection, prevention, and disease control.

Several initial targets were not met as a result of construction delays on health centers. The government funded and managed the completion of the health centers within one year of compact closure, and post-compact monitoring will provide updated performance data in the future.

MCC’s original ERR of 12 percent was reduced to 6 percent after factoring in increased costs, borne by the government, decreased benefits due to incorrect baseline assumptions, and adding other donor costs for benefits which were attributable to the efforts of other donors in addition to MCC.

Evaluation Findings

MCC is conducting a combined independent performance evaluation of the infrastructure and Health Systems Strengthening Activities within the Health Sector Project. The evaluation will assess what services are provided in the renovated facilities, measure staffing and use of the facilities, change in key health outcomes, and improvements in overall health systems. Data collection took place in 2018 and final results were published in 2019.

Key performance indicators and outputs at compact end date

Key performance indicators and outputs at compact end date
Activity/Outcome Key Performance Indicator Baseline End of Compact Target Quarter 1 through Quarter 20 Actuals (as of Dec 2013) Percent Compact Target Satisfied (as of Dec 2013)
Health Centers Activity Deliveries conducted in health centers (%) 36 80 47 25%
Health centers equipped (%) 0 100 33 33%
People with HIV still alive 12 months after initiation of treatment (%) 74 80 72 -33%
Physical completion of health center facilities (%) 0 100 88 88%
Physical completion of Outpatient Departments (OPDs) (%) 0 100 99 99%
Physical completion of the Blood Transfusion Services facilities (%) 0 100 100 100%
TB notification (per 100,000 pop) 640 400 644 -2%