A Comprehensive Approach Seeks to Reduce Stunting and Improve Health Services in Lesotho

Outside of Mamela Hospital, a group of village health workers (VHW) enthusiastically sing about nutrition being a shield in the community. This is particularly poignant in Lesotho which has been plagued with stunting. In 2014, about one in three (33.4%) children in Lesotho were stunted. A decade later, that number grew to 35.6%.

In collaboration with the government and through the Lesotho Nutrition and Health System Strengthening Project (LNHSSP) efforts are underway to increase the utilization and quality of key nutrition and health services and improve selected nutrition behaviors known to reduce childhood stunting. Stunting is primarily caused by chronic undernutrition, especially during the first 1,000 days of life, due to inadequate dietary intake and frequent infections. Other key causes include poor maternal nutrition, lack of access to clean water and sanitation, and limited healthcare, which together impair growth and development.

The first project component supports the delivery of essential health and nutrition services, ensuring that they reach the most vulnerable populations. This includes training of frontline and village health workers; behavior change and communication campaigns for improved nutrition and health practices at both facility and community levels; and, growth monitoring and promotion; procurement and distribution of nutrition commodities and supplies. The project has trained 8,363 VHWs to facilitate these community interventions.

"We cannot talk about health, without considering good nutrition and it is imperative that our communities are on a good nutrition program," says Nompumelelo Snyman, a VHW in Butha-Buthe District.

At a community outreach in the same district, Duduzile Zilehlangalala from Tlhonolofatso Letnsohla Village has brought her 18-month daughter to the facility for growth monitoring and immunization.

"I am very pleased with my daughter's development. Based on her weight and other measurements she is developing well for her age. She also received an immunization shot and I am grateful to the village health workers for giving me guidance on how to ensure that my child grows well," she said.

Duduzile is part of over 580,000 women who have received quality health, nutrition, and population services.

Childhood stunting leads to long-term impairments in physical growth, cognitive development, and school performance. Stunted children often struggle in school, starting later and learning more slowly, which can lead to dropping out. As adults, they may face limited job opportunities and lower earnings due to these educational setbacks. On a broader scale, widespread stunting can hinder a country's economic growth by reducing overall productivity and reducing human capital gains.

To improve adolescent health and nutrition, the project focused efforts on peer educators and herd boys. The peer educators helped establish herd boy clubs to provide them with access to health and nutritional education, which is crucial given their unique lifestyle and challenges. 168 peer educators were recruited across four districts (Butha-Buthe, Thaba-Tseka, Mohale's Hoek, and Quthing) and have been trained on the Comprehensive Sexuality Education Package. They have now reached nearly 6,000 adolescents, delivering key health and nutrition messages focused on sexual and reproductive health and prevention of teenage pregnancy. . Around the country, over 22,400 adolescents have been reached with at least one health and nutrition topic through the package.

The project has also played a pivotal role in enhancing the quality and accessibility of health services across the nation. Through Quality Improvement Grants, training, and provision of equipment, it builds the ability of government and health providers at primary and secondary levels to deliver higher-quality reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N) services effectively and efficiently. Additionally, annual bonus payments are awarded to top-performing facilities based on their coverage, quality, and efficiency indicators. This approach addresses the underfunding of lower-level facilities but also shifts the focus from input-based to output-based payments, rewarding efficiency, equity, and quality in healthcare provision.

"We have used the quality grants to address the weak points in our services and as a result there is a marked improvement in service delivery," says Celestina Moepa, Manager of Nursing Services at Seboche Mission Hospital. The quality grants are provided across public and private facilities run by the Christian Association of Lesotho for equitable service delivery.

The implementation of quality grants has shown significant improvements in service delivery across various health facilities. Hospitals and health centers have undergone multiple rounds of assessments, showing enhanced quality scores in several domains. The project emphasizes sustainability, with efforts to establish a recurrent budget line for QIGs and bonuses, ensuring long-term impact. The digital platform Shahidi is being used for monitoring and evaluation, providing transparency and accountability in the grant mechanism. This comprehensive approach is helping improve healthcare services and strengthen the overall health system, contributing to better health outcomes for the population.

By enhancing health service delivery and promoting better nutrition practices the project is taking a comprehensive approach to tackling stunting and improving nutritional outcomes in Lesotho and aims to create long lasting improvements in the health and well-being of Basotho.