Better coordination could save lives of mothers in Lesotho

From IRIN, a story about a new program that targets the worst performing Millennium Development Goals in Lesotho.

A new joint programme is changing the way the Lesotho government and its development partners deliver aid by getting different government departments, UN agencies and civil society organizations working together to help mothers and their families.

Tens of thousands of Basotho already depend on food and agricultural assistance as well as free HIV/AIDS treatment, but the country is no closer to achieving a number of the Millennium Development Goals (MDGs) and progress on some has reversed.

Over half the population lives in extreme poverty, an estimated 23 percent of adults are infected with HIV, and for every 100,000 live births, 1,155 women died during or after delivery in 2009; up from 762 in 2004.

“Because we’re looking at negative trends in these areas, we discussed with the government and I think there was consensus that there was something we weren’t doing right," said Ahunna Eziakonwa-Onochie, the UN resident coordinator in Lesotho.

Starting in June 2010, the joint programme began targeting the four worst performing MDGs - those relating to the eradication of poverty and hunger, to reducing child and maternal mortality and combating HIV - in the four worst performing of Lesotho's 10 districts. The best chance of success, everyone agreed, was to focus interventions on helping mothers. Research has shown that improving their lives has a knock-on effect on other family members.

The programme also tries to address the lack of coordination and wasted resources that have plagued aid delivery in the past.

Joint assessments

Take for example Mphu Mopeli*, who is seven months pregnant with her fifth child and living with HIV. Her only income comes from collecting and selling firewood to her neighbours and the small amount her two sons earn working as herd boys. Like many others in her district of Thaba-Tseka, one of Lesotho’s most remote and impoverished areas, she might not make it without outside help.

Previously, that help would have come, if it came at all, from various sources - the local clinic, the UN World Food Programme (WFP), and extension officers from the Ministry of Agriculture. Mopeli may have been listed as a beneficiary by all of these organizations who would have visited her in separate vehicles, asked her similar questions and never shared her responses with one another.

Now various UN agencies and government departments are teaming up to carry out joint assessments and agree on the same group of beneficiaries to receive a comprehensive set of services.

The health department is working with partners including the World Health Organization and the UN Children's Fund (UNICEF) to identify pregnant, breast-feeding and HIV-positive mothers and their infants who are in need of food rations from the WFP. The Food and Agricultural Organization (FAO) together with the Ministry of Agriculture makes sure the same women receive seeds, tools and advice on how to grow vegetables and raise chickens that may eventually eradicate the need for food assistance.

Eventually, some of the women will receive training on how to start small businesses that could permanently lift them and their families out of poverty.

"The concentration of complementary activities in a given location for a given population is something we’ve never attempted in a development context," said the UN’s Eziakonwa-Onochie. "The goal is to have greater impact because when you programme in bits and pieces, you miss important components and it's not sustainable or complete."

More efficient

She added that the new approach was also more efficient because it allowed for the sharing of skills and resources. In Thaba-Tseka, officials from the ministries of agriculture and health, as well as from the FAO, WFP and NGO Caritas have formed a nutrition team.

"We've tried to mix people from different backgrounds," explained Washi Mokati, WFP head of office for the district. "Previously, different organizations were building keyhole gardens [small raised vegetable gardens] in different styles; now we're bringing similar practices together."

Mokati added that the programme is still in its infancy and faces challenges. The new level of coordination requires "lots of meetings and not everyone attends".

In charge of coordinating those meetings, both at national and district level, is the Food and Nutrition Coordination Office (FNCO), a government entity that previously had an uncertain role as one of many government departments dealing with nutrition.

"This programme has reaffirmed our coordinating role," said FNCO director Masekonyela Sebotsa. "Our role is bringing everyone together so we work as a team, because often in government each ministry is doing its own work.

"Now you might see [officials from] the Ministry of Health and [the Ministry of] Agriculture travelling in one car; now we work as one."

Although the UN is funding the programme until December 2012 as part of its "Delivering as One" initiative aimed at encouraging UN agencies to deliver development assistance in a more coordinated way, Eziakonwa-Onochie said their role had mainly be "catalytical".

By 2012, the programme should have yielded enough results and best practices for government to decide whether to take over and replicate it in other districts.

"It needs to be rooted in a national budget," Eziakonwa-Onochie told IRIN, "otherwise we run the risk of starting something that fizzles out."