Outside Mamela Hospital in Lesotho, village health workers sing about the importance of nutrition as part of a broader initiative to address childhood stunting. According to data from 2014, 33.4% of children in Lesotho were affected by stunting. By 2024, this figure had risen to 35.6%.
Efforts are being made through the Lesotho Nutrition and Health System Strengthening Project (LNHSSP), in collaboration with the government, to improve both access to and quality of nutrition and health services. The project aims to change behaviors that contribute to childhood stunting, which is often caused by chronic undernutrition during the first 1,000 days of life. Other contributing factors include poor maternal nutrition, inadequate water and sanitation, and limited healthcare access.
The first component of the project supports essential health and nutrition services for vulnerable populations. This includes training frontline and village health workers (VHWs), conducting behavior change campaigns at community levels, monitoring child growth, and distributing necessary supplies. To date, 8,363 VHWs have been trained for these interventions.
“We cannot talk about health without considering good nutrition and it is imperative that our communities are on a good nutrition program,” said Nompumelelo Snyman, a VHW in Butha-Buthe District.
At a recent outreach event in Butha-Buthe District, Duduzile Zilehlangalala brought her 18-month-old daughter 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 among more than 580,000 women who have received quality health, nutrition, and population services through this project.
Childhood stunting can result in long-term physical growth issues as well as cognitive delays that affect school performance. Stunted children may start school later or learn more slowly compared to their peers; these setbacks can lead to lower educational attainment and reduced job opportunities as adults.
To reach adolescents—especially herd boys who face unique challenges—the project recruited 168 peer educators across four districts: Butha-Buthe, Thaba-Tseka, Mohale’s Hoek, and Quthing. These educators have been trained on a Comprehensive Sexuality Education Package and have reached nearly 6,000 adolescents with information on sexual health topics such as reproductive health and teenage pregnancy prevention. Across Lesotho over 22,400 adolescents have engaged with at least one topic through this package.
The LNHSSP has also contributed significantly toward improving healthcare service quality nationwide by providing Quality Improvement Grants (QIGs), training staff members at various levels of care facilities—including those managed by public entities or run by organizations like the Christian Association of Lesotho—and supplying new equipment where needed. Top-performing facilities receive annual bonus payments based on coverage rates as well as efficiency indicators—a system designed to encourage output-based rather than input-based funding models.
“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,” said Celestina Moepa, Manager of Nursing Services at Seboche Mission Hospital.
Facilities receiving QIGs undergo regular assessments that track improvements across several domains related to care quality; digital tools such as Shahidi are used for ongoing monitoring so progress can be measured transparently. The project seeks sustainability by working toward establishing permanent budget lines for QIGs within national financing structures.
By supporting better healthcare delivery systems alongside improved nutritional practices throughout communities in Lesotho—with particular attention given both mothers/children under five years old plus adolescent groups—the initiative aims not only at reducing current rates of stunting but also creating lasting positive outcomes for overall public health among Basotho citizens.