VZCZCXRO6903
RR RUEHBZ RUEHDU RUEHJO RUEHRN
DE RUEHMR #0387/01 3070734
ZNR UUUUU ZZH
R 030734Z NOV 09
FM AMEMBASSY MASERU
TO RUEHC/SECSTATE WASHDC 4453
RUEHC/USAID WASHDC
RUEHPH/CDC ATLANTA GA
INFO /MCC COLLECTIVE
RUCNSAD/SADC COLLECTIVE
RUEHMR/AMEMBASSY MASERU 4887

UNCLAS SECTION 01 OF 03 MASERU 000387 
 
SIPDIS 
 
STATE FOR O/GAC, AF/S 
USAID FOR OHA, AFR/SA 
STATE PASS TO MCC: JBLOOM AND ASHERINIAN 
PRETORIA FOR USAID 
CDC FOR OGHA 
 
E.O. 12958: N/A 
TAGS: EAID KMCA KHIV LT
SUBJECT: PEPFAR / MCC COLLABORATION YIELDS RESULTS IN LESOTHO 
 
MASERU 00000387  001.2 OF 003 
 
 
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Summary 
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¶1.  Excellent collaboration between Embassy Maseru's PEPFAR and 
MCC teams is resulting in efficient linking of USG-funded 
activities and leveraging resources for greater impact in 
pursuit of common health goals. High level support for 
interagency collaboration; common objectives; Lesotho 
government-led development of the MCC Compact and PEPFAR 
Partnership Framework; and on-the-ground coordination between 
USG personnel have contributed to this success.  Post values the 
outstanding cooperation and strong interpersonal relationships 
formed between the members of the PEPFAR and MCC teams in what 
has became an outstanding example of effective interagency 
collaboration. 
 
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Background 
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¶2.  In 2003, the PEPFAR program began working in Lesotho from a 
regional base in Pretoria. The focus of the program was to 
assist the Government of Lesotho (GOL) in addressing the 
HIV/AIDS crisis through supporting prevention of mother-to-child 
transmission, counseling and testing, TB/HIV, and prevention 
programs, while also strengthening the human resource and health 
systems capacity of the Ministry of Health and Social Welfare 
(MOHSW). Over the past three years, the PEPFAR program has 
transitioned to management by a country-based team that includes 
representatives from the Department of State, USAID, CDC, DOD, 
and Peace Corps. 
 
¶3.  In 2005,  the GOL started negotiations with MCC to develop a 
Compact to reduce poverty through sustainable economic growth 
targeting water and private sector reform. In 2006, GOL 
requested assistance to broaden the proposed MCC Compact to 
include a health component, recognizing the significant link 
between poverty and HIV/AIDS. The proposal, developed by the 
MOHSW, in consultation with other GOL bodies, NGOs, and 
development partners, briefly analyzed gaps in the essential 
health services program, including HIV/AIDS, and targeted health 
infrastructure improvements for MCC funding. Priorities were for 
enlarging and refurbishing health centers nation-wide, including 
staff housing, strengthening up to 14 anti-retroviral treatment 
(ART) centers at district and sub-district hospitals, 
construction of a new National Reference  Laboratory, a new 
Blood Bank Center and a new dormitory facility at the National 
Health Training Center. A significant health systems 
strengthening component, addressing human resources, health 
information and support for decentralization, was later added to 
this proposal. The proposal included activities in infection 
control, improving service quality, laboratory strengthening, 
ART program strengthening, health information systems 
development, support of de-centralization of health services, 
medical waste management and human resources and capacity 
building to maximize  health service delivery. 
 
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Early Collaboration and Support to the Lesotho Government 
--------------------------------------------- ------------ 
 
¶4.  Collaboration between MCC and  PEPFAR was established early 
during compact development in 2006 to facilitate development of 
the health component of the compact. The PEPFAR Coordinator was 
instrumental in providing information regarding USG and other 
donor activities; frank assessment of the MCA request and 
perceived strengths and weaknesses of the MOHSW; information 
regarding the structure of the donor community; assistance in 
identifying and accessing important informants; and identifying 
important areas for MCC assessment. In addition, the PEPFAR 
Coordinator hosted meetings with relevant NGOs and PEPFAR 
contractors to facilitate discussion and fact-finding by the MCC 
team. This collaboration between the PEPFAR and MCC teams was 
fully supported and encouraged by Mission management. 
 
¶5.  During the ensuing 6 months - through December 2006 - the 
PEPFAR Coordinator, her staff and PEPFAR contractors assisted 
the MOHSW and the Millennium Challenge Account-Lesotho (MCA-L), 
the national body responsible for proposal preparation, in 
developing further information as needed for strengthening the 
MCA-L health proposal. This included preparation of a human 
resources/capacity building component to complement the original 
infrastructure component, supported by a PEPFAR-funded 
 
MASERU 00000387  002.2 OF 003 
 
 
IntraHealth consultant working in the MOHSW's Human Resources 
Department, and assistance from the CDC in Pretoria to conduct 
due diligence on the MOHSW's proposals for a new National 
Reference Laboratory and a new Blood Collection and Processing 
Center. 
 
--------------------------------------------- -- 
Common Objectives/Comprehensive Health Response 
--------------------------------------------- -- 
 
¶6.  The goal of the MCC Compact was to reduce the excessive 
mortality rates due to high prevalence of HIV/AIDS and 
tuberculosis. Economic rate of return analyses undertaken by the 
MCA-L and by MCC confirmed the importance of this goal not only 
to improve lives and health, but also for economic growth. The 
objectives for the MCA-L health proposal were to improve health 
infrastructure needed to strengthen health services delivery and 
to improve working conditions for health staff , thereby 
improving job satisfaction and reducing the loss of qualified 
health care workers to other countries. PEPFAR indicators were 
reviewed, and those that focused on measuring reduction in 
HIV/AIDS were included in the MCC Compact monitoring and 
evaluation plan for the health project. These are now a main 
element of the MCA-L evaluation framework. 
 
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Compact Proposal Assessment 
--------------------------- 
 
¶7.  Given the wide range of technical areas covered by the 
proposal, and the extraordinary level of expertise represented 
by PEPFAR implementing agencies CDC and USAID and their 
respective contractors in the region, the MCC health team 
requested support. CDC experts based in Pretoria provided 
technical support for reviewing the proposed national laboratory 
plans. PEPFAR-funded NGO Safe Blood for Africa, mobilized 
consultants to review the proposal and plans for blood banking 
facilities, and also provided consultant expertise on physical 
means of infection control to the MCC infrastructure due 
diligence team. In addition, the PEPFAR Coordinator continued to 
play a role in donor and NGO coordination, calling meetings and 
providing fora for consultation and discussion. 
 
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Continued MCC PEPFAR Collaboration 
---------------------------------- 
 
¶8.  Since MCC Compact signing in 2007, the PEPFAR team in 
Lesotho has grown to include resident staff from US Department 
of State, USAID, CDC, DOD, and Peace Corps. PEPFAR support 
through these agencies has also grown significantly, most 
recently with the signing of PEPFAR's Partnership Framework 
between Government of Lesotho and the USG. The Partnership 
Framework (PF) includes significant investments in health 
systems strengthening, which complement the MCC Compact health 
infrastructure initiatives and health systems strengthening 
activities.  In developing the PF, PEPFAR set ambitious goals 
and objectives, which took into account MCA-L's infrastructure 
and other health plans. For example, PEPFAR intends to work 
closely with the MOHSW and Ministry of Public Service to develop 
a retention policy and strategy; MCA-L's support to develop a 
education strategy, and its construction or refurbishment of 
staff housing at health clinics, provide key pieces of that 
strategy. 
 
¶9.  Collaboration continues to grow between PEPFAR and MCC in 
both MCC Compact and PF implementation. PEPFAR and MCC hold 
monthly strategic meetings to ensure collaboration and maximal 
leverage of resources. PEPFAR has recently funded an additional 
health infrastructure staff position within the MCA through a 
PEPFAR partner. CDC has provided support to ensure infection 
control training and consultation on MCC Compact infrastructure 
activities. MCC and PEPFAR collaborate to support the MOHSW in 
decentralization, human resources for health, and health 
informatics initiatives. Likewise MCC and PEPFAR are 
collaborating in assisting MOHSW to develop and operationalizing 
a national infection control policy to prevent spread of TB, 
including multi-drug resistant (MDR) and extreme drug resistant 
(XDR) TB in health facilities. 
 
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Lessons Learned 
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MASERU 00000387  003.2 OF 003 
 
 
¶10.  Early collaboration between PEPFAR implementing agencies, 
MCC, and the MOHSW led to fruitful and efficient design and 
assessment of the MCC Compact's Health Project. US 
Government-led donor coordination in the health sector provided 
the background against which a gap analysis could be undertaken 
and specific components targeted for MCC funding. It also 
provided an effective framework for early agreement on project 
goals and objectives, allowing MCC and MCA-L economic analysis 
at an early stage to confirm the appropriateness of the proposed 
activities in meeting the MCC economic growth mandate. Today, 
ongoing work by MCA-L, and the newly signed Partnership 
Framework, provide additional areas of collaboration to address 
significant health challenges in Lesotho. The combined 
coordination and expansion of USG efforts in health is providing 
an opportunity to assist the Government of Lesotho in 
overhauling the health system to meet the nation's needs. 
NOLAN