Audit of the Millennium Challenge Corporation's Health Sector Project in Lesotho

We recommend that the Millennium Challenge Corporation eliminate from the project the nine health centers that Medical Care Development International recommended decommissioning, whose renovation will cost an estimated $8 million, or justify in writing their continued inclusion in the project.

We recommend that the Millennium Challenge Corporation follow-up on the Medical Care Development International report to determine whether the inclusion by default of the 20 health centers within the MCC project is warranted, and document its analysis and decision.

We recommend that the Millennium Challenge Corporation reassess the decentralization efforts to determine whether the District Health Management Teams will be functional upon health center completion; document its efforts; and implement additional mitigation measures, if necessary, to manage the risk to sustainability.

We recommend that the Millennium Challenge Corporation develop a policy requiring conditions precedent to focus on outcomes, where appropriate, rather than prescribing specific activities.

We recommend that the Millennium Challenge Corporation review the annual budget of the Government of Lesotho to determine whether sufficient amounts were budgeted to cover its share of the cost of the health center renovations and document its review.

We recommend that the Millennium Challenge Corporation develop and implement a strategy with the Millennium Challenge Corporation, Millennium Challenge Account-Lesotho, and the supervisory engineer to coordinate oversight during renovation of all health centers in the project.

We recommend that the Millennium Challenge Corporation determine whether the health centers included in its project are complying with the memorandum of understanding establishing that all of the essential health services must be provided, and document its review. If centers are not complying, MCC needs to take appropriate action and document its rationale.

We recommend that the Millennium Challenge Corporation review and document the role of private sector providers in compact implementation and establish a written policy for compliance with service delivery requirements to receive Millennium Challenge Corporation funding.

We recommend that Millennium Challenge Corporation revise its Health Sector Project monitoring and evaluation plan to properly attribute the comprehensive efforts being provided by other donors.

We recommend that the Millennium Challenge Corporation review its strategy for health systems strengthening, determine and document whether it will achieve its intended purpose, and take appropriate action and document its rationale if it will not.

We recommend that the Millennium Challenge Corporation require that the Millennium Challenge Account-Lesotho develop a comprehensive, documented communications strategy to increase the transparency of its project activities and provide adequate and timely information to other donors and stakeholders for use in coordinating efforts.