The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) Concept Environmental and Social Review Summary Concept Stage (ESRS Concept Stage) Public Disclosure Date Prepared/Updated: 10/16/2019 | Report No: ESRSC00882 Oct 16, 2019 Page 1 of 12 The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) BASIC INFORMATION A. Basic Project Data Country Region Project ID Parent Project ID (if any) Lesotho AFRICA P170278 Project Name Lesotho Nutrition and Health System Strengthening Project Practice Area (Lead) Financing Instrument Estimated Appraisal Date Estimated Board Date Health, Nutrition & Investment Project 11/18/2019 11/14/2019 Population Financing Borrower(s) Implementing Agency(ies) Proposed Development Objective(s) To increase utilization and quality of key nutrition and health services. Public Disclosure Financing (in USD Million) Amount Total Project Cost 60.00 B. Is the project being prepared in a Situation of Urgent Need of Assistance or Capacity Constraints, as per Bank IPF Policy, para. 12? No C. Summary Description of Proposed Project [including overview of Country, Sectoral & Institutional Contexts and Relationship to CPF] Lesotho is a small, landlocked, lower-middle-income country facing high levels of poverty, low human capital outcomes, and is highly vulnerable to food insecurity and climate shocks. Despite a per capita gross national income of US$1,280 in 2017 (in current US$)[1], approximately 57% of its 2.1 million Basotho inhabitants live below the national poverty line[2]. Despite agriculture being a major component of the economy, Lesotho is by large a food- deficient country due to frequent climate shocks (i.e., recurrent droughts, dry spells and floods) that result in chronic food insecurity, especially in rural areas. This is exacerbated by other vulnerabilities such as Lesotho’s high HIV/AIDS, TB, maternal and infant mortality, and stunting rates; as well as climatic vulnerability (El Niño) that impacts Lesotho’s large agricultural industry. Oct 16, 2019 Page 2 of 12 The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) Although public expenditures on health have increased to 8.1% of GDP in 2014 - almost four times the Sub-Saharan Africa average of 2.3 percent – health and nutrition outcomes remain low for the current level of spending. Lesotho has a maternal mortality ratio (MMR) of 1,024 deaths per 100,000 live births[3], which is almost twice the Sub- Saharan Africa average (560) and over three times the Southern Africa sub-regional average (310). Malnutrition was among the top causes of death among children in Lesotho, with an estimated one third of children under 5 years of age stunted in 2014. Inadequate care and feeding practices, lack of dietary diversity, and environmental health all contribute to high stunting rates. Additionally, Lesotho is grappling with a high adolescent pregnancy rate that has remained around 20 percent within the last decade. These high-risk pregnancies are more likely to cause delivery complications and low birth weight, which increases the risk for child stunting. It is estimated that only 9 percent of children have simultaneous access to adequate health care, WASH and nutrition services. Recognizing these challenges, the project design is aligned with Lesotho’s policy agenda and the Country Partnership Framework (CPF). The importance in advancing the nutrition and health agenda in Lesotho was embodied under the Government’s 2018-2023 National Development Strategic Plan (NSDP II), with one of the NSDP’s key pillars is to strengthen health and nutrition, education and skills development for human capital development. Additionally, the project will support the CPF’s first pillar on improving the efficiency and effectiveness of the public sector, to reduce fragmentation of government institutions and support health system strengthening to improve both quality and efficiency of public spending on health. The project will provide technical assistance to policies and strategies such as a patients’ referral system and defining the basic benefit package to be funded by the government, establish a multisectoral nutrition information system, and strengthen M&E capacity at the MOH. The project is also aligned with the CPF recommendation to consider the recurrence and high risk of climate-related shocks in Lesotho, and includes a Public Disclosure Contingency Emergency Response Component in the project design. Project design and implementation will also be coordinated with development partners to strategically fill in financing and coverage gaps for priority interventions. Reducing the prevalence of stunting in Lesotho will require a focused, multisectoral effort. Efforts would need to focus on overcoming three major systemic bottlenecks including: a) absence of a coordinated response and platform at the community level; b) low quality of health and nutrition services; c) weak governance and management capacity at the local, provincial, and central levels. The US$ 60 million Project will support the Government of Lesotho to increase utilization and quality of key nutrition and health services, and strengthen institutional capacity to implement key policy reforms in the health sector. It will have three major components that correspond to the identified bottlenecks: Component 1. Providing Multisectoral Services to Address Chronic Malnutrition (US$25 million) – This component will support the government deliver multi-sectoral interventions through national level institutions and community based platforms to address chronic malnutrition. Activities include the development of a Multisectoral National Nutrition Communication Strategy, development and implementation of a community-based nutrition program for Lesotho with a package of essential services, provision of nutrition-sensitive services to ECCD centers, and provision of TA and supplies to strengthen existing adolescent school health programs at the MoE and MoH. Component 2: Strengthening Health Systems (US$29.5 million) – This component aims to deliver health system strengthening activities that contribute to enhancing the quality of both service delivery and health spending. It will finance activities for the second-generation performance-based financing, development of policies and guidelines, strengthen health sector governance and quality of care, and capacity building for the health workforce. To support the GoL’s focus on results in the health sector, the project will motivate the adoption of key actions to improve the Oct 16, 2019 Page 3 of 12 The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) effectiveness of the health sector with Disbursement-Linked Indicators. Eligible expenditure groups will be identified. Eligible Expenditures for the DLIs would be subject to the ESF, as applicable and will need to be identified and assessed with this in mind prior to appraisal. Component 3. Project Management, Multi-stakeholder Coordination, Program Monitoring, Evaluation and Learning ($5 million) – This component strengthen overall project management, multisectoral coordination, monitoring, evaluation and learning. Component 4. Contingency Emergency Response Component/CERC - A CERC will be included under the proposed project to allow for rapid reallocation of project proceeds in the event of a natural or man-made disaster or crisis that has caused, or is likely to imminently cause, a major adverse economic and/or social impact. D. Environmental and Social Overview D.1. Project location(s) and salient characteristics relevant to the ES assessment [geographic, environmental, social] The Kingdom of Lesotho is mountainous country entirely landlocked by South Africa with a population of 2.2 million. It is an open economy, traditionally centered on trade, with textiles, water, and diamonds as its main exports. Lesotho is a member of the Southern African Customs Union (SACU), the Southern African Development Community (SADC), and the Common Monetary Area all of which create strong opportunities for regional trade. Lesotho is one of the poorest countries in the region, with high levels of poverty and inequality. An estimated 57 percent of the population lives below the national poverty line and 34 percent fall below the extreme poverty line. Rural areas, heavily dependent on Public Disclosure subsistence and semi-subsistence agriculture, account for 70 percent of the population and 87 percent of all people living below the poverty line (SCD, 2015). A wide (30 percent) poverty gap, high rates of unemployment, wide prevalence of HIV/AIDS, and climate vulnerability further constrain the scope for inclusive growth and improvements in living standards. Adolescent fertility among 15 to 19-year-old girls remained high at 20 percent in 2009 and 19 percent in 2014. These are high-risk pregnancies that are more likely to cause delivery complications and low birth weight which increases the risk for child stunting. Inadequate care and feeding practices, lack of dietary diversity, and environmental health all contribute to high stunting rates. Prevalence of diarrhea and enteric infection is common among children with poor feeding practices and inadequate access to water, sanitation and hygiene facilities. Children with prolonged exposure to unsanitary environments develop environmental enteric dysfunction (EED), a major cause of stunting. Only 9 percent of children have simultaneous access to adequate health care, WASH and nutrition services. Lesotho has limited coverage of a combined package of nutrition specific and sensitive services in part due to limited capacity, coordination and funding across participating ministries/agencies at central and community levels. The proposed project will support overall health system strengthening to ensure essential health services and nutrition specific interventions are provided to improve both quality and efficiency. It will finance complementary interventions in agriculture; education; water, sanitation and hygiene; and social protection to help increase demand and promote adoption of healthy behaviors. In addition, it will contribute to addressing the Food Nutrition Coordination Office to oversee multi-sectoral coordination nationwide, as well as support institutional strengthening of participating ministries. Lastly, it will finance mapping and enhancing capacity of existing community platforms such as agricultural nutrition clubs and mobilizing key community actors to have a well-coordinated response at central and local levels. The proposed interventions will be implemented nationwide and primarily consists of quality improvements through Oct 16, 2019 Page 4 of 12 The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) technical assistance. Therefore, the precise geographic location of project activities, therefore, is not known at this stage. The health care facility interventions will require careful management of waste streams. The footprint of other activities under the proposed Project is limited. Component 1.2 provides small grants to households to improve nutritional status and Component 1.3 provides funding to establish kitchen gardens at existing school facilities to improve school feeding programs and children’s nutritional status (farm to table). The Project will not support any development of infrastructure or fund construction activities. The full description of these activities and exact locations will be defined during project preparation. The proposed Project is expected to have generally positive environmental and social impacts, and where minor, site specific impacts are identified, they will either be avoided or effectively mitigated. D. 2. Borrower’s Institutional Capacity The proposed Project will be implemented by the Ministry of Health (MOH), which has experience in implementing World Bank funded projects under the Safeguard Operational Policies, namely, the Southern Africa TB and Health Systems Support Project (SATBHSSP) and Lesotho Health Sector Performance Enhancement Project. The proposed Project will be implemented through the existing SATBHSSP Project Implementation Unit (PIU). The PIU will have the overall responsibility for environment and social risk management including monitoring compliance with the agreed on mitigation measures and actions that will be outlined in the Environmental and Social Commitment Plan (ESCP). Over the course of implementing both projects, the MOH has demonstrated moderately satisfactory implementation Public Disclosure and monitoring of environmental and social Safeguards Operational Policies. Currently, the SATBHSSP PIU has a dedicated qualified and experienced Environmental and Social Specialist (E&S Specialist) with experience in implementing World Bank projects under the Bank’s Safeguards Operational Policies. However, given the expanded scope of the Environmental and Social Framework (ESF) and the MOH’s unfamiliarity with the ESF, the MOH will need training in the Bank’s Environmental and Social Standards (ESSs) to ensure that the project will be implemented in accordance with the Bank’s ESF requirements. In addition, the Bank will provide MOH capacity building and intensive support for environmental and social risk management during preparation and implementation phases of the Project to comply with ESF requirements. The PIU will recruit and retain an E&S Specialist who will be responsible for implementing and monitoring the Environmental and Social Management Framework (ESMF), Pest Management Plan (PMP), potential Labor Management Procedures (LMP), Stakeholder Engagement Plan (SEP), GBV/SEA risk mitigation measures and the operation of the Grievance Redress Mechanism (GRM). The client’s capacity will further be assessed before project implementation and capacity gaps will be filled through implementation of the ESCP. Significant effort is anticipated to build the capacity of the MoH and the PIU at both national, district and community levels with respect to the ESF and its applicable Standards. II. SCREENING OF POTENTIAL ENVIRONMENTAL AND SOCIAL (ES) RISKS AND IMPACTS A. Environmental and Social Risk Classification (ESRC) Moderate Oct 16, 2019 Page 5 of 12 The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) Environmental Risk Rating Moderate The environmental risk classification for the proposed Project is Moderate due to the nature of the proposed Project activities and associated environmental risks, the capacity of the Ministry of Health and the PIU in the understanding and application of the Bank’s ESF, and relevant Standards. The proposed Project is expected to have generally positive environmental impacts and components are not anticipated to result in any substantial or irreversible impacts as the project will not support any construction activities. However, it is anticipated that activities under Component 2 to support the strengthening of health Systems will result in the increase of health services utilization which will, in turn, lead to marginal increases in the generation, handling and disposal of health care waste streams. Expected environmental risks would be related to the inappropriate and unsafe handling, transportation, treatment and disposal of hazardous medical waste, including infectious waste; pharmaceutical waste; chemical waste; and sharps. Potential impacts are expected to be site specific, reversible and managed through established and proven mitigation measures. Social Risk Rating Moderate The social risk rating for the proposed Project is considered Moderate. The project footprint is small with limited and manageable adverse social impacts that can be mitigated and managed with the application of appropriate mitigation measures. Component 1.2 and 1.3 (increasing access to nutrition sensitive services in Early Child Care Development (ECCD) settings, primary and secondary schools which will include establishment of kitchen gardens, improved food production and livelihoods through small-scale food processing, raising small livestock, cooking demonstrations) have minor footprints as these are scaled only for consumption in schools or private households receiving the support, none of the investments are on a scale that enables commercialization. However, if the school kitchen gardens require the use of fertilizers and pesticides, such use will need to be carefully managed through an Integrated Pest Public Disclosure Management Plan set out in the ESMF to ensure that there is no risk of exposure to the surrounding community or school children. Currently the project GBV risk rating is assessed as moderate. Lesotho has made efforts to attain gender equity and equality, but legislation, customary law and practice still contain considerable gaps and GBV incidents are common. The GBV risk for the project is therefore contextual and it is not expected that the project will induce additional GBV risk. The GBV risk rating will be reassessed once potential subproject sites and specific project activities have been identified. The social rating takes into account the limited capacity of the MOH and other key implementing agencies at both national, district and community levels in the application of the ESF and applicable Standards. However, the current risk rating is based on the concept for the project and may be adjusted as components are further developed. B. Environment and Social Standards (ESSs) that Apply to the Activities Being Considered B.1. General Assessment ESS1 Assessment and Management of Environmental and Social Risks and Impacts Overview of the relevance of the Standard for the Project: The proposed project will not support any construction activities, but will include establishment of kitchen gardens, improved food production and livelihoods activities. However, these activities will be at small scale and with minimal environmental and social footprints. The Project will undertake an assessment of the environmental and social risks Oct 16, 2019 Page 6 of 12 The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) and impacts of the proposed subprojects under Component 1 and Component 2. It is probable that implementation of activities under these components will result in some potential adverse environmental and social impacts which will need to be mitigated and managed through preparation and implementation of an Environmental and Social Management Framework (ESMF). The ESMF will be prepared prior to Project Appraisal and site-specific Environmental and Social Management Plans (ESMPs) to be implemented for each health facility/school/ECCD center will be developed during Project implementation. The ESMF will include an Integrated Pest Management Plan (IPMP) to be applied to the entire proposed Project to manage risks and impacts emanating from farming activities that may require the use of agrochemicals. The Consolidated Lesotho National Health Care Waste Management Plan (CLNHCWMP) was prepared in 2012 by the MoH specifically for adoption in the management of health care waste under the Bank funded Lesotho Health Sector Performance Enhancement Project (P166946). Prior to project appraisal and as part of the ESMF, the Plan will be reviewed and updated to meet ESF requirements, if necessary, and implemented to manage health care waste during project implementation. Though labor influx is not anticipated, the site specific ESMPs will include measures to avoid, minimize, manage and mitigate any Gender Based Violence (GBV) / Sexual Exploitation and Abuse (SEA) risks. Additionally, GBV/SEA, HIV/AIDS risks will be monitored throughout the project cycle. In addition, the project will be guided by a Stakeholder Engagement Plan which includes a Grievance Redress Mechanism which is currently under establishment in MoH and should be operational prior to project appraisal. Areas where “Use of Borrower Framework” is being considered: Use of the Borrower’s E&S Framework will not be considered, in whole or in part. Public Disclosure ESS10 Stakeholder Engagement and Information Disclosure Stakeholder engagement is a principal tool for environmental and social risk management and successful implementation and sustainability of the project. An inclusive Stakeholder Engagement Plan (SEP) proportional to the nature and scale of the Project as well as the expected risks and impacts, will be developed and implemented by the MOH. The SEP will identify all key existing and potential stakeholders, and describe, in addition to other relevant information, stakeholders’ level of influence in project planning and implementation, and means, timelines and frequency of communication with each stakeholder/stakeholder group. The SEP will include a Project wide grievance mechanism which will be established, monitored and reported on. The Draft SEP will be disclosed as early as possible prior to Appraisal. The MOH will thus engage in meaningful consultations with all stakeholders including health workers, District Health Management Teams, water and health women groups, youth and adolescent groups (including out of school adolescents), agriculture nutrition clubs, adolescent mothers, traditional leaders, community leaders, traditional birth attendants, teachers, project affected communities, women and youth groups, NGOs, community-based groups and Disabled People’s Organizations (DPOs) and other vulnerable and disadvantaged members of the community) throughout the project life cycle. The MOH will provide stakeholders with an accessible and inclusive GRM to raise issues and grievances, that will allow MOH to receive, respond to, facilitate resolution of concerns and manage grievances. The MOH will ensure that all stakeholder consultations are accessible and inclusive (in format and location taking into consideration vulnerable and disadvantaged groups), and appropriate for the local context. The MOH will subsequently provide stakeholders with timely, relevant and understandable information in a culturally appropriate format. As part of the environmental and social assessment process, the Borrower will maintain and disclose documentation of stakeholder engagements, which will describe the stakeholders consulted, Oct 16, 2019 Page 7 of 12 The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) summary of issues discussed and responses from the MOH. If during implementation the SEP is considerably modified, a revised SEP will be publicly disclosed as soon as possible. B.2. Specific Risks and Impacts A brief description of the potential environmental and social risks and impacts relevant to the Project. ESS2 Labor and Working Conditions The Project footprint is relatively small and with no construction activities. Activities to be implemented under the project, including the establishment of school kitchen gardens and livelihood activities will be supported by local farmers and are not expected to have significant adverse impacts in terms of labor and working conditions as specified in ESS2 and in accordance with the requirements of national laws (Lesotho Labor Code, 2000). A Labor Management Procedure (LMP) will be prepared and disclosed as part of the ESMF by MOH that will include direct workers and will meet requirements for: terms and conditions of employment; non-discrimination and equal opportunity; worker’s organizations; child labor; forced labor; an accessible workers’ grievance mechanism; and, occupational health and safety (OHS). Civil servants from the implementing ministries working in the project full-time or part-time will remain subject to the terms and conditions of their existing public service employment or agreement, unless there has been an effective legal transfer of their employment or engagement in the project. The LMP will include a workers’ GRM for labor disputes. The National Labour Code and related amendments cover many of the principles included in ESS2. Measures for prevention and mitigation of GBV/SEA risks involving project workers will be put in place before project effectiveness. The LMP will include requirements for preparation of OHS plans and the proposed Project’s OHS requirements will align with the Bank’s General Environment, Health and Safety Public Disclosure Guidelines (EHSGs), the industry sector EHSGs for Health Care Facilities and other good international industry practice (GIIP). ESS3 Resource Efficiency and Pollution Prevention and Management It is anticipated that Project financed activities under Component 2 which will support the strengthening of health systems will result in the increase of health services which will, in turn, lead to the risk of generation, handling and disposal of biomedical waste. This risk will be mitigated through the implementation of the Consolidated Lesotho National Health Care Waste Management Plan (CLNHCWMP) which was prepared in 2012 by the MoH specifically for adoption in the management of health care waste by the ongoing Bank funded Lesotho Health Sector Performance Enhancement Project (P166946). Farming activities associated with Component 1 may require the use of agrochemicals. The ESMF will include guidance and measures to promote Integrated Pest Management and safe use of chemicals. The proposed Project is not expected to be a significant user of water or generate significant greenhouse gas emissions. ESS4 Community Health and Safety No irreversible community health and safety impacts are anticipated for the project. However, it is anticipated that inadequacies in the management of waste disposal sites and facilities in the rural areas where the possibility of mixing domestic and Health Care Waste (HCW) exists might pose a risk to community health and safety. Similarly, the application of fertilizers and/or pesticides in small kitchen gardens and plots in public institutions particularly schools Oct 16, 2019 Page 8 of 12 The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) may cause risks of exposure to chemicals. To mitigate this impact, ongoing monitoring of handling of clinic waste streams and implementation of Pesticide Management Plan will be in place during project implementation. The project ESMF will be prepared which will include clauses on avoidance, minimization and mitigation of all the abovementioned risks. Lesotho has made efforts to attain gender equity and equality, but legislation, cultural norms and practices still contains considerable gaps and GBV incidents are common. The GBV risk for the project is therefore contextual and while it is not expected that the project will heighten GBV risks, it should adopt procedures set out in the Good Practice Note on addressing GBV. Specifically, the PIU will be trained in addressing GBV throughout the Project. GBV prevention and response will be mapped out, and GBV actions will form part of the ESMF/ESMP and stakeholder consultations. These requirements will also apply to all contractors and be specified in related procurement. The project’s GRM will be incorporated into the SEP in order for the community to lodge complaints and receive answers to any questions they have about the project and a specific pathway for grievance related to GBV will be provided. Relevance of ESS4 will further be assessed throughout the project cycle. ESS5 Land Acquisition, Restrictions on Land Use and Involuntary Resettlement The project activities are not expected to result in land acquisition, restrictions on land use and involuntary resettlement. No infrastructure development is planned, and no temporary or permanent acquisition of land or assets is expected to be required. The project footprint is relatively small with establishment of school kitchen gardens at existing school/clinics/ECCD centers and livelihoods activities within homesteads through the small grant provisions to include household nutritional status (Component 1.2 and 1.3). The Project activities under Component 1 will be implemented in land already owned by benefiting public institutions and households as project beneficiaries Public Disclosure (e.g. schools, clinics, hospital, ECCD centers, etc.) and will not be eligible for project support should they induce land acquisition and/or adversely affect or restrict livelihoods. The ESMF will outline screening procedures with community participation to ensure avoidance of adverse livelihood impacts. The site-specific Environmental and Social Management Plans (ESMPs) will be prepared and implemented in each health facility/school/ECCD center during Project implementation. ESS6 Biodiversity Conservation and Sustainable Management of Living Natural Resources ESS6 is not currently relevant as the proposed Project will not finance any activity which would impact biodiversity and/or living natural resources. ESS7 Indigenous Peoples/Sub-Saharan African Historically Underserved Traditional Local Communities There are no identified vulnerable or marginalized groups with identities and aspirations that are distinct from mainstream groups as defined under the ESF’s Indigenous Peoples/Sub-Saharan Historically Under-served Traditional Local Communities standard in the project area of influence. Therefore, this Standard is not currently relevant to the project. ESS8 Cultural Heritage Given the Project’s context, this ESS is not relevant as the proposed Project activities will not affect or involve risks to tangible and intangible cultural heritage. Nevertheless, the ESMF for the project will identify measures to address Oct 16, 2019 Page 9 of 12 The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) risks and impacts on cultural heritage and develop a chance finds procedure – if applicable – to be implemented during project implementation phase. ESS9 Financial Intermediaries The standard does not apply as the Project will not include financial intermediaries. B.3 Other Relevant Project Risks Currently, no other significant environmental or social risk are envisaged. C. Legal Operational Policies that Apply OP 7.50 Projects on International Waterways No OP 7.60 Projects in Disputed Areas No III. WORLD BANK ENVIRONMENTAL AND SOCIAL DUE DILIGENCE A. Is a common approach being considered? No Public Disclosure Financing Partners No other financing partners are involved in the project. B. Proposed Measures, Actions and Timing (Borrower’s commitments) Actions to be completed prior to Bank Board Approval: Actions to be completed prior to Bank Board Approval: • Preparation of an Environmental and Social Management Framework (ESMF), including IPM and an institutional capacity assessment and Consolidated Lesotho National Health Care Waste Management Plan • Preparation of Environmental and Social Commitment Plan (ESCP) • Preparation, consultation and disclosure of the Stakeholder Engagement Plan including a Project wide grievance mechanism (GRM) • Draft Labor Management Procedures (LMP) with the workers GRM prepared and disclosed (incorporated in the ESMF) Oct 16, 2019 Page 10 of 12 The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) Possible issues to be addressed in the Borrower Environmental and Social Commitment Plan (ESCP): • Reporting procedures to the Bank and ESSA • Preparation of site specific ESMPs where required • Accident and incident reporting, using the WB’s Serious Incidents Reporting Toolkit • Finalization of LMP • Measures to prevent GBV and SEA risks during project implementation, including GBV Action Plan, if the GBV impact assessment indicates the need • Strengthening capacity within the MOH and key stakeholders. C. Timing Tentative target date for preparing the Appraisal Stage ESRS 25-Nov-2019 IV. CONTACT POINTS World Bank Contact: Christine Lao Pena Title: Senior Human Development Economist Telephone No: 5220+35421 / Email: cpena@worldbank.org Public Disclosure Contact: Pia Helene Schneider Title: Lead Economist Telephone No: 5220+89328 / Email: pschneider@worldbank.org Borrower/Client/Recipient Implementing Agency(ies) V. FOR MORE INFORMATION CONTACT The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects VI. APPROVAL Task Team Leader(s): Christine Lao Pena, Pia Helene Schneider Oct 16, 2019 Page 11 of 12 The World Bank Lesotho Nutrition and Health System Strengthening Project (P170278) Practice Manager (ENR/Social) Africa Eshogba Olojoba Recommended on 15-Oct-2019 at 11:26:29 EDT Safeguards Advisor ESSA Nathalie S. Munzberg (SAESSA) Cleared on 16-Oct-2019 at 11:54:38 EDT Public Disclosure Oct 16, 2019 Page 12 of 12