Final report National Local service delivery survey

THE DEEPENING
DECENTRALISATION
PROGRAMME (DDP)
6/12/2015
National & Local Service Delivery
Survey for Lesotho, July 2015

The National and Local Service Delivery Survey for Lesotho
UNDP/UNCDF/EU - Deepening Decentralisation Programme 1

Table of Contents
Acronyms ....................................................................................................................................6
Acknowledgment.........................................................................................................................8
1. Executive Summary..................................................................................................................9
1.1. Challenges to the Delivery of Services........................................................................... 10
1.2. Key Recommendations Proposed ................................................................................. 11
1.3. Possible Solutions........................................................................................................ 12
2. Introduction........................................................................................................................... 14
2.1. Background ................................................................................................................. 14
2.2. Service Delivery by Local Governments......................................................................... 14
2.3. New Structure and Relationship within LocalGovernment ............................................ 15
2.4 Objectives of the New Decentralisation Policy................................................................. 16
2.5 Re-defining the Role and Position of Chiefs and the Chieftainship .................................. 17
3. The Survey Scope ................................................................................................................... 18
3.1. Purpose of the Assignment .......................................................................................... 18
3.2. Objectives of the Survey .............................................................................................. 18
3.3. Scope of Work ............................................................................................................. 18
3.4. Deliverables................................................................................................................. 19
3.5. Institutional Capacity................................................................................................... 19
3.6. Emerging Issues ........................................................................................................... 19
4. Approach and Methodology ................................................................................................... 20
4.1. Document Review........................................................................................................ 20
4.2. Key Informant Interviews (KIIs) and Focus Group Discussions (FGD) .............................. 20
4.3. Quantitative Analysis................................................................................................... 21
4.4. Approach..................................................................................................................... 21
4.4.1. Inception Stage ...................................................................................................................21
4.4.2. Sampling Design and Sample Selection ..............................................................................21
4.4.3. Developing Data Collection Tools .......................................................................................23
4.4.4. Data Management and Analysis .........................................................................................25
4.4.5. Qualitative Analysis.............................................................................................................25
4.4.6. Report Writing ....................................................................................................................25
5. Findings ................................................................................................................................. 26
5.1. Education .................................................................................................................... 26
5.1.1. Availability and Access to Services......................................................................................26
5.1.2. Satisfaction with Different Aspects of Education Services .................................................29
5.1.3. Factors Limiting Access to Services.....................................................................................29

5.1.4. Grievance Handling Mechanisms........................................................................................31
5.2. Health ......................................................................................................................... 32
5.2.1. Availability and Utilisation of Services................................................................................32
5.2.2. Satisfaction with Health Service Provision Aspects ............................................................34
5.2.3. Grievance Handling Processes in Place...............................................................................35
5.2.4. Factors Limiting Access and Utilisation...............................................................................35
5.2.5. Grievance Handling Processes in Place...............................................................................37
5.3. Agriculture................................................................................................................... 40
5.3.2. Satisfaction with Agricultural Services................................................................................40
5.3.3. Grievance Processes in Place..............................................................................................41
5.4. Energy ......................................................................................................................... 42
5.4.1. Availability and Utilisation of Energy Services....................................................................42
5.4.2. Satisfaction with Electricity as a Source of Energy; ............................................................44
5.5. Water and Sanitation................................................................................................... 46
5.6. Road Infrastructure...................................................................................................... 50
5.6.2. Satisfaction with Regard to the Aspects of Road Transport ..............................................51
5.7. Civil Registry................................................................................................................ 53
5.7.2. Satisfaction with Services....................................................................................................54
5.7.3. Grievance Handling.............................................................................................................55
5.7.4. Factors Limiting Access to Services.....................................................................................55
5.8. Social Protection.......................................................................................................... 57
5.8.1. Availability and Access to Service .......................................................................................57
5.8.2. Satisfaction with Services....................................................................................................58
5.8.4. Factors limiting Utilisation of Services................................................................................60

5.9. Child Protection Services.............................................................................................. 61
5.9.1. Availability and Access to Service .......................................................................................62
5.9.2. Satisfaction of Services .......................................................................................................63
5.9.3. Challenges to Access Services.............................................................................................63
5.10. Forestry and Lands..................................................................................................... 64
5.10.1. Availability and Utilisation of Services..............................................................................64
5.10.2. Factors Limiting Access and Utilisation.............................................................................65
6. Assessment of Institutional Capacity to Support Decentralied Service Delivery ........................ 66
6.1. General Findings .......................................................................................................... 67
6.2. Sector Specific Findings................................................................................................ 69
6.2.1. Water & Sanitation .............................................................................................................69
6.2.2. Civil Registration .................................................................................................................71
6.2.3. Roads...................................................................................................................................74
6.2.4. Forestry...............................................................................................................................75
6.2.5. Agriculture...........................................................................................................................76
6.2.6. Energy .................................................................................................................................77
6.2.7. Social Protection .................................................................................................................78
6.2.8. Education ............................................................................................................................79
7. Challenges ............................................................................................................................. 81
8. Lessons Learned/Best Practices .............................................................................................. 83
8.1. Possible Solutions Based on Best Practices ................................................................... 84
9. Conclusion and Recommendations ......................................................................................... 86
9.1. Recommendations from FGDs/KIIs for Sector Institutions.................................................. 87
Annex 1: House-Hold Questionnaire (English) Service Delivery Survey .............................................. 89
Annex 2: House-Hold Questionnaire (Sesotho) Service Delivery Survey............................................. 96
Annex 3: Focus Group Discussions (FGDs) Survey Form ............................................................. 103
Annex 4: Sample KIIs Institutional Capacity Assessment............................................................ 106
Annex 5: Macro Overview of Survey Sectors............................................................................. 107
Annex 6: Work Plan ................................................................................................................. 121
Annex 7: List of Informant Interviews....................................................................................... 122
7.1. UNV Surveyors........................................................................................................... 125
Annex 8: Team Responsibilities ................................................................................................ 126
8.1. Stakeholders Roles and Responsibilities for the Survey............................................... 127
Annex 9: Terms of Reference.................................................................................................... 128
Annex 10: Documents Consulted.............................................................................................. 130

Table of Tables
Table 1: Summary findings of perceptions on service access and satisfaction.........................9
Table 2: Six selected districts:..................................................................................................22
Table 3: Population in the six districts.....................................................................................22
Table 4: Sample distribution per district .................................................................................23
Table 5: Access and perceptions on quality of various health services ..................................38
Table 6: Perception on satisfaction with certain health service aspects ................................39
Table 7: Satisfaction with agricultural activities......................................................................40
Table 8: Sanitation facilities used by the HH ...........................................................................47
Table 9: Level of satisfaction with the services in the services roads infrastructure..............51
Table 10: Time taken to access the different services from the civil registry.........................54
Table 11: Satisfaction rating for civil registry services.............................................................54
Table 12: Satisfaction with various social protection services ................................................58
Table 13: Satisfaction with the regularity of payment: ..........................................................59
Table 14: Access to child protection services by any member of the household ...................62
Table of Figures
Figure 1: Reasons for not taking children to IECCD schools ....................................................27
Figure 2: Perception on Quality of IECCD ................................................................................27
Figure 3: Types of primary schools attended ..........................................................................28
Figure 4: Quality of education .................................................................................................29
Figure 5: Percentage of population accessing public health services .....................................32
Figure 6: Perception of quality of health services ...................................................................33
Figure 7: Waiting time for various health services..................................................................34
Figure 8: Perception on satisfaction with various health service aspects...............................35
Figure 9: Main source of lighting .............................................................................................43
Figure 10: Main source of energy for heating .........................................................................43
Figure 11: Satisfaction with electricity services.......................................................................44
Figure 12: the main source of water........................................................................................46
Figure 13: the main type of road used.....................................................................................50
Figure 14: perception of the quality of roads..........................................................................51
Figure 15: Respondents or any member of the HHs having accessed civil registry services ..53
Figure 16: Knowledge of grievance handling mechanisms .....................................................55
Figure 17: Access to various social protection programmes...................................................58
Figure 18: Awareness of grievance handling mechanisms under social protection ...............60
Figure 19: Awareness of services under forestry and land reclamation.................................64

Acronyms
AfDB African Development Bank
ARV Antiretroviral
ASWO Auxiliary Social Welfare Officers
BA Beneficiary Assessment
CBOs Community Based Organisations
CCs Community Councils
CCS Community Council Secretary
CGP Child Grants Programme
DA District Administrator
DCPTs District Child Protection Teams
DCS District Council Secretary
DCs District Councils
DDC District Development Council
DDCC District Development Coordinating Committee
DGD Decentralized Governance for Development
DLG Developmental Local Government
DDP Deeping Decentralisation Program (UNDP/CDF)
DPU District Planning Unit
DS District Secretary
EU European Union
FGDs Focus Group Discussions
FPE Free Primary Education
GoL Government of Lesotho
GIZ German International Corporation
HETCT Higher Education and Technical and Vocational Training
HH Household
HHSs House Hold Surveys
IDP Integrated Development Plan
IECCD Integrated Early Childhood Care and Development
KIIs Key Informant Interviews
LACD Land Affairs and Constitutional Development
LAs Local Authorities
LED Local Economic Development
LHWC Lesotho Highlands Water Commission
LG Local Governance/Local Government
LGA Local Government Act
LGS Local Government Service
LGSC Local Government Service Commission
LGUs Local Government Units
LIPAM Lesotho Institute of Public Administration and Management
LRA Lesotho Revenue Authority
MAFS Ministry of Agriculture and Food Security
MCC Maseru City Council
MoET Ministry of Education and Training
MoJ Ministry of Justice

MFDP Ministry of Finance and Development Planning
MLGC Ministry of Local Government and Chieftainship
MoHSW Ministry of Health and Social Welfare
MoSD Ministry of Social Development
MoET Ministry of Education and Training
MPWT Ministry of Public Works and Transport
MSD Ministry of Social Development
NICR National Identification and Civil Registry
NSPS National Social Protection Strategy
NES National Environmental Secretariat
NGOs Non-Governmental Organisations
OAP Old Age Pension
ODPS Office of the Director of Passport Services
OVC Orphans and Vulnerable Children
PRSP Poverty Reduction Strategy Programme
RD Roads Directorate
RWSD Rural Water and Sanitation Department
SPSS Statistical Package for Social Scientists
UNCDF United Nations Capital Development Fund
UNDP United Nations Development Programme
UNICEF United Nations Children’s Fund
USAID United States Aid for International Development
VDC Village Development Council/Committee
VO Village Organisation
WASCO Water and Sanitation Company
WDC Ward District Council
WB World Bank
WHO World Health Organisation
July 15th 2015, Prepared By:
Henry H. Kellam III, PhD (FEI)
Robert H Muwanga (EFICON)
Melody Niwamanya (EFICON)
Disclaimer: This report is intended for use by UNDP and the GoL and members. Only they may expressly
authorize to use the report. The circulation and use of the contents of this report, is therefore limited and any
analysis and interpretation of the contents of the report must be made within the context of the ToRs. The
views in this survey study do not necessarily reflect the views of the clients.

Acknowledgment
The Study Team would like to thank the numerous people who helped us in the course of
preparing this report. Special thanks goes out to Mrs. Jenifer Bukokhe Wakhugu, UNCDF-
Regional Technical Advisor, Mr. Thabo Mosoeunyane, UNDP Governance Specialist, and
Liau Motoko, newly appointed UNDP-DDP Programme Manager for devoting their time
assisting with the background materials, arranging and attending meetings and site logistics
for our mission. The Team would also like to thank Mr. Morabo Morojele, UNDP M&E
Consultant, for all of his assistance on so many levels of the study.
The Team is highly indebted to all the local UNV's for their dedication and hard work in
carrying out the District's HHS and FGDs. These include:
1. Lerato Julia Lesoetsa
2. Moroesi Mabetha
3. Retselistoe Lenoesa
4. Sekabi Tjatjapa
5. Lipuo Nkholi
6. Ntheosi Patience Makara
7. Seoehla Moremoholo
8. Gloria J. Nkundanyilazo
We were also privileged to be able to meet with many senior members of government who
are actively involved with the Local Government system in Lesotho and who provided open
and meaningful contributions to the survey study. This was also the case with a number of
Development Partners involved in decentralization, such as the EU and GIZ, as well as the
many UN agencies who took the time to provide their valuable insights and feedback. We’d
also like to thank the key technical people at various sector Ministries pertaining to the
study areas for their information and insights.
The Study team visited six Districts and met numerous local government officials, local
residents, members of Civil Society Organisations, etc. Everywhere we went - people were
very willing to share their time and views with us as well as making us feel as a part of their
community. For all their time, contributions and support, we are very thankful.
Henry H. Kellam III, Robert H. Muwanga and Melody Niwamanya
All Report photos credits: Melody Niwamanya

1. Executive Summary
This national and local service delivery survey was commissioned by the United Nations
Development Programme (UNDP) working together with other Development Partners in
Lesotho that provide support to the Government’s Deepening Decentralisation Programme
(DDP), the European Union (EU) and the United Nations Capital Development Fund
(UNCDF).
The DDP was established with the main purpose of promoting decentralized service delivery
and facilitating social and economic growth through the development of transparent
funding mechanisms and the strengthening of accountability systems of local authorities.
Using the DDP, the Government has recently formulated and approved a Decentralization
Policy for Lesotho - its implementation is underway. Commencement of disbursements from
the local development fund, a non sectoral development financing mechanism to districts, is
another major achievement under the DDP.
The main purpose of the service delivery survey is to provide baseline information about the
quality, quantity and accessibility of service delivery in Lesotho. This data is intended to
provide a basis for measuring progress as a result of interventions to improve service
delivery.
This was a perception survey involving six (6) districts. User perceptions were collected on
accessibility and quality of service as well as service satisfaction levels across the sectors of
education, health, agriculture, energy, water and sanitation, road infrastructure, civil
registry, forestry and lands, social protection and child protection. Key Informant Interviews
(KIIs), Focus Group Discussions (FGDs) and structured survey instruments were the
mechanisms used to collect these perceptions during the survey. To augment the results of
the survey, institutional capacity issues affecting service delivery within central and local
government units were also discussed and documented.
This report presents the findings on the users’ perception regarding the availability and
utilisation of services, user satisfaction with services, grievance handling mechanisms and
factors limiting access and utilisation of services across all sector selected for the survey.
Table 1 below provides summary statistics on access and user satisfaction findings.
Table 1: Summary findings of perceptions on service access and satisfaction
Services Access Satisfaction
Rural (%) Urban (%) Rural (%) Urban (%)
Roads 75.2 89.3 17.5 26.5
Central Sewage System 1.1 22.9 N/A N/A
Electricity 14.9 79.1 12.6 44.5
Water supply 82.8 88.4 52.2 35.5
Public schools 68.7 73.6 43.3 61.2
Public hospitals and health
facilities
68.9 80.7 42.8 54.3
Agricultural support services 36.2 26.9 33.3 12.5

Services Access Satisfaction
Rural (%) Urban (%) Rural (%) Urban (%)
Civil registry
Birth certificate 73.7 68.5 62.5 64.4
ID card 68.5 71.8 66.56 71.6
Passport 53.0 59.7 40.2 48.6
Death certificate 33.8 33.5 49.5 60.5
Marriage/divorce certificate 25.3 29.0 38.9 78.9
Social Assistance
Child Grants Programme 5.8 11.9 68.2 53.6
Free Primary Education 55.8 46.3 50.8 83.6
Public Assistance 8.4 12.0 55.6 48.9
OVC Bursary 9.1 11.3 41.7 61.0
Old Age Pension 56.7 44.6 66.8 75.4
Agricultural inputs 26.2 13.5 51.5 24.0
Public Works 19.9 29.0 24.3 56.0
School Feeding 57.0 44.2 14.7 42.8
Respondents were asked whether they or members of their households had accessed1
particular services in the 12 months preceding the Survey. As shown in the table above, the
access to services was disaggregated between rural and urban. For those that had accessed
(used) particular services, they were asked to rate their satisfaction or the quality of
services. Those that were either satisfied or very satisfied were qualified as being satisfied.
Additionally, for service quality aspects those that mentioned services as being good or very
good were qualified as being satisfied. Overall, 42% accessed the different services in rural
areas while 47% accessed the same services in the urban areas. In terms of satisfaction,
overall, 44% were satisfied with the services they accessed in the rural areas, compared to
43% in the urban areas.
The report further highlights (see summary below) the challenges to service delivery which
have emerged as a result of information obtained from the Survey. The report then provides
recommendations on areas that will need to be addressed in order to improve the quality of
services.
1.1. Challenges to the Delivery of Services
The following key challenges have been identified in the study as impediments to the
smooth implementation of service delivery:
1. Participation of local councils in the planning, management and supervision is very
limited. It will need strengthening, in the context of the Decentralisation Policy, so that
local ownership and accountability for programme service delivery is assured;
2. While the decentralization legislation (Local Government Act) dates back to 1997, sector
policies and legislation were largely not adjusted to embrace decentralisation. Sectors
should be required to implement a program of actions to update their policies and
legislation gradually;
1
Acccessed in this context means that the respondent used the services, or the products.

3. LGs have no structures and therefore capacities to carry out their full mandate. On the
other hand, central sector agencies are often stretched because they have fill-in gaps
left by the absence of LGs. The issue of capacity of both local and central government
agencies needs to be addressed in the context of the Decentralisation Policy;
4. There are gaps in the coordination mechanism; within sectors and within the Ministry
for Local Government that will need to be addressed to improve harmony in the
supervision and management of service delivery within LGs;
5. Sharing costs in service delivery between users and government is not often clear. There
will be need for policy consistency on cost sharing across all services so that users are
well aware about their obligations;
6. There will be need to establish a policy and provide resources for the maintenance of
service delivery infrastructure in order to sustain service delivery capacity and assets;
and
7. The Decentralisation Policy, as well as this Survey, has highlighted the issue of
information management in service programs under LGs. Roles and mechanisms for
information sharing and dissemination will need to be clarified as the new
Decentralisation Policy is implemented.
1.2. Key Recommendations Proposed
The study also makes the following general recommendations. Most of these
recommendations are institutional in nature and relate to or have been cited in previous
studies – more notably the 2013 Decentralisation Diagnostic Study:
1. Expedite implementation of the Decentralisation Policy so that LGs can begin to
participate more effectively in service delivery. In particular, as provided by the 2013
Decentralisation Diagnostic Study, issue a plan of actions and guidelines to sector
institutions for the transfer of functions from central government institutions to local
governments;
2. Issue guidelines to all sector institutions on streamlining their legal and policy
frameworks in order to embrace decentralisation. This may be limited to future
enactments of legislation or the formulation of policies, as the case may be, so that they
explicitly address and comply with decentralisation principles;
3. Formulate and prepare to implement a change management and capacity building
plan to prepare LGs and central government sector institutions for their roles under the
new dispensation of roles based on the Decentralisation Policy;
4. As provided in the 2013 Decentralisation Diagnostic Study, formulate and implement a
plan to reorient the Ministry for Local Government and Ministry of Finance so that their
coordination roles under the Decentralisation Policy are implemented effectively;
5. In the opinion of the Consultant Team, one of the greatest impediments in
implementing quality services unique to Lesotho is the distance, time and expense (by
foot or motorized) it takes citizens and service providers to receive and give services.
In 2011, the GoL reduced by approximately one-half the number of Community Councils
(CCs). It is highly recommended that the previously closed CCs be re-established or that
satellite centres be established to fill these gaps, and as mentioned previously, key

sectors must be decentralized. Moreover, sector staff in the districts must have enough
trained staff to cover their district as well as adequate transportation; and
6. Detailed findings of the HHs, FGDs and KIIs surveys should be presented to citizens and
local government officials in the districts in which citizen reviews can be undertaken. As
a result of these citizen reviews, the DDP should work with local consultants to develop
a curriculum for delivery to district officials in three priority areas: communications,
participatory budgeting, and mechanisms for citizen feedback on local government
performance and delivery of public services.
1.3. Possible Solutions
Best practice is a method or technique that has consistently shown results superior to those
achieved with other means, and that is used as a benchmark. In addition, a best practice can
evolve to become better as improvements are discovered. The Team made an extensive
review of other countries’ experiences with relevant strategies to improve service delivery
at the Local Government level. Moreover, the Consultants have extensive experience
working with similar practices in numerous other countries. Set forth below are some
solutions to consider when going forward with improved methods to delivery public
services:
Issue Possible Solutions to Consider
Citizen
Participation
 Districts could develop more innovative communication strategies
to inform citizens about the policies, programmes, services and
initiatives of the local government; listen to the public; and
respond to citizens’ needs.
 Collaboration with CSOs and CBOs could also be promoted to
utilise their comparative advantage for being on the ground to
raise awareness on the policies, programmes and services.
 District councillors could meet with citizens and visit communities
more often.
 An audit mechanism could be established to evaluate government
performance.
 Community committees (Village Development Council/Committee)
could be promoted as the main mode of community organisation
at the local level and the main channel through which citizens
could influence decision-making processes. They could also serve
as the main source of information about district activities. 2
Women in the
participatory
processes of LG
 Local governments could use civic education to include more
women in participatory processes at the local government levels.
 Cooperation with local women’s NGOs could help build capacity
among women and motivate them to voice their interests.
Citizens exercise
their rights
through grievance
 Local governments could work with service providers to establish
and promote grievance mechanisms with the aim of improving
service delivery.
2 Lessons learned and best practices of a Citizen Review of Service Delivery and Local Governance in
Zambia, WB, 2004, Kenya, WB, 2009, Indonesia, WB, 2006, Bosnia and Herzegovina, WB, 2009.

Issue Possible Solutions to Consider
mechanisms  If the problem cannot be solved immediately, the reasons should
be explained to citizens.
 Introducing a participatory performance monitoring system that
takes place on a regular basis (such as a social audit or citizen rating
card) could help identify and address service delivery problems.
Local
government's
management
capacity,
prioritization
mechanisms,
financial
resources and
qualified
personnel.
 Additional resources could come from citizens’ financial
participation, such as through voluntary contributions, private
financing of projects, and higher taxes; new government
investments; and greater financial commitments from higher levels
of government.
 Government actors should focus more on the quality, quantity and
reliability of services to ensure both access and satisfaction.
 District agencies should employ more qualified, professional staff.
 Local governments could adopt a formalized code of conduct for
civil servants.
 Transparency and citizen monitoring of service delivery could help
prevent corruption.
 Local governments and service providers could hire more
inspectors to contribute to higher quality public services.
LG responsibilities
between local and
other government
levels.
 Government actors could strengthen the decentralization process
by promoting and moving forward with the Decentralization Policy
of 2014 and synchronize districts responsibilities and financial
resources with the appropriate workloads.

2. Introduction
2.1. Background
The Government of Lesotho in partnership with the United Nations Development
Programme (UNDP) and United Nations Capital Development Fund (UNCDF) with funding
from the European Union is implementing a four year (2012-2016) programme titled
“Deepening Decentralization Programme” (DDP) in Lesotho. The programme is being
implemented under the Ministry of Local Government, Chieftainship (MLG). The main
purpose of the programme is to promote decentralized service delivery for social economic
growth through the development of transparent funding mechanisms and by improving the
accountability of local authorities. Specific components of the programme are: i) improving
development funding through local authorities, ii) promoting decentralization and
accountability systems at the local level and iii) enhancing the capacities of line ministries
and local authorities to decentralize functions.
Line ministries have been delivering services at the national and local level, while the local
authorities are mandated under the Local Government Act, 1997 schedules 1 and 2 to
provide some services. The Local Authorities have also been receiving grants from the
central government for local development.
Under the DDP, the Government of Lesotho, the (GoL) is receiving a Local Development
Grant accessed by the Local Authorities to assist them to successfully undertake assigned
functions and deliver public services to community members as defined by the 1993
constitution and Local Government Act, 1997 as amended. Implementation of this fund is in
its first year.
The Government of Lesotho is committed to deliver quality services at both central and local
government levels. According to outcome three of the Lesotho United Nations Development
Assistance Plan (2013-2017), the UN in Lesotho is committed to support the GoL to achieve
by 2017, national and local governance structures that deliver quality and accessible
services to all citizens.
2.2. Service Delivery by Local Governments3
Previous studies identified the continued implementation of de-concentrated functions as
limiting the roles and visibility of Councils in service delivery. Many of the key
socioeconomic functions (health, education, agriculture, water, etc.) which affect citizen’s
wellbeing were planned for and delivered directly by central government. This arrangement
affected the image and profile of the Councils as agents that can impact services among the
citizens.
In the Diagnostic Study of Decentralization carried out by DDP in late 2013, many comments
and complaints came from Councils regarding factors that limit their efforts to effectively
serve their communities. They attributed this state of affairs to poor cooperation and
3
The following sections are excerpts from the MoLG Diagnostic Study of Decentralisation carried out
by DDP in late 2013 by the same consultants that are carrying out this survey.

support received from central government. Most of the problems that the Councils raised
related to budget forecasting, delays in local financing, and insufficient budget allocation
promised to them in the form of grants from central government.
Staffing and competences were another key factor limiting delivery of services by Councils.
Low staff complements were also affecting service delivery. This situation was not helped by
the slow recruitment process through the Local Government Service Commission. For
example, Maseru Municipal Council (MMC) had difficulty maintaining sufficient staff at its
two clinics leading to a severe degradation in services over the years.
Low funding and the inability to raise revenues locally also hampered Councils’ efforts to
deliver services. Services in the areas of solid waste management, drainage, soil erosion,
keeping utilities (electric and water) running and maintaining such basic services as public
toilets were particularly affected by low financial resources. Councillors expressed
frustration that as elected members that made promises to their communities, they could
not move forward on their commitments because of the lack of financial resources. To make
matters worse, budget allocations were routinely cut to the point that Councils could not
even keep up with their running (overhead) costs, salaries, etc. Many Councils also
confirmed the accumulation of arrears (outstanding debts to suppliers).
Councils were generally very frustrated by the delays and lack of response for support.
Predictable project implementation had almost become impossible. This is particularly
serious at the Community Council level since they are wholly dependent on funding from
the District Councils. Councillors often stated that they did not receive enough support and
felt that they were in a relatively rigid system that does not appreciate their value to the
communities.
This situation is expected to change, with the implementation of the recently adopted
Decentralisation Policy and Support Programmes such as the DDP as outlined below:
2.3. New Structure and Relationship within Local Government4
Under the recently adopted Decentralisation Policy, the Head of the Local Government shall
be the Mayor with 2 Vice Mayors, one in charge of Economic Development Affairs and the
other in charge of Social Development Affairs. The Mayor shall have executive powers. The
Mayor will regularly report to the Council on the Executive’s vision and development plan,
as well as provide briefs on progress towards the implementation of approved plans, and
the state of the District to which Councillors may ask questions or seek clarification. Vice
Mayors will provide day to day political supervision of the implementation of plans in
respective domains (clustered under social and economic development affairs).
The District/Municipal Councils shall be presided over by a Chairperson. The Council’s
principal task shall be to formulate local legislation (bylaws) and to provide checks and
balances through political oversight on the local government operations, as representatives
4
National Decentralization Policy, Ministry of Local Government, Chieftainship and Parliamentary
Affairs, P.O. Box 686, Maseru 100, Lesotho. February 2014.

of the people. The scope of jurisdiction for local legislation shall be determined by law. The
Council shall be comprised of directly elected Councillors and persons specially nominated
on the basis of their expertise, experience and specific interest in the development of the
area. These nominees shall not be remunerated as Councillors but may be facilitated in
the course of their work as the Council may afford. They may be requested to chair
special committees such as on budget and accountability.
The District Executive Secretary (or Town Clerk in the case of Municipal and City Local
Government) shall be the Chief Executive of the District responsible for all financial and
administrative matters. S/he will report to the Mayor and will execute the decisions and
directives of the Executive through the administrative and technical structures. All staff in
the Local Government shall report to him/her. However, Heads of Departments and
technical staff will have a direct technical relationship with respective line ministries for
purposes of the smooth execution of sectoral functions and to avoid overloading the
District Chief Executive with unnecessary bureaucracy. The District Executive Secretary shall
be the most senior civil servant and the Head of the Public Service in the local government.
The Technical Departments will be headed by Directors who will be responsible for
developing and executing technical plans in their areas of jurisdiction, within the priorities
set by the local government executive, ministerial/ sectoral plans and national policies.
The technical and administrative structure at the lower level (Community and Urban
Councils), shall be headed by the respective Executive Secretary or Town Clerk. These shall
report directly to the District Executive Secretary/ Municipal Town Clerk.
2.4 Objectives of the New Decentralisation Policy5
In 2014, the Government passed a new Decentralization Policy. The purpose of the
Decentralisation Policy is to deepen and sustain grassroots-based democratic governance
and promote equitable local development by enhancing citizen participation and the
strengthening of the local government system, while maintaining effective functional and
mutually accountable linkages between central and local government entities. The specific
objectives of the Policy are to:
1. Increase citizens’ access to public services;
2. Ensure quality and accountable service delivery at local levels;
3. Increase the participation of citizens and non-state organisations in governance and
service delivery;
4. Promote equitable economic development;
5. Promote livelihood and economic security;
6. Enhance local autonomy by ensuring that local government institutions are
sustainably capacitated and organised with a strong collective voice; and
7. Promote the preservation of national values, identity and unity by re-positioning
and empowering the chieftainship and other traditional institutions.
5
National Decentralisation Policy, Ministry of Local Government, Chieftainship and Parliamentary
Affairs, P.O. Box 686, Maseru 100, Lesotho. February 2014.

2.5 Re-defining the Role and Position of Chiefs and the
Chieftainship
The Government considers devolution a new and remarkable phase of Lesotho’s
democratisation process. It however, appreciates that the Chieftainship and chiefs will
remain integral part of the country’s local governance, albeit with re-defined roles to
create harmony and avoid conflicts.
The Government will ensure that chiefs at all levels and in all parts of the Kingdom are well
positioned and facilitated to effectively serve as the symbol of Basotho’s identity and unity;
custodians of Basotho culture and security; and embodiment of His Majesty’s authority,
while advancing the principles of grass-root democracy, local justice, security, human rights
and accountability.
The Government will ensure that the dignity, respect, authority and relevance of chiefs and
the Chieftainship institution is maintained, preserved and promoted by improving their
welfare; and ensuring that they conduct themselves in ways prescribed by the Chieftainship
code ofconduct; and have the information, knowledge, facilities and tools to perform their
roles under decentralisation .
Strategic actions include:
1. Ensure that village chiefs are protected from partisan political activities and such
other activities as are likely to compromise their neutral and inherited authority;
2. Review the status, functioning and welfare of chiefs and identify appropriate
functions and platforms for chiefs and the chieftainship institution in the democratic
decentralisation process;
3. Review legislation and institutional structures to ensure appropriate placement and
functioning of chiefs while maintaining their dignity, respect and authority; and
4. Ensure that chiefs at all levels are adequately empowered, facilitated and equipped
to actively and effectively play their new roles, such as conflict mediation.

3. The Survey Scope
3.1. Purpose of the Assignment
The main purpose of the assignment is to provide baseline information about the quality,
quantity and accessibility of service delivery in Lesotho in order to measure progress as a
result of interventions to improve service delivery. The Survey findings will provide a
benchmark upon which contributions by the DDP will be evaluated. The results of the
Survey will also provide baseline information for policy formulation/reforms for
implementation, coordination and monitoring of improved service delivery at both national
and local government levels.
3.2. Objectives of the Survey
1. To assess the accessibility and quality of service delivery at the central and local levels in
Lesotho using international protocol of service delivery;
2. To ascertain the level of satisfaction (in terms of accessibility, quality, timeliness etc.) of
citizens with regard to national and local service delivery institutions in Lesotho;
3. To identify the institutional capacity needs to support decentralized service delivery;
4. To identify challenges faced by community members in demanding and accessing
services;
5. To examine the existing oversight mechanisms for quality assurance in service delivery
and accountability; and
6. To document best practices and provide recommendations for improving service
delivery.
3.3. Scope of Work
The Survey covered selected sectors namely; education, health, agriculture, energy, water
and sanitation, road infrastructure, social protection, civil registry and institutional capacity
and efficiency. The Survey covered households in six districts selected based on their
demographic diversity. The indicators of focus during the Survey from the service users
include the following:
1. Availability and access to the services: The availability of services as well as the access
to services was determined in the selected sectors in the six districts. It is one thing to
make services available and another thing for the services to be accessed by those who
need them. The two elements require systematic planning and coordination from the
supply and demand side. This indicator measures whether the citizens have access to
the services provided by government, and whether the services provided are utilised.
Utilisation is a critical element of service delivery as it looks at the efficiency of service
provision from the supply and demand side.
2. Satisfaction: This measures how well the services meet the demands and quality
expectations of the citizens. Satisfaction measures the quality, quantity, and timeliness
highlighting the issues of the relevancy of the services, their efficiency and the extent to
which the services are designed to meet the needs of the citizens.

3. Factors limiting access and utilisation: These factors were determined from the service
users and from the providers. Having good knowledge of factors that hinder access and
utilisation enables proper planning and delivery of services that are useful to the
citizens.
4. Grievance handling processes in place: The process of service delivery brings the
providers and users together; normally there are grievances encountered which must be
addressed to ensure successful service provision. The process of grievance handling in
place was assessed. Moreover, the Team looked at this issue in terms of whether there
are participatory and transparent mechanisms in place.
3.4. Deliverables
1. Inception report showing the Consultant’s understanding of the ToR in relation to the
scope of the assignment. The inception report will include the methodology and a work
plan.
2. Draft and Final Service delivery survey design.
3. Draft report of the service delivery survey.
4. Final report of the survey and related observations and recommendations.
3.5. Institutional Capacity
The scope of the ToRs included an institutional capacity assessment in relation to service
delivery. The 2013 UNDP/UNCDF/EU supported Diagnostic Study on Decentralization
provided baseline data on the state of the institutional and organisational management of
local authorities’ operations. The Study focused broadly on administrative institutions, both
at central and local government level that play critical roles in implementing Lesotho’s
decentralisation programme. The focus of the consultancy was to appreciate the capacity of
service delivery institutions in sectors covered by the Survey (education, health, agriculture,
energy, water and sanitation, social protection, road infrastructure and civil registry) in the
context of the recently passed Decentralisation Policy. The Survey was be used to obtain
perceptions from the citizens on the capacities of such sector institutions. In addition,
interactions were extended to relevant central government sector institutions to
understand key capacity challenges and needs and to generate recommendations for
interventions.
3.6. Emerging Issues
At the request of the key donor clients, the Team included the following additional Sectors
in the Survey not included in the original ToR: 1) Social Protection; 2) Child Protection; 3)
Forestry and Lands, and 4) Issues related to Chiefs. After the Team met with key
stakeholders, the Team updated the Survey tools to include all of their comments and
recommendations. Additionally, the Team brought in an M&E specialist to design, supervise
and train the surveyors and analyse the completed Survey tools.

4. Approach and Methodology
As much as possible, given the challenges at the local government level, the Team followed
the methodology outlined in the ToR. The depth and details of the discussions depended
greatly on the availability of key stakeholders and relevant data, both at the national and
local levels. The following key elements of the methodology were adopted for this study.
1. Document Review: Review of programme documents, including relevant reports and
surveys; review of GoL reports; review of policy documents.
2. Qualitative Analysis: Key Informant Interviews (KIIs) with key stakeholders, other
donors, and key GOL officials; KIIs with local government officials, councils, District
Administrator (DAs), NGOs, women and youth; and Focus Group Discussion (FGDs) with
key local participants.
3. Quantitative Analysis: Survey on access and satisfaction of services at household level
with 1,116 households across six districts of Lesotho delivery.
4.1. Document Review
The Team undertook an extensive literature review during the inception period of the study.
The Team obtained a wide range of documents and materials from the client. The full list of
documents and materials collected is provided in Annex 10. The Team prepared and issued
its Inception Report based on the knowledge and understanding acquired during the
inception stage. Collectively, these documents provided background and contextual
information on service delivery issues.
4.2. Key Informant Interviews (KIIs) and Focus Group
Discussions (FGD)
Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) provided a useful source
of information for the study. Individual key-informant interviewees included: members of
local government bodies, staff from local government ministries, staff of donor organisations
working with local government, local opinion leaders, community members and
beneficiaries, etc. FGDs, included, when possible, balanced numbers of men and women as
appropriate to local circumstances. The study carried out two FGDs in each of the 6 districts,
one each in the urban and rural areas.
The KIIs, FGDs were guided by a tailored discussion protocol, appropriately adjusted for
different types of participants. Each KII was guided by an interview protocol, appropriately
adjusted for different types of interviews. The purpose of the protocols was threefold:
1. To ensure all key issues are covered during interviews;
2. To elicit rich, sometimes unanticipated, information from informants; and
3. To help to organise information in a form that can be usefully and efficiently analysed.
The Survey Team met with several sets of key stakeholders at the national level. In addition
to discussions with UNDP, UNCDF, GIZ and the EU, the Team conducted Key Informant
Interviews (KIIs) with representatives in a wide variety of the sectors examined in this
report. The Team ensured that key issues regarding service delivery and institutional
capacities in the sectors identified in the scope were discussed in depth through a

participatory and open FGD process that encouraged concerns of communities to emerge.
The Team tried as much as possible to facilitate/organise information in a concise form that
can be usefully and efficiently analysed.
4.3. Quantitative Analysis
The Survey questions covered aspects of access to services, satisfaction with services and
timeliness of services. There were closed questions referring to participation in service
delivery, and open questions about the improvement in service delivery.
Quantitative analysis was undertaken following field activities - to assess whether citizens
had been able to access services in the different sectors and the level of their satisfaction.
The Survey results were used to inform and complement other in-depth field work in the
form of FGDs and KIIs with participants and other stakeholders.
4.4. Approach
The approach to the Survey was phased in four different but closely interlinked stages
including: The Inception stage, Data Collection stage, Data Analysis stage and the Report
Writing stage. These are standard processes for surveys of this type.
4.4.1. Inception Stage
The first phase of the assignment was to produce an Inception Report, and a survey design
presenting the agreed methodology and a work plan for undertaking the Survey. The
Inception Report was based on the ToRs and technical guidance from the client. The
inception stage required discussions between the Consultants and the Government of
Lesotho representatives, UNDP, UNCDF and EU officials to agree on a methodology and
work plan for the execution of the Survey. The inception phase addressed the following:
1. Discussions of the approach and methodology to execute the assignment;
2. Soliciting of key documents related to the assignment for literature review;
3. Agreement on the sample procedures and the sample size;
4. Agreement on time lines, deliverables, deliverable dates and key workshop dates;
5. Development of the survey tools and profiling of key informant interviews;
6. Agreement on the field work plan;
7. Completion and approval of the survey design;
8. Confirmation of quality assurance procedures;
9. Training of research teams;
10. Pretesting the survey tools; and
11. Field work planning and dispatch of teams.
4.4.2. Sampling Design and Sample Selection
The Survey had a mixed methods approach for the assessment, including KIIs, FGDs,
document reviews and the use of questionnaires at the household level. The sampling for
key informant interviews was confirmed with the client and a list of Key informants met is
included as Annex 7. The sample of the households was calculated using a sampling formula
by Taro Yamane (1967).
𝑧2 𝑝 1−𝑝𝑁

n=
𝑧2p1−p + (𝑒)2
Where,
n is the required sample,
N is the household population size,
e is the assumed level of precision, set at 0.03,
z is the value of the standard normal variable given the chosen confidence level. Our
confidence level is 95%; therefore the Z value is 1.96, and
p is the proportion or degree of variability/success estimated at 0.5.
1. Selection of six districts: The selection of districts was guided by the client and used two
main factors: the poverty levels of the districts and the distribution between low and high
lands. As such, the selected districts include those with the lowest and highest levels of
poverty. The table below shows the six districts, their relative poverty levels (UNDP 2015)
and their categorisation as Low or High land.
Table 2: Six selected districts:
District Poverty levels High/Low lands
Butha Buthe 67%, Both High and Low land
Mohale's Hoek 66% Both High and Low land
Mafeteng 62% Low land
Maseru 56% Low land
Quthing 42% High Land
Thaba Tseka 46% High land
2. Selection of sample size: With the districts selected, the Team determined their
household population sizes as per the latest projections from the Lesotho Bureau of
Statistics shown in the table below:
Table 3: Population in the six districts
No. District Total Population6
per district
House Holds Ratio of HH in
the sample
1 Botha- Bothe 104,690 23,793 0.09
2 Maseru 474,791 107,907 0.14
3 Mafeteng 183,268 41,652 0.10
6 Mohale’s Hoek 171,069 38,879 0.11
5 Quthing 118,948 27,034 0.09
6 Thaba Tseka 136,094 30,930 0.14
Lesotho 188,860 270,195 1
6
The source of these figures is the 2015 population projections by the Lesotho Bureau of Statistics.

3. Using our formula, above where
n is the required sample,
N = 270,195
e = 0.03
z = 1.96
p = 0.5
1.96*1.96 *0.5 (1-0.5) 270,195
1.96*1.96*0.5(1-0.5) +270,195*0.03*0.03
= 259495.3/244.1359
n= 1,062.913
A non-response rate of 5% was added, to cater for any forms of non-response, thus bringing
the final sample size to: 1,066.913 + 53.146 = 1,116. The final sample (n) was therefore
1,116 households.
Since each district has a different population, the relative populations determined the size
of the sample as shown in the table below:
Table 4: Sample distribution per district
No. District House
Holds
Ratio of HH in the
sample
HH Qnrs
1 Botha- Bothe 23,793 0.09 98
2 Maseru 107,907 0.14 446
3 Mafeteng 41,652 0.10 172
6 Mohale’s Hoek 38,879 0.11 161
5 Quthing 27,034 0.09 112
6 Thaba Tseka 30,930 0.14 128
Lesotho 270,195 1 1,116
The entire household numbers allocated to each district were interviewed. The basis of
selection of households was random, although this was completed in selected councils. Two
councils in each district were selected; an urban and a rural council. The household head or
the representative of the household head was interviewed in each household.
4.4.3. Developing Data Collection Tools
Data collection tools were developed, in line with the requirement to address specific
indicators and objectives listed in the ToR. The Survey tools (in Annexes 1-4) include:
1. Key informant interviews (KIIs) guides for national and local government stakeholders;
2. Focus Group Discussions (FGDs) for community members;
3. Structured Questionnaires for household interviews; and
4. Document review checklists for various key documents.

5. Translation of tools: The Household questionnaires were translated into the Sesotho
language, to ensure that the questions were clearly understood and responded to
consistently.
6. Training of researchers: UNDP, DDP, UNVs, and UNFPA UNVs conducted the household
interviews and organised community Focus Group Discussions. UNV researchers were
vigorously trained in the survey tool-kits, and attended the pretest sessions to acclimatize
themselves with the questions and processes.
7. Completion of survey design report: The survey design report was prepared, with all agreed
methods, samples and tools. This was submitted to the client for approval prior to the Team
proceeding with the pretesting of tools.
8. Pretesting: Pretesting of questionnaires was conducted:
 To familiarize the researches with the questions;
 To determine the average time it takes for each questionnaire, in order to plan and
allocate practical targets to the researchers; and
 To ensure that the questions are understandable, clear and easily translated into the
local languages, especially the part of the existing interview.
9. The field work stage organisation: Field work was led by the Consultant Survey Coordinator
who provided overall quality assurance and guidance. The Field work stage involved KIIs at
the central level, FGDs and administering of questionnaires in the six districts. The
Consultant Team carried out Key Informant Interviews within the central (sector line
ministries) and local institutions (District Councils, etc.), and was assisted by additional
researchers where necessary.
10. Quality assurance for field work: Field work was supervised by the Consultant Team. The
Team monitored the work done by each district team leader, to ascertain the day’s field
work activities, challenges and constraints. Any issues arising were addressed by the
Consultant Team and where need be, in consultation with the Client. The assignment team
leaders provided feedback on the progress of the field work to the Consultants weekly. If
questionnaires were inappropriately filled-out or incomplete, the researcher was asked to
make a second visit to the household to complete them. The district team leader consulted
with the Consultant Team on any clarifications that was needed during the course of the
field work.

4.4.4. Data Management and Analysis
This stage had a set of activities interlinked to enable final outputs, conclusions and
recommendations.
1. Data cleaning: this preliminary review of questionnaires in the field by the district team
leaders was done on a daily basis. This was aimed at ironing out errors and omissions
and to make any clarifications while in the field. This process ensured high quality
datasets.
2. Data entry: this was done using Epi-data 3.02 and exported into SPSS and STATA. Data
was further cleaned using both visual and computer aided checks based on summary
statistics in order to identify errors, missing cases, outliers, and extremes before the
final analysis was done.
3. Data analysis: analysis was done using SPSS version 17.0 where the summary statistics
included frequencies, percentages means and totals. Results were presented in legible
text, graphs, tables and pictorial evidence where necessary.
4.4.5. Qualitative Analysis
At the stage of analysis and report writing, the Team used information generated through
the document review described and triangulated it with the results of qualitative analysis, in
the form of Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) with
stakeholders. The Team analysed the information collected to establish credible answers to
the questions and provide major trends and issues.
4.4.6. Report Writing
The draft report was written using the analysed qualitative and quantitative data. The draft
report will be presented to the stakeholders for validation. Comments arising from the
validation workshop were used to finalize and fine-tune the report in readiness for the final
submission.

5. Findings
5.1. Education
The national Constitution stipulates that Lesotho shall endeavour to make education
available to all and shall adopt policies aimed at ensuring: a) education is directed to the full
development of the human personality and sense of dignity and strengthening the respect
for human rights and fundamental freedom; b) primary education is compulsory and
available to all; and c) fundamental education is encouraged or intensified as far as possible
for those persons who have not received or completed their primary education.
Education services are delivered mainly through the following key programmes within the
sector; Integrated Early Childhood Care and Development (IECCD); Free Primary Education
(FPE), Secondary Education, Higher Education and Technical and Vocational training
(HETCT).
IECCD programmes have been a part of the basic education framework since the early
1990s. It is available to children aged 2 to 6 and offered through home-based and centre-
based providers. FPE is also compulsory, and is offered to all children of school going age.
Secondary education has received tremendous pressure from the FPE system (as the
numbers have grown significantly since it was introduced in 2000) due to limited number of
school facilities.
5.1.1. Availability and Access to Services
The survey sought to establish the availability and utilisation of services under the education
sector. The services surveyed were IECCD and free primary education in line with the
country’s focus on attaining MDG 2 on universal primary education.
1. Access to IECCD: About 63% of respondents said they had children between the age of
three and five years in the household, which is the IECCD school going age. 59% of those
who had children of this age group, said they were attending IECCD. 47% in the urban
and 73% in the rural areas reported that the children were in school. This shows that the
rural areas have responded better to sending their children to the IECCD.
Respondents were asked to give reasons for not taking their children to IECCD. A list of
pre-determined reasons was read to the respondents and the results in the figure below
were returned:

Figure 1: Reasons for not taking children to IECCD schools
Overall, the main reasons given for not taking children to IECCD included; not reasonable
for that age group to go to school (37.% in urban and 28% in rural), poor facilities at the
IECCD (33% in rural and 24% in urban) and lack of money to facilitate the education of
children (29% in rural and 13% in urban). There were other reasons cited by FGDs such
as poor feeding and hygiene.
2. Quality of IECCD schools: Respondents whose children were in IECCD were asked to rate
the quality of the IEECD schools using the scale of Very Poor, Poor, Neutral, Good and
Very Good. The results are shown in the figure below:
Figure 2: Perception on Quality of IECCD

The average time taken by the
children to reach their school is
48 minutes; 42 minutes in the
urban and 51 minutes in the rural
areas.
Respondents generally rated the quality of IECCD highly (Very Good - 11%, and Good -
40%). Only about 29% thought it was poor (Poor - 22%, Very Poor - 7%)
3. Access to FPE: The 2009 MDGs report places Lesotho’s primary schools enrollment at
80.9%. 59% of the respondents had children of Primary going age in their households.
These children attend both private and public schools as shown below:
Figure 3: Types of primary schools attended
Public primary schools are most widely attended by children with 81% while only 19%
attended private schools. Private schools are most used in urban areas (about 25%)
while children in rural areas are less likely to go to private schools (about 9%).
4. Mode of transport to primary schools: Distance to
primary schools is one of the major constraints faced
by children attending FPE. From the Survey, the
majority of the children (85%) walked to school in the
rural areas and in the urban areas (75%). A small
percentage used public and private transport mainly
in the urban areas. The average time taken by the
children to reach their school is 48 minutes; 42 minutes in the urban and 51 minutes in
the rural areas.
5. Quality of education (FPE): Respondents were asked to rate the quality of education.
The results of this process are shown as below in Figure 4:

Figure 4: Quality of education
The quality of education was rated generally high by respondents. As seen from the figure
above, about 40% and 14% believe that the quality of public primary schools is good and
very good respectively, while only about 23% in the rural and 16% in the urban rate the
quality as poor or very poor.
5.1.2. Satisfaction with Different Aspects of Education Services
Respondents were asked to rate their satisfaction with the different aspects of education.
The aspects where respondents were mostly very unsatisfied included; school feeding
(45%), quality of infrastructure (33%) and distance to school (31.6%), while the services
where respondents were satisfied included: quality of teachers (64%), quality of education
(57%) and quality of taking care of children (51%).
5.1.3. Factors Limiting Access to Services
Through FGDs, the following factors were identified as constraining education services:
1. Inadequate service infrastructure - buildings and classrooms, particularly for early
childhood development centres, were cited as major factors. Government does not
provide buildings to house IECCD. Some of these schools have classes in makeshift
structures or dilapidated buildings which pose a danger to the students.

In Litseotse council in Thaba
Tseka, the parents said that 30
tins of fish are used to feed 300
children. In several places it was
reported that children are fed on
maize brand (Papa) and salt.
An Early Childhood Development Centre in Mafeng Young children attend IECCD in Mafeteng
2. Parents not meeting their financial obligations; Lack of funds to pay the IECCD
facilitators: Parents under the IECCD programme are required to make regular
payments (40 Maloti monthly) to facilitate the teachers. However, 80% do not meet this
obligation on time or do not pay at all. This leaves the facilitators underfunded and de-
motivated. Discussants in the FGDs proposed that government take up the responsibility
to make the payments as they felt that most parents could not afford it.
3. Shortage of food supply at the IECCDs and primary schools: Several FGDs widely
stated that their children had gone without meals for lunch because the supplies ran
out. This means the parents have to pack food for their children or may not send them
to school when meals are not provided.
4. Inadequate portions or poor food quality for FPE:
The most common complaint was the poor quality
of food at the primary schools; In Litseotse council
in Thaba Tseka, the parents said that 30 tins of fish
are used to feed 300 children. In several places it
was reported that children are fed on maize brand
(Papa) and salt.
5. Hidden costs that deter some parents from taking children to schools: There are some
costs that were reported by parents i.e. building maintenance costs, uniform costs which
still hinder enrollment and continuity of primary education.
6. Declining quality education: Many FGD discussants expressed worry at the declining
quality of education received from the FPE system. They were concerned that children in
some classes are promoted without proper assessment and even those who fail end up
getting promoted. Moreover, it was reported that the abolition of term exams affected
the quality of performance. Indeed this is in agreement with the international
comparison that ranks Lesotho’s primary education as low (World Bank 2011/12
database – data.worldbank.org).

7. Long distances to schools: As estimated from the survey, it takes about 48 minutes for
children to reach their schools on average. In some cases, children have walked through
difficult conditions – flooding rivers, for example children from Kololo village to Makoele
primary school and from Likhahleng village to Serut Primary school. This poses
significant danger to their lives. Two children reportedly drowned in December 2014
while trying to cross a river from Sekubung village to Lepekola primary school.
5.1.4. Grievance Handling Mechanisms
The School Board, at which parents and teachers are represented, meet quarterly to discuss
any issues and grievances. The respondents expressed satisfaction with grievance handling
mechanisms, which also included PTA meetings and parents contacting the teachers or
Principal directly regarding issues and concerns.

5.2. Health
Government of Lesotho’s main priorities in health sector include: strengthening
reproductive health care services; improving child survival and nutrition services;
strengthening HIV and AIDS prevention, care and treatment; improving tuberculosis
treatment success rate; improving Human Resources Management and Development; and
improving prevention of non-communicable disease.
Lesotho is currently ranked as having the 3rd highest HIV/Aids prevalence rate globally. 27%
of the female population aged 15-49 and 18 % of the male population aged 15-49 were HIV
positive according to the LDHS 2009. The 2006 Census placed Maternal Mortality Rate
(MMR) at about 939 per 100,000 live births - the highest in the SADC region along with
Malawi (MOHSW 2011). Child Mortality Rate stands at 23.7% (26.5% for males, 21.1% for
females) which is one of the highest in Southern Africa. The LDHS 2009 also reported that
61.7% of all children aged 12-23 months have received all basic vaccinations (and coverage
for individual vaccines ranges from 74.9% to 95.7%). It further states that 39.2% of children
are stunted (short relative to their age) while 14.8% are severely stunted.
5.2.1. Availability and Utilisation of Services
1. Availability: The availability of services was discussed through the FGDs. FGDs were
most commonly aware about services in the areas of HIV testing and counselling,
HIV/AIDS treatment, prevention of mother to child transmission, tuberculosis treatment,
maternal and child health care, diabetes treatment and immunisations.
2. Access to the different services: In terms of access to the different services, the
respondents were asked whether they or any member of their household had accessed
services from government health centres in the 12 months prior to the study. The results
are shown in the chart below.
Figure 5: Percentage of population accessing public health services

From the figure above, a large number of households surveyed, 78%, had accessed
public health services while 22% had not. In the urban area, this figures was 79.8%
compared to 75.6% in the rural areas. The most accessed health services were HIV/AIDS
sensitization (79.3%) and awareness, HIV counselling and testing (75.7%), child
immunisation (59.5%), family planning (57.3%) and adolescent health services (56.8%) –
see more details in Table 5 at the end of this Health section.
3. Quality of services: Users of the different services were asked to rate the quality of
health services that they received. Responses are reflected in the results presented in
the figure below.
Figure 6: Perception of quality of health services
The majority of respondents regarded the quality of services highly (good or very good).
About 84% of respondents in the urban areas rated the quality of health services as
Good (58%) and Very Good (26.4%), while 81% of the rural households rate services as
Good (56%) and Very Good (25.2%). The quality of health services across the districts
was rated good especially in the areas of HIV/AIDS treatment, care and counselling, as
well as TB treatment – see details in Table 5 at the end of this Health section.
4. Waiting time to receive medical attention: The time users wait to receive a service is a
good indicator of its accessibility and availability. Health service users gave the average
waiting time to receive a particular service as shown below:

The survey found that users
generally wait moderate times -
about 50% of respondents waited
between one to four hours to
receive services, while about 29%
waited between five to 12 hours
to receive services.
Figure 7: Waiting time for various health services
The Survey found that users generally wait moderate
times - about 50% of respondents waited between
one to four hours to receive services, while about
29% waited between five to 12 hours to receive
services. Only 3% said they had waited for more than
a day to receive services. The waiting time was closely
similar between the rural and urban areas.
5. Confidence with government health facilities: The
respondents were asked whether they had confidence in using government health
services. Respondents had a relatively high level of confidence in the health services
provided with about 65% saying they would confidently take their wives/go by
themselves to give birth in the nearest health facility, while 68% would take a sick child
to the nearest health facility for treatment.
5.2.2. Satisfaction with Health Service Provision Aspects
Respondents gave their perceptions on how satisfied they were with various service delivery
aspects. The aspects covered in the survey included the cost of medication and treatment,
availability of HIV/AIDS drugs, treatment by community health workers, level of amenities,
emergency services and distance to health facilities.

Figure 8: Perception on satisfaction with various health service aspects
Overall, there is a high degree of satisfaction with health services; about 43% in the rural
areas and 54% in the urban areas were satisfied (or very satisfied) with the services - see
figure above. About 39% in the rural and 26% in the urban were unsatisfied or very un-
satisfied.
Services that had the highest percentage of very unsatisfied respondents were; waiting time
(31% urban and 49% rural), distance to health facilities (18% urban and 46% rural), and
emergency services (19% urban and 39% rural). It is important to note that a high number
of respondents are affected by the long distances to health facilities and the lack of
emergency care services in the rural areas. More details on the satisfaction with each health
service aspect can be seen in Table 6 at the end of the Health section.
5.2.3. Grievance Handling Processes in Place
The survey found that about 72% did not know where to go to have their grievances solved.
Those who said they knew where to go normally referred to the District Administrator as
the office to approach when they have grievances. Some people in Butha Buthe claimed to
use radio stations to air out their grievances with health care providers.
5.2.4. Factors Limiting Access and Utilisation
1. Low health workers staff levels; participants cited the low numbers of health workers as
a major constraint to service delivery across all the districts. For example, a case was
cited Butha Buthe hospital where a woman was said to have delivered a baby with the
help of other patients in December 2014, because there was no midwife. The issues of
low health worker staffing gaps was identified in the NDP 2012 with levels (ratio of
doctors to population at 0.5 per 10,000 and of nurses and midwives at 6.2 per 10,000)
well below the WHO Africa region averages of 2.4 and 10.9 respectively.
2. Poor supervision: FGDs also raised the issue of supervision repeatedly. Most of the
challenges were related to health worker’s absenteeism. Past assessments have also

In Mafeteng district, it was
reported that people travel for
over four-five hours to go to
the nearest health centres.
In Makoabating community
council, a man from Ha-bofihla
was stabbed by his wife in April
2015, almost lost his life due to
bleeding for long hours but was
saved only using a hired vehicle
to take him to a hospital.
described the supervision system as a “routine” and insufficient for supervision of health
workers (Lesotho health systems assessment 2010).
3. Long distances to health facilities: This was said to be
a major challenge especially in the rural areas where
people take several hours travelling to the nearest
health facility. The average time to a health facility was
estimated at approximately one hour (64.2 minutes)
with 70.8 minutes in the rural and 52.2 minutes in the
urban areas. In Makoabating community council in Mafeteng district, it was reported
that people travel for over four hours to go to the nearest health centres.
4. Confidentiality in handling client information: Weakness in handling confidential
information was mostly associated with community nurses. Community nurses play a
vital role in linking the health service providers with the patients. However, it was
reported that some community nurses disclose client confidential information such as
HIV Status results to unauthorised persons. As such the respondents expressed a lack of
trust and an unwillingness to work with community nurses.
5. Shortage of medicines and supplies: Health facilities were said to often run out of drugs
with patients asked to go to private clinics and pharmacies to procure the needed drugs.
FGD cited particular examples of health facilities where drug stock outs were reported -
among them; Thabana Morena HC, Mount Olivett HC in Mafeng.
6. Expired medicines: Cases of expired medicines sometimes erroneously given to patients
were cited; there was a particular case of a woman from Telle Council in Quthing, whose
condition worsened after receiving ARVs from one of the health centres. When the
drugs were checked after one week, they were found to have expired.
7. Inadequate facilities and equipment: There are no antenatal rooms in some hospitals
i.e. St Mathew’s Health Centre in Telle Community Council in Quthing. Various FGDs
reported a shortage of beds in their districts. In Mafetenge, there was a shortage of
blankets in the main hospital. In Mahales’ Hoek Urban Council, there is no X-ray machine
in any public health facility and patients are forced to use private services which are
costly.
8. Lack of ambulance services: FGDs found the lack of or
inadequate ambulance service a major challenge –
particularly across highland areas. This was said to
affect the timely provision of health care services to
patients in critical conditions. For example, in
Makoabating Community Council, a man from Ha-
bofihla was stabbed by his wife in April 2015, almost
lost his life due to bleeding and was saved only using a
hired vehicle to take him to a hospital.

5.2.5. Grievance Handling Processes in Place
Most participants did not know where to go in case they had grievances with the health care
providers. Some mentioned that they go to the District Administrator; others use radio talk
shows to call in and voice their grievances on radio.

Table 5: Access and perceptions on quality of various health services
Services
Urban Rural
Accessed Quality of service Accessed Quality of service
Yes No Very
poor
Poor Neutral/not
decided
Good Very
Good
Yes No Very
poor
Poor Neutral/not
decided
Good Very
Good
Antenatal services 51.0 49.0 1.8 3.6 12.7 58.2 23.6 23.8 76.2 2.3 25.6 4.7 46.5 20.9
Delivery care 49.8 50.2 2.8 3.3 10.4 59.0 24.5 23.3 76.7 3.6 26.2 4.8 46.4 19.1
Postnatal services 50.8 49.2 0.9 4.6 11.5 59.2 23.9 22.6 77.4 7.3 20.7 4.9 47.6 19.5
Family planning services 57.3 42.7 0.8 2.4 14.6 55.3 26.8 36.7 63.3 0.8 3.9 7.0 66.4 21.9
Adolescent health services 56.8 43.2 5.8 6.2 16.5 52.5 19.0 35.3 64.7 3.3 9.1 11.6 66.9 9.1
Child immunization services 59.5 40.5 0.4 2.3 7.3 54.8 35.1 28.4 71.6 6.1 4.0 4.0 73.7 12.1
Services for sick children in need of
treatment 56.3 43.7 3.8 4.2 9.7 53.8 28.6 40.3 59.7 7.8 14.9 6.4 60.3 10.6
Community health education 54.9 45.1 4.5 11.5 9.5 56.8 17.7 47.9 52.1 2.4 5.3 5.3 64.7 22.4
HIV/AIDS sensitization and awareness 79.3 20.7 0.5 1.4 4.4 64.1 29.6 59.0 41.0 1.9 2.4 1.9 58.0 35.8
HIV counselling and testing 75.7 24.3 0.6 1.7 3.7 63.0 31.0 56.6 43.4 2.0 3.0 2.5 57.2 35.3
HIV/AIDS treatment 48.8 51.2 0.0 1.4 6.9 62.0 29.6 24.2 75.8 4.7 2.3 11.6 45.4 36.1
HIV/AIDS care and support services 43.4 56.6 0.0 1.6 7.4 63.5 27.5 18.6 81.4 4.7 0.0 10.9 43.8 40.6
TB treatment and support services 45.8 54.2 0.0 2.5 5.6 59.6 32.3 25.5 74.5 1.2 20.7 3.5 48.3 26.4
Growth monitoring sessions for
children 43.5 56.5 1.6 4.4 16.9 52.2 25.0 26.2 73.8 1.1 1.1 5.4 56.5 35.9
Nutrition education 45.9 54.1 2.6 6.2 13.9 56.2 21.1 36.9 63.1 2.3 0.0 7.6 58.3 31.8
Overall 54.6 45.4 1.7 3.8 10.1 58.0 26.4 33.7 66.3 3.4 9.3 6.1 56.0 25.2

Table 6: Perception on satisfaction with certain health service aspects
Facilities Urban Rural
Very
unsatisfie
d
Unsatisfie
d
Neutral/
Undecide
d Satisfied
Very
Satisfied
Very
unsatisfie
d
Unsatisfie
d
Neutral/
Undecide
d Satisfied
Very
Satisfied
Distance to the health facility 17.5 22.2 8.6 32.6 7.5 46.0 18.8 5.7 25.6 4.0
Care given by the health workers 11.0 13.5 17.2 48.8 9.6 26.6 16.4 9.4 41.9 5.7
Time of waiting to receive
medical attention 30.9 25.6 12.7 24.0 6.8 48.9 17.3 11.4 21.0 1.4
Level of amenities at the health
facilities 5.9 10.0 19.8 55.1 9.2 17.0 12.2 25.2 40.2 5.4
Availability of medicine and
supplies 7.8 19.1 13.5 50.3 9.4 24.7 25.3 6.0 39.8 4.3
Community health workers 6.7 13.7 24.5 43.7 11.4 10.3 9.7 32.2 37.3 10.5
HIV/AIDS Drugs (ARVS) 0.6 3.3 41.1 37.4 17.6 4.5 11.1 36.1 37.7 10.7
Cost of medication and
treatment 2.7 6.1 11.1 56.3 23.8 4.9 7.5 9.0 33.8 44.8
Emergency services 19.2 16.2 20.0 29.6 15.1 38.7 12.0 27.8 17.2 4.3
Overall 11.4 14.4 18.7 42.0 12.3 24.6 14.5 18.1 32.7 10.1

5.3. Agriculture
A big proportion (over 70%) of Lesotho’s population is reported to depend directly on
agriculture. The government has made commitments to support the sector with different
subsidy programmes over the years. The major services offered to the citizens are
community development and training of farmers on themes such as conservation
agriculture and modernising agricultural technologies (such as artificial insemination),
increasing agricultural output, irrigation, nutrition, extension services, husbandry, and
technical guidance. Support is also provided to farmers’ associations and to facilitate market
access. Provision of agricultural extension services and inputs, such as seeds, fertilisers, and
other farming materials including fields and farming tools and equipment is also a major
service.
5.3.1. Availability and Utilisation of Services
About 45% of the surveyed households had engaged in agricultural activities in the 12
months preceeding the survey. About 36% in the rural areas and 27% in the urban areas
reported to have accessed agricultural support services in the 12 months preceeding the
survey. FGDs identified a range of services most widely accessed by farmers including;
injections for pets; subsidies on seeds/fertilizers; food and nutrition training; training on
farming practices (demonstration farms); training on soil conservation and land
management. While some respondents claim to have access to these services, others
reported they had no idea as to how to get access to these services.
5.3.2. Satisfaction with Agricultural Services
The survey sought to identify the level of satisfaction with the agriculture services delivered
through various programmes namely; subsidy on seeds, tools and fertilizers; food and
nutrition sensitisation; crop and livestock marketing; support in livestock programmes and
management of animal theft. The Survey obtained results as seen in the table below:
Table 7: Satisfaction with agricultural activities
Rural (%) Urban (%)
Agriculture Services
Very
unsatisfied
Unsatisfied
Neutral/Un
decided
Satisfied
Very
Satisfied
Very
unsatisfied
Unsatisfied
Neutral/Un
decided
Satisfied
Very
Satisfied
Subsidy on seeds, tools and
fertilizers
30.3 23.9 13.0 29.2 3.5 51.6 15.9 19.0 11.1 2.4
Food and nutrition
sensitisation
19.2 18.9 26.3 29.5 6.0 47.6 16.9 21.8 11.3 2.4
Farmer training 28.5 12.7 18.3 26.1 14.4 40.0 16.0 26.4 13.6 4.0
Crop and livestock
marketing
31.7 16.5 39.8 9.9 2.1 54.0 20.2 22.6 2.4 0.8
Support in livestock
programmes
27.8 18.3 29.9 22.2 1.8 50.4 16.8 24.8 5.6 2.4
Management of animal
theft
34.2 4.6 6.0 36.3 19.0 52.0 15.2 13.6 14.4 4.8
Average 28.6 15.8 22.2 25.5 7.8 49.3 16.8 21.4 9.7 2.8

One participant in Thaba Tseka
remarked; “when I get the free
seeds, I wash them well to take off
the chemicals and cook them for
food because I do not know
whether I will be alive when the
harvest time reaches”.
Overall, higher levels of satisfaction were recorded in rural areas (about 33% satisfied or
very satisfied) than in urban areas (about 12% satisfied or very satisfied) with services under
the programmes considered in the Survey. Services provided under management of animal
theft were rated most favourably about 55.3% satisfied (or very satisfied) among rural
communities while subsidy on seeds (54.2%), crop and livestock marketing (48.2%), and
support to livestock programmes (46.1%) were rated unsatisfactory or very unsatisfactory
among the same communities. This indicates a need to strengthen the agricultural
marketing to enable farmers in rural areas get access to markets for their agricultural
products.
In the urban areas, respondents were mostly un-satisfied (or very unsatisfied) with
agricultural services with the poorest performing programme being crop and livestock
marketing (74.2%), followed by subsidy on seeds, tools and fertilizers, food and nutrition
sensitization, support in livestock programmes, and management of animal theft (65%-68%). The
high levels of dissatisfaction in the urban areas could be attributed to the fact that
agricultural support services are mainly offered in the rural areas.
5.3.3. Grievance Processes in Place
From the Survey, about 75% did not know the channels to address grievances with the
agricultural support services. For example most people said they were not happy with the
extension workers and how they select beneficiaries, yet they were not raising their
complaints with any authority.
5.3.4. Factors Limiting Access and Utilisation
FGDs provided the following factors constraining service delivery in agriculture:
1. Poor quality seeds: Respondents reported that some
of the seeds sold on the market are of poor quality
and sometimes fail to germinate. This was reported
mainly in Quthing and Thabatseka.
2. Diversion of seeds meant to other uses: In times of
hunger, seeds provided as inputs are sometimes used
for food. One participant in Thaba Tseka remarked;
“when I get the free seeds, I wash them well to take off the chemicals and cook them for
food because I do not know whether I will be alive when the harvest time reaches”.
3. Tractors for ploughing arrive late when the planting season is ending: Some of the
respondents were concerned that the tractors which are organised by government to
help farmers in preparing the farm land many times come late into the planting season.
This affects the planning of the farmers and the productivity of the land.
4. Inadequate water resources for farming: Many farmers fail to harvest good quantities
because of the devastation caused by the dry weather. While Lesotho has extensive
water sources, there are hardly any irrigation schemes to deliver some of the water to
farmers during dry conditions. Farmers have asked government to support them in this
area.

Animals grazing in Thaba Tseka An animal “kraal” in Thaba Tseka
5. The illegal importation of cattle: Illegal and unregulated imports of cattle are largely
from South Africa. This practice is reported to be harmful to the local breeds as some
of these animals do carry diseases which are passed on to others. This was reported
in Butha Buthe.
5.4. Energy
The government’s long term goal is to have universal accessibility and affordability of energy
across all of Lesotho but in a sustainable manner and with minimal negative impacts on the
environment. At the household level, energy is used mostly for cooking, space and water
heating, lighting, powering entertainment appliances (radios and televisions), and running
small-scale income-generating activities, which are more common in the urban areas
because of the relative availability of energy sources (Energy Policy Kingdom of Lesotho).
Sources of energy used include electricity, LP gas, paraffin, candles, coal and biomass fuels
(wood fuel, cow dung, crop residues and shrubs). The extent of usage of different energy
sources differs from urban to rural households, depending on the availability of energy
sources, as well as extent of disposable household income.
5.4.1. Availability and Utilisation of Energy Services
FGDs identified the main sources of energy mentioned for lighting, cooking and heating as
biomass fuels; paraffin and LP gas.
1. Main source of energy for lighting in your household: The Survey determined the main
source of energy for lighting as shown in the figure below:

Figure 9: Main source of lighting
Overall, the main source for lighting was identified to be electricity (48%). In urban centres,
electricity accounts for 73.8% but falls significantly to 12.7% in the rural areas. The next
source of energy for lighting was paraffin at 27.5% but more predominantly used in the rural
(45.5%) and lower usage in the urban areas at 14%. At 23%, the candle is also significantly
used but mainly among rural communities (at approximately 40%) and less so in urban areas
(11%).
2. Main source of energy for heating: The figure below provides the sources or energy
used for heating:
Figure 10: Main source of energy for heating

Final report National Local service delivery survey

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