July 1, 2017 marked a renewed start of the Maternal and Newborn Health (MNH) Performance-Based Financing (PBF) project funded by the World Bank and the Government of Lesotho, and implemented by the MCDI and HealthNet TPO Joint Venture, who act as the Performance Purchasing Technical Assistance (PPTA). Originally, this PPTA contract was slated to end in September 2017. Based on the success of the PPTA, the contract was extended for another XX year period until 2019.

PBF is a results-oriented, health systems strengthening approach that incentivizes health providers (public facilities or individuals) based on their performance and delivery of health services. Common elements of PBF include using independent agencies for a purchaser role or management support and having a controller (an intermediary between the purchaser and provider) who validates data and coaches providers for improved performance. The consumers of these PBF-verified services in Lesotho are women and newborns, as well as HIV and TB patients.

In Lesotho, local district data verifiers collect monthly data on the minimum package of activities at each health facility in their area, based on the facility reports and patient registers. The minimum package of activities for health centers and community level health providers includes services to be incentivized at the health center level with relative weights and fees. This package consists of twelve incentivized indicators, including, in part: the number of pregnant women having their first antenatal care visit in the first trimester, the number of women delivering in health facilities, and the number of children under 5 years old whose weight and height are monitored regularly according to protocol. The local hospitals' incentive systems are based on quality of care indicators, such as antenatal and HIV services. This incentivized data is used to determine payment of top-up salaries for Ministry of Health staff, and is available online for public knowledge.

As of 2015, Lesotho's maternal mortality ratio is 487 per 100,000 live births. The neonatal mortality rate dropped slightly from 33.4 per 1000 live births in 2014 to 32.7 per 1000 live births in 2015. 77.9% of births in 2014 were attended by a skilled health professional. These numbers indicate that there is more work to be done in order to strengthen the health service delivery system in Lesotho.