Loop closure across the Lushoto portfolio reached 74.0% this quarter, up from 61% at baseline — but the headline number obscures a sharp split between partners and terrain. Amref's highland catchments (Mlalo, Mtae) close 58% of loops against 84% for Mkombozi Trust in the valley corridor, a gap driven primarily by transport failure during the long rains rather than clinical factors. Three adverse outcomes this quarter all originated as referrals that never arrived at Bumbuli DDH; two had been flagged as high-probability failures by the system but the alerts were not actioned within the 6-hour window. Recommendation for Q3 allocation: shift the transport voucher line from partner-agnostic to terrain-weighted, and set a 6-hour escalation SLA on flagged-critical referrals. Both changes are costable from existing budget.