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 last-mile transport friction — multi-transfer daladala routes, capacity-refusal of visibly ill passengers, and unaffordable private-hire alternatives — rather than by clinical or workforce 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 line from partner-agnostic subsidy to terrain-weighted pay-on-arrival dispatch, and set a 6-hour escalation SLA on flagged-critical referrals. Both changes are costable from existing budget.