Accepted Paper
Paper short abstract
This article examines the Queen Mamohato Memorial Hospital PPP in Lesotho and analyses factors behind the agreement’s premature termination. Drawing on field research conducted in 2024, it identifies design and implementation flaws that led to the cancellation of the PPP contract in 2021.
Paper long abstract
The attainment of Universal Health Coverage (UHC) is a central objective of both the 2030 Agenda for Sustainable Development and the African Union’s Agenda 2063. In this context, greater private-sector involvement in health financing is often promoted as a means of complementing insufficient public resources. Public-private partnerships (PPPs) in health have been identified as a promising strategy to mobilise private finance without increasing public debt. However, existing research suggests that health PPPs risk diverting public and development funds toward the private sector, with significant implications for health equity. This article examines the lessons that can be drawn from Africa’s first PPP hospital, the Queen Mamohato Memorial Hospital (QMMH) in Lesotho. In 2008, the International Finance Corporation advised the Government of Lesotho to enter into a PPP agreement with a South African healthcare company to design, build and operate a 425-bed referral hospital in Maseru. Promoted by the IFC as a ‘model PPP’, the project was expected to improve access to healthcare while enhancing efficiency and quality of service delivery. In practice, however, the PPP absorbed a significantly larger share of national resources than anticipated and was prematurely terminated by the Government of Lesotho in March 2021. Drawing on field research conducted in Lesotho in June 2024, this article analyses the design and implementation flaws that contributed to the project's discontinuation. It highlights how contractual complexity, fiscal rigidity, and governance challenges undermined the sustainability of the PPP, offering broader lessons for the use of health-sector PPPs in low-income contexts.
Reimagining public health: Power, inequality, and empowerment in uncertain futures in the global South