The Queen 'Mamohato Memorial Hospital in Lesotho was built under a public–private partnership (PPP), which is the first of its kind in a low-income country and has been described as opening a new era for private sector involvement in healthcare in Africa. Instead, the Ministry of Health in one of the poorest and most unequal countries in the world is locked into an 18-year contract that already consumes more than half of its health budget. This is a dangerous diversion of scarce public funds from primary healthcare services in rural areas, where three-quarters of the population live.

The PPP was developed under the advice of the International Finance Corporation (IFC) and is seen as their flagship model to be replicated across Africa. Lesotho’s experience supports international evidence that health PPPs of this kind are high risk and costly, and fail to advance the goal of universal and equitable health coverage. Oxfam argues in this report that the IFC should be held to account for the poor quality of its advice to the Government of Lesotho and for marketing this health PPP as a success internationally, despite its unsustainable costs.