Queen 'Mamohato Memorial Hospital

The contract for the hospital was negotiated by the International Finance Corporation (IFC), an arm of the World Bank.^[11][4] The contract was signed in 2009 and was touted as by the IFC as a flagship model for public/private partnerships in Africa.^[6] In 2007, Bernard Sheahan, the IFC‘s Director of Advisory Services, said in a press release:

"This project provides a new model for governments and the private sector in providing health services for sub-Saharan Africa and other regions. The PPP structure enables the government to offer high-quality services more efficiently and within budget, while the private sector is presented with a new and robust market opportunity in health services."^[12]

For the construction of the hospital, the costs were split between the government of Lesotho (40%), Development Bank of Southern Africa (which is owned by the Government of South Africa) (almost 60%) and Netcare (less than 4%).^[13]

In 2012, the terms of the PPP contract were made public.^[13] Lesotho's government paid an annual $32.6 million (US) fee to Tšepong Ltd. consortium for a maximum of 20,000 in patient admissions and 310,000 outpatient attendances.^[13] If the number of patients served annually exceed these totals, the consortium would bill extra.^[13]

Africa Health reported in 2014 that the government of Lesotho was paying $67 million a year to the private consortium, which amounted to over 51% of its annual health budget.^[4] Oxfam reported in 2014 that the new hospital was costing the country at least three times what the old public hospital would have cost to run.^[6]

In 2014, the private shareholders were set to receive a 25 per cent rate of return on equity, meaning a cash income that was 7.6 times higher than their original investment.^[6] The deal was described by Oxfam as a "dangerous diversion of scarce public funds from primary healthcare services in rural areas".^[11] In 2016, a review of the contract in the journal Models of public-private engagement for health services delivery and financing in Southern Africa described the contract design as having "serious flaws"^[11]

In the spring of 2014, hospital workers went on strike for more than three weeks.^[14] The striking workers sought a pay review, and the strike included, what was described by the Lesotho Country Monitor as, a "violent confrontation with the police".^[14]

In 2021, The Reporter published an account of another strike, this time by nurses, who left their posts in February of that year demanding higher pay.^[15] The Lesotho Nurses Association reported that nurses at the hospital were paid about 9,000 South African rand a month, compared to nurses at other government-run hospitals, who were paid at least R13,000 a month.^[7] In March of 2021, the hospital dismissed 345 nurses and nursing assistants.^[7] This move is cited by The Reporter as the "final straw" that ended the contract between the government of Lesotho and Tšepong Ltd.^[15]

In a 2024 study by Annals of Global Health, employees expressed dissatisfaction with worker pay.^[9] They voiced concerns that the hospital was unable to recruit and retain experienced employees due to low pay.^[9]