The Queen Mamohato memorial hospital in Maseru, Lesotho's capital, was built to replace the Queen Elizabeth II hospital as part of a wider public/private partnership. Worryingly, its $67m a year running costs represent 51% of the country's total annual healthcare budget. This is a huge proportion, especially in such an impoverished nation where resources are always in short supply.
Talking to the Guardian newspaper, Mark Hellowell, lecturer in global health policy at Edinburgh University, calls it “the most ambitious public/private partnership in existence.” Understandably, this massive expenditure has come under intense criticism from a range of sources. In the end it could have a profound impact not only on Lesotho, but also on health policy at a global scale.
The International Finance Corporation (IFC), the private sector arm of the World Bank who advised on this initiative, have argued that the results prove the effectiveness of the model. They point to the fact that overall death rates at the hospital have dropped by 41% and that this fall has been even more pronounced in some instances, such as child deaths from pneumonia. The IFC also argues that the broader public/private partnership has improved healthcare for around a quarter of the country since starting in 2010-2011.
However, critics have argued that this does not justify the cost. Chief amongst them are Oxfam, who produced this report and who argue that this model of public/private partnership does not suit low-income countries, like Lesotho. They go on to argue that the Queen Mamohato memorial hospital is drawing resources away from equally needy rural areas, where much of the population live. Even the operations director at the hospital itself has recognised the risk of neglecting funding to other areas of the country in favour of the focus on Maseru.
The high running costs could also have a major impact outside the healthcare sector in Lesotho. As the health budget grows to meet the increasing costs, funding to other departments such as agriculture and education is being cut. One anonymous minister quoted in the report argues that even if healthcare does improve, the government will not be able to ensure that everyone has enough to eat.
Equally, the problems of the project in Lesotho could have ramifications for global health. Already this example is being highlighted as a warning to other countries in Africa. Further afield, Hellowell is also an adviser to the UK Treasury select committee on private finance initiatives, and is sceptical of the project's success after visiting it in 2013. The problems in Lesotho could, therefore, cause concerns about the effectiveness of these projects even in richer countries around the world.
SOS Children has worked in Lesotho since the 1980s. Today, we care for the most vulnerable children in three SOS Children's Village across the country. Find out more about our work in Lesotho.