Lesotho organisations push back against US health deal

The Lesotho Ministry of Health’s headquarters in Maseru. Archive photo: Sechaba Mokhethi

Civil society organisations in Lesotho want the government to disclose a health funding agreement signed with the United States on 10 December.

They also want the agreement to be debated in Parliament.

The agreement will see the US investing $232-million (R3.97-billion) in Lesotho’s healthcare system over the next five years, while the Lesotho government will be required to invest $132-million (R2.26-billion).

But in a statement on 24 March, 21 civil society organisations warned that the agreement threatens “national sovereignty” and lacks “transparency, consultation, and compliance with Lesotho’s constitutional and legal frameworks”.

The organisations include the Lesotho Council of NGOs, the People’s Matrix Association, Lesotho Network of AIDS Service Organisations, Unlocking Love, Leseli Resources Development, and the Global Health Access Initiative.

They argue there was insufficient consultation prior to the agreement being signed.

They are also concerned about the inclusion of a 25-year commitment for the sharing of biological specimen data.

Their concerns are based on a leaked copy of the agreement, which GroundUp has not been able to independently verify.

The organisations are concerned that “critical documentation”, including annexures to the agreement, have not been made public.

“This lengthy contract, coupled with possible implications for existing national legislation, including data protection and constitutional rights to privacy, does not only require careful legal review but concurrence of Parliament,” said the statement.

US aid

At the beginning of 2025, Lesotho’s healthcare sector was decimated when the US froze and subsequently terminated PEPFAR-funded HIV programmes. Hundreds of healthcare workers were dismissed. By March 2025, according to UNAIDS, 72% of PEPFAR funding had been paused or terminated.

In December, a new agreement was signed between the US and Lesotho. A statement from the US Embassy said there was a “comprehensive vision to save lives, strengthen Lesotho’s health system, and make America safer, stronger, and more prosperous”.

According to the leaked memorandum of understanding, the US will fund ARV medicines, diagnoses, and healthcare workers.

Funding will also go towards setting up laboratories and a health data system. The two countries will collaborate on an “outbreak surveillance system” and “response system”, which includes a biological specimen “sharing arrangement”.

Government spokesperson Boitelo Rabele responded to GroundUp: “We are unable to comment on the matter at this stage, as the Speaker of Parliament has not yet issued a ruling on the issue that arose in Parliament yesterday regarding the agreement in question.”

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