…as govt dismantles health facilities unit
…living 1.3m Basotho at risk
By Mohloai Mpesi
THE health of more than 1.3 million Basotho, over half the nation, hangs in the balance after the government ordered the shutdown of the unit that keeps 226 clinics and hospitals running. The unit closes on 30 September 2026, and there is no handover plan in sight.
The closure of the Health Maintenance Project Implementing Unit (HM-PIU) also threatens an estimated 5000 jobs across 111 contractors that service health facilities, as well as about 70 posts within the unit itself.
The HM-PIU keeps water flowing, power on, sewerage and medical waste systems working, and buildings and ICT networks functional at health facilities countrywide. Without these services, clinics cannot safely treat patients.
Sources close to the development warned that more than a million people could face serious health risks if the infrastructure deteriorated and facilities were forced to close or reduce services. One source said a water supply failure alone could disrupt maternity services, infection prevention, sanitation and cleaning, and undermine a clinic or hospital’s ability to provide safe patient care.
The concerns follow a 1 September 2026 letter from the ministry’s Ascting Principal Secretary, Matšoanelo Monyobi, informing stakeholders that HM-PIU operations would cease on 30 September 2026.
Sources close to the development, who spoke to the Lesotho Times on condition of anonymity, warned that dismantling the unit without clear transitional arrangements could disrupt essential maintenance services from 1 October.
According to Ms Monyobi’s letter, the unit’s responsibilities and functions will thereafter be taken over by relevant departments within the ministry.
The sources, however, questioned the practicality of the transition, saying there was no clear direction on how HM-PIU’s functions, resources, systems and ongoing activities would be transferred.
“The absence of clear transition arrangements creates a significant risk of disruption to maintenance operations from 1 October 2026. Potential consequences include delays or interruptions in the provision of essential maintenance services, and challenges in monitoring and verifying work undertaken,” one source said.
The source said the discontinuation of HM-PIU would also result in the termination of maintenance services currently extended to Christian Health Association of Lesotho (CHAL), Maseru City Council and Lesotho Red Cross health facilities from 1 October.
“These services are not covered under existing contractual arrangements and no alternative arrangements have been made,” the source said.
They argued that the situation posed a substantial risk to the continuity and sustainability of health facility maintenance services.
“Without urgent action, clear direction and coordinated participation from the ministry, essential maintenance functions may not be adequately sustained after 30 September 2026,” the source said.
Background
HM-PIU began operations in 2023 within the Ministry of Health after the Lesotho Millennium Development Agency (LMDA)’s health infrastructure maintenance arrangement ended that year.
The unit took over maintenance responsibilities and systems previously managed by LMDA, expanding coverage from 172 to about 190 public health facilities. It provides hard facilities maintenance, environmental and healthcare waste management, ICT-related support and other facilities management services.
HM-PIU now oversees 226 health facilities countrywide.
LMDA operated from around 2015 to 2023 following the closure of the Millennium Challenge Account-Lesotho (MCA-L) compact programme.
It was established to manage and maintain a portfolio of health facilities and other infrastructure built under the Millennium Challenge Compact (MCC), providing preventive and corrective maintenance, technical support and contractor management.
At its peak, LMDA developed technical capacity and maintenance systems that became central to the Ministry of Health’s operations.
The MCC, implemented through MCA-L, financed the construction, rehabilitation and upgrading of health centres across Lesotho.
As the programme approached closure, a mechanism was needed to ensure that the newly built and rehabilitated facilities remained functional and properly maintained.
CHAL is among the beneficiaries of maintenance support now facing possible disruption.
Monyobi’s letter
In her letter dated 1 September 2026, Ms Monyobi formally notified stakeholders, contractors, service providers and partners engaged under HM-PIU of the transition.
“The Ministry of Health hereby formally notifies all stakeholders, contractors, service providers and partners currently engaged under the Health Maintenance Project Implementing Unit (HM-PIU) of an important institutional transition.
“Please be informed that the operating HM-PIU will come to an end on 30 September 2026,” she said.
She added that, with effect from 1 October 2026, HM-PIU’s functions and responsibilities would fall under the administration of the Ministry of Health.
Ms Monyobi said the ministry would communicate further instructions regarding the transition through appropriate channels.
She also thanked stakeholders, contractors, service providers and partners for their cooperation during HM-PIU’s operation.
The Lesotho Times sought comment from Ms Monyobi on the concerns raised by the sources.
She promised to get back to this publication by 2pm yesterday, but had not done so until late in the afternoon.
Efforts to contact her thereafter were fruitless, as her mobile phone rang unanswered until the time of going to press.
Four main components
HM-PIU operates under four main components, including hard facilities management, ICT infrastructure management, and environmental and healthcare waste management.
Hard facilities management covers buildings, electrical systems, plumbing, water supply, sanitation, mechanical systems and other physical infrastructure.
ICT infrastructure management supports connectivity, networks and related equipment in health facilities, while environmental and healthcare waste management covers waste segregation, collection, treatment and disposal, as well as compliance with infection-prevention requirements.
Condition precedent
Sources also questioned whether the government would be able to maintain health infrastructure to the required standard when it already faces challenges managing health centres under its direct care.
According to one source, the United States had set a condition precedent requiring the Lesotho government to maintain infrastructure built under its Compact I investment to an acceptable standard.
“The United States made a condition precedent that the infrastructure under Compact I investment given to Lesotho should remain in good standard. The government has to see to it that it maintains the standard of the infrastructure.
“When the United States government returns to review its investment, would the infrastructure be at the expected standard?” the source asked.
Employment and socio-economic impact
Another source said approximately 111 contractors were currently engaged to provide maintenance and other essential support services at health centres countrywide, coordinated and supported by HM-PIU, sustaining an estimated 5000 jobs.
“The discontinuation of HM-PIU on 30 September may place these contracts at risk, particularly if there are no clear arrangements for their continuation under the Ministry of Health,” the source said.
The source said the closure would also directly affect about 70 employees working within the unit.
“The combined effect could therefore be significant, extending beyond the loss of HM-PIU positions to the livelihoods of thousands of Basotho employed by service providers.
“The potential termination or disruption of these contracts could have wider household, community and local economic impact, including loss of income, reduced household purchasing power and increased unemployment,” the source said.
The source called for transitional arrangements to ensure continuity of maintenance services and minimise potential employment and socio-economic consequences.
Over a million people at risk
Another source estimated that more than a million people could face health risks if infrastructure deteriorated and some health facilities were forced to close or reduce services.
The government estimates suggest a typical clinic or health centre serves between 6000 and 10 000 people, while a national health-system study recorded 265 health centres and 20 hospitals serving a population of about 2.2 million.
The source said the figures illustrated the large population dependent on public health infrastructure.
“Using the government’s estimate of 6000 to 10 000 people per health centre, the 190 facilities maintained by HM-PIU served an estimated population of 1.4 million to 1.9 million, while the 226 facilities it currently oversees serve between 1.35 million and 2.25 million people.
“Therefore, even using a conservative estimate, the HM-PIU maintenance portfolio supports infrastructure used by well over one million Basotho,” the source said.
Another source cautioned that integrating HM-PIU into the ministry should not come at the expense of its specialised operational model.
“If HM-PIU is simply absorbed into the existing ministry structure without preserving its dedicated technical teams, systems, processes, budget arrangements and accountability mechanisms, the impact could be significant,” the source said.
Delays in emergency maintenance
Sources also warned that absorbing HM-PIU into the government structure could delay responses to emergencies involving water supply, electricity, sewerage and sanitation, medical and general waste systems, building infrastructure, ICT and communications, heating and ventilation, and other critical services.
“These functions will become fragmented across different departments and administrative approval processes, and emergency repairs may take longer.
“A problem that previously received a coordinated technical response could move through several offices before action is taken, and a maintenance problem can quickly become a service delivery problem,” one source said.
The source said, for example, that a water supply failure could affect maternity services, infection prevention, sanitation, cleaning and a clinic or hospital’s ability to provide safe patient care.
Another concern was the potential loss of preventive maintenance, with repairs possibly being undertaken only after infrastructure had already failed if there was no dedicated unit responsible for inspections and planning.
Rising long-term maintenance costs
According to another source, dismantling the specialised maintenance system could ultimately increase government expenditure because of delayed intervention.
“Dismantling the specialised maintenance system may initially appear to reduce administrative costs. However, delayed maintenance generally results in more expensive corrective and emergency repairs.
“Repairing a small roof leak, for example, is cheaper than rehabilitating a damaged ceiling and electrical system, and maintaining a water system is cheaper than responding after complete failure,” the source said.
The source said preventive maintenance could extend the useful life of infrastructure and equipment.
“Therefore, the apparent saving from reducing the HM-PIU structure may ultimately result in higher costs to government,” the source said.
Another source warned that dismantling the unit could also result in the loss of specialised technical expertise and institutional memory developed through previous MCA-L, MCC and LMDA maintenance arrangements.
This includes knowledge of individual facilities’ condition and history, technical specifications, contractors, recurring infrastructure problems and outstanding contractual disputes.
“If the existing team and operational systems are dispersed, this knowledge may be lost,” the source said.
The source said distributing HM-PIU’s functions among different ministry departments could fragment responsibility, leaving hard facilities vulnerable to delayed inspections and repairs, ICT infrastructure to slower responses amid competing priorities, and environmental and waste management to increased compliance and public-health risks.
“The danger is that everyone may have partial responsibility, while no single unit has complete accountability for the condition and functionality of the health infrastructure,” the source added.
