Civil society organisations in Lesotho are raising serious concerns about a recently signed health funding agreement between the government and the United States, calling for greater transparency and parliamentary oversight. The agreement, signed in December 2025, outlines a significant investment in Lesotho’s healthcare system, with the United States committing $232 million over five years, while the Lesotho government is expected to contribute $132 million. Despite the scale of the investment, critics argue that the process lacked adequate public consultation and disclosure.
A coalition of 21 organisations has expressed concern over the terms of the agreement, particularly its potential implications for national sovereignty and compliance with domestic legal frameworks. They emphasize that key documents, including annexures, have not been made publicly available, making it difficult to fully assess the scope and impact of the deal. The groups are urging that the agreement be subjected to parliamentary debate to ensure accountability and legal scrutiny.
One of the most contentious issues relates to provisions for long-term data sharing, including a reported 25-year commitment involving biological specimen data. Civil society groups warn that such provisions could raise serious privacy and data protection concerns, especially if they conflict with existing national laws or constitutional rights. These concerns are based on a leaked version of the agreement, which has not yet been independently verified, adding to the uncertainty surrounding the deal.
The broader context of the agreement is shaped by recent disruptions in Lesotho’s healthcare system. In early 2025, significant funding cuts to HIV programs previously supported by US initiatives led to the dismissal of many healthcare workers and reduced access to essential services. The new agreement is positioned as an effort to rebuild and strengthen the healthcare system, including support for medicines, diagnostics, healthcare personnel, and the development of laboratory and surveillance systems.
While the investment has the potential to improve healthcare delivery and infrastructure, stakeholders remain concerned about the governance and long-term implications of the agreement. The lack of official clarification from government authorities has further fueled calls for transparency, as civil society groups seek assurances that the deal aligns with national interests, protects citizens’ rights, and undergoes proper legislative review.
