…as govt grapples with M145m SA debt
Mohloai Mpesi
THE Queen ‘Mamohato Memorial Hospital (QMMH) has referred more than 10,000 patients—most of them cancer cases—to South African hospitals between 2024 and 2025, highlighting the heavy cost of Lesotho’s lack of a domestic cancer treatment facility.
This according to a QMMH patients referral data sheet seen by the Lesotho Times.
Ministry of Health Principal Secretary, ‘Maneo Moliehi Ntene, said the referrals were largely attributed to the absence of a cancer centre in the country, with construction of the long-awaited facility at Ha Leqele in Maseru still incomplete.
As a result of the lack of a treatment centre, the government has accumulated a debt of approximately M145 million to the Free State Department of Health for services rendered to Basotho patients at Pelonomi Tertiary Hospital and Universitas Academic Hospital, according to a provincial South African government official.
Although the official could not tabulate the exact period covered by the M145 million debt, the amount is expected to increase as patient referrals to South Africa continue on a daily basis. Notably, the 2026/27 national budget does not provide a specific allocation for patient referrals to South Africa.
The Free State Department of Health spokesperson, Mondli Mvambi, confirmed that the debt stood at M145 million as of the end of February 2026.
“There are different kinds of patients, including oncology cases ranging from childhood cancers to adult cases, as well as trauma patients such as those requiring orthopaedic surgery, treatment for head and spinal injuries, and other specialised interventions,” Mr Mvambi said.
He explained that the debt was not static but fluctuated depending on referral volumes and payments made.
“At one stage it was M61 million, then M75 million. It increases as the number of patients rises. It changes over time depending on how much is paid and how many patients are referred,” he said.
Number of referrals
The QMMH data indicated that 4936 patients were referred between January and December 2024, while 5697 were referred between January and December 2025.
| 2024 | 2025 | |
| January | 114 | 449 |
| February | 364 | 481 |
| March | 405 | 481 |
| April | 582 | 454 |
| May | 436 | 504 |
| June | 369 | 454 |
| July | 509 | 472 |
| August | 442 | 502 |
| September | 489 | 545 |
| October | 507 | 505 |
| November | 527 | 510 |
| December | 292 | 339 |
| TOTAL | 4936 | 5697 |
Services Continue
Mr Mvambi said the long-standing bilateral arrangement between Lesotho and South Africa continues to function, with both parties expected to honour their obligations.
“There is an existing relationship where the Free State Department of Health admits referrals from QMMH. The commitment is to ensure that the debt is serviced regularly so that services, systems, equipment and human resources remain sustainable,” he said.
He warned that unpaid debt could strain service delivery.
“Any unpaid debt becomes a hindrance to beneficiaries, as it places pressure on service providers and their operational capacity,” he said.
However, he emphasised that services would not be discontinued as long as Lesotho continued to make payments.
“There is no reason to stop services at this stage, given the good working relationship between the two parties,” he added.
Ms Ntene confirmed that the government continued to make payments in an effort to reduce the recurring debt.
Cancer centre delays
Ms Ntene said delays in constructing the cancer centre had made it impossible to reduce referrals.
She also said the QMMH’s planned private wing, expected to ease pressure by reducing referrals to Bloemfontein, had not yet become operational.
“Most of these referrals are cancer-related because we do not have a cancer hospital. Cancer treatment is specialised and cannot be handled like other conditions.
“Until the cancer centre is completed, referrals will not stop. We currently do not have the capacity to treat cancer patients locally,” she said.
She added that the debt remained fluid due to continuous referrals.
“I cannot confirm whether it is still M145 million because referrals are made daily. While we are reducing the debt, it continues to grow,” she said.
Ms Ntene explained that construction of the cancer centre was initially scheduled to begin in June last year but was delayed after the International Atomic Energy Agency identified critical gaps in the original design.
“The initial design lacked essential components such as a theatre, laboratory and key cancer-treatment infrastructure.
“As a result, the project had to be redesigned with their guidance. The revised design was completed towards the end of last year, and construction has now begun, starting with the foundation.”
Budget constraints
The Ministry of Health has been allocated M3.1 billion for the 2026/27 financial year, which began on 1 April. Of this, M1.2 billion is earmarked for operational costs, while approximately M700 million will go towards salaries.
This is not the first time Lesotho has faced a mounting referral debt. In March 2024, the Free State Department of Health demanded payment of more than R218 million owed for similar services.
