This article presents evidence from a study in the hospital
sector in Lesotho, a small, land-locked country in Southern
Africa which has been implementing public finance and
budgeting reforms since 2005 in an effort to create more
realistic budgets and provide incentives for efficient and
effective management of government services (Central Bank
of Lesotho 2007). The study encompassed three principle
objectives: to design methods to measure budget reform progress in the health sector, to apply this framework to
describe reform progress in Lesotho’s health sector and to
explore factors affecting reform progress. The main purpose of
this article is to report the empirical findings on reform
implementation progress. The results show that budget reform
in Lesotho has not changed institutions or decision-making
practices in the health sector, and reform goals were not
achieved. After presenting these findings, the study begins to
explore some of the possible reasons for failure.