The notable failure of this reform to change governance in the
health sector raises questions of how it came about, and where
the demand for this reform originated. The purpose of this
study was not to document the process by which Lesotho
created its vision of what good governance would mean for the
country, and how involved government officials were in
determining the actual content of the PFM reforms to bring
the country closer to that vision. But the evidence suggests that
the vision for reform was too complex for the health sector, and
possibly for the country as a whole. It appears that donors and
reform-minded officials promoted initiatives that were beyond
Lesotho’s capacity, and did not adequately assess or attempt to
modify the goals or reform activities to account for the
institutional preconditions which were missing at the level of
line ministries. The reasons for this are not clear, and beyond
the scope of this study.