For many years, Lesotho has urgently needed to replace its main public hospital, Queen Elizabeth two. In 2006, to maximize the use of limited resources and ensure long-term improvement in facilities and services, the government adopted the public-private partnership (PPP) approach for a new hospital. International Finance Corporation (IFC's) infrastructure advisory services department advised the government in structuring a PPP for the design and construction of a new 425-bed hospital and adjacent gateway clinic, the renovation of three strategic filter clinics, and the management of facilities, equipment, and delivery of all clinical care services for 18 years. The project has a capital value of over $100 million, and the private operator, the Tsepong consortium headed by Netcare, a leading South African health care provider, has significant local ownership: 40 percent of shares held by Lesotho-owned businesses, increasing to 55 percent during the project term. This smart lesson describes this pioneering PPP project, and shares some lessons learned from it.