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Problems can be traced to a complex reform design, inadequate personnel and capacity to implement, professional boundaries between financial and clinical personnel and weak leadership.

The Lesotho reform experience suggests that less complex designs for budget reform, better adapted to the context and realities of health sectors in developing countries, may be needed to improve governance.

A main channel to accomplish this is through reform of the budgeting system.

Public financial management (PFM) institutions are integral to governance (Andrews 2010).

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steps executed by the staff of the ministries who are responsible for implementing plans and achieving objectives. PBB has been defined as procedures intended to ‘strengthen links between the funds provided to public sector entities and their outcomes and/or outputs through the use of formal performance information in resource allocation decision-making’ (Robinson and Brumby 2005).It also highlights the importance of measuring reform implementation at the sectoral level.The purpose of governance is to protect and promote the well being of citizens.The success of public budgeting reforms also has implications for health systems strengthening (World Health Organization 2007).If successful, budget reform could help improve health sector governance, strengthening the capacity of governments to implement health policies efficiently and fairly and achieve better outcomes (Veenstra and Lomas 1999; Siddiqi 2009).

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