In order to meet the growing demand for power generation and mining activities in the Lephalale area, two main bulk raw water transfer systems were also required.

[27] The dates for full commercial operation were shifted numerous times mostly due to labour disputes such as: On 9 August 2021, in the second week after Eskom announced that Medupi had attained commercial operation, Medupi Unit 4 was extensively damaged in a hydrogen explosion[34][35] which caused a loss of 700 MW in generating capacity.

[42][43] Some of the primary reasons for the cost escalation was the importing of components affected by a fluctuating Rand exchange rate, redesigns and rework as well as labour disputes and standing time.

Due to cost escalations the African Development Bank has stated that they do not expect the power plant to produce a positive financial return over the course of its lifetime.

[45][46] Critics alleged that the government endorsed the project due to the ruling party, the African National Congress holding a 25% share of a package and stood to make a profit of close to 1 billion Rand.

The approval of the World Bank loan drew criticism for supporting increased global emissions of greenhouse gases.

[51] By 2018, the government's Public Enterprises Minister Pravin Gordhan announced a forensic probe into the delays and cost overruns on the completion of Kusile and Medupi Power Stations.

[53][54] As of 11 February 2019, Eskom reinstated load-shedding due to ongoing strain on the national grid from failing older power stations.