Open let­ter to the prime min­is­ter

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THE Min­istry of Health (MOH) un­der the su­per­vi­sion of its Min­is­ter Pinkie Manamolela and Prin­ci­pal Sec­re­tary, Lefu Manyokole, who is also the chief ac­count­ing of­fi­cer, has for much of the year 2014 been in the news for good and bad rea­sons.

A gen­uine ques­tion an or­di­nary cit­i­zen may ask is whether this is pol­icy change that was ad­vo­cated by the coali­tion gov­ern­ment or it is sim­ply as a re­sult of medi­ocrity?

Di­ary of events

A short scan of what tran­spired in the min­istry in 2014.

Fe­bru­ary

Tues­day 18, Tše­pong Staff pro­ces­sion led by Le­sotho As­so­ci­a­tion of Work­ers (LEWA) to the Prime Min­is­ter about wages dis­pute and fail­ure of the Min­is­ter of Health to as­sist in the mat­ter.

March

Mon­day 24, Ox­fam ground break­ing re­port on gov­ern­ment of Le­sotho and Tše­pong PPP model as a can­cer for tax pay­ers’ money (over 51 per­cent of min­is­te­rial bud­get).

April

Tues­day 1, Na­tional Health Train­ing Col­lege closed as a re­sult of stu­dents strike.

Wed­nes­day 9, Min­is­ter of Health (Dr. Manamolela) agreed with the Ox­fam re­port.

Mon­day 14, cater­ing com­pa­nies filed ap­pli­ca­tion for con­tempt of court against the Prin­ci­pal Sec­re­tary (Mr Manyokole). Tues­day 29, Tše­pong work­ers strike be­gan. Wed­nes­day 30, Tše­pong strike cul­mi­nated into chaos and crit­i­cal in­juries of three nurses en­sued.

May

Wed­nes­day 8, Min­is­ter of Health re­ceived US$17 mil­lion from Global Fund to com­bat HIV/AIDS and TB.

Fri­day 16, Min­is­ter of Health, Tše­pong rep­re­sen­ta­tive and LEWA signed a mem­o­ran­dum to end two weeks strike.

July

Fri­day 18, Min­is­ter of Health fired doggy doc­tors at Quthing Gov­ern­ment Hos­pi­tal.

Au­gust

Mon­day 4, Le­sotho De­mo­graphic and Health Survey (LDHS/DHS) train­ing at Khot­song Lodge post­poned to Wed­nes­day 6, due to im­proper re­cruit­ment.

Tues­day 12, bru­tal mur­der of two nurses at Ha Mos­alla.

Satur­day 16, Thaba-bo­siu women hold pro­ces­sion to con­demn the killing of the two nurses in the ab­sence of MOH rep­re­sen­ta­tive.

Min­is­te­rial state­ment about Ebola out­break, fol­low­ing cab­i­net decision com­mu­ni­cated on Wed­nes­day 13, to re­strict move­ment in all bor­ders.

Thurs­day 24 war­rant of ar­rest for the Prin­ci­pal Sec­re­tary is­sued by the High Court.

Septem­ber

Mon­day 1, Le­sotho Med­i­cal School re­sumed op­er­a­tion.

Oc­to­ber

Fri­day 31, the Queen El­iz­a­beth II Hos­pi­tal re­opened.

Of the above 17 in­ci­dents re­ported in the me­dia I could hardly find five pos­i­tive mea­sures taken by the min­is­ter and her prin­ci­pal sec­re­tary, no doubt they have been in the me­dia for the wrong rea­sons.

Amongst those five mea­sures the Ebola pan­demic re­sponse is not im­ple­mented fully; as a fre­quent user of Maseru Bridge and I have never seen any health of­fi­cers in­spect­ing pass­ports of peo­ple en­ter­ing the coun­try de­spite the fact that sign boards in­di­cate the pres­ence of health of­fi­cials at the bor­der post.

I must ad­mit I have seen posters and of course cater­ing ar­range­ments for Ebola train­ing work­shop at the min­istry head­quar­ters.

LDHS

The LDHS will be dis­cussed in de­tail as it is the one which en­abled me to put the MOH un­der the mi­cro­scope.

I find it nec­es­sary to share with the na­tion the in­trigues and dis­crep­an­cies en­tailed in this survey which in my opin­ion the MOH of­fi­cers used bu­reau­cratic bun­gle to their ad­van­tage as a to­ken of ex­change to rip the na­tion pub­lic funds for per­sonal gain while at the same time al­low­ing the survey to con­tinue.

The LDHS is vi­tal in the sense that it is a study in­tended cover 10 000 house­holds in all 10 dis­tricts of Le­sotho.

In­for­ma­tion col­lected in th­ese house­holds re­lates to re­pro­duc­tive health, HIV/AIDS preva­lence and knowl­edge, child and in­fant mor­tal­ity, anaemia and io­dine salt test­ing, bio­met­ric data (height and weight) col­lec­tion, gen­der roles and lit­er­acy level. It is done ev­ery five years and the pre­vi­ous one was done in 2009.

Un­em­ploy­ment cri­sis

To ac­com­plish this mis­sion the MOH needed slightly over 115 hu­man re­sources com­pris­ing of co­or­di­na­tors, su­per­vi­sors, driv­ers, enu­mer­a­tors and data ed­i­tors.

The majority of the staff com­pli­ment is from the MOH, com­ple­mented by four from the Bureau of Statis­tic (BOS) and another from the Prime Min­is­ter’s of­fice.

I am strug­gling to come to terms with the fact that in a coun­try where un­em­ploy­ment is rife peo­ple who are em­ployed can du­pli­cate their em­ploy­ment op­por­tu­ni­ties at the ex­pense of oth­ers. Dr Ma­joro es­ti­mated that about 300 000 (57 per­cent) youth are un­em­ployed. The 2009 Labour Force Survey es­ti­mates un­em­ploy­ment rate to be 25,3 per­cent but we know this fig­ure is con­ven­tional.

The ILO Global Wage Re­port of 2012/13 jus­ti­fies this by point­ing out that youth in de­vel­op­ing coun­ties are no longer search­ing for jobs as such they are not counted as un­em­ploy­ment due to dis­il­lu­sion­ment.

I may not have a prob­lem with co­or­di­na­tors, su­per­vi­sors and some driv­ers be­ing pub­lic of­fi­cers ei­ther from MOH and BOS but when pub­lic of­fi­cers be­come enu­mer­a­tors it is a fun­da­men­tal ad­min­is­tra­tive prob­lem in the MOH and BOS be­cause they are not em­ployed as such.

Data col­lec­tion work in the LDHS is a tem­po­rary thing which in this case has to have peo­ple em­ployed on tem­po­rary ba­sis.

They are sim­ply pro­hibit­ing grad­u­ates who are idle at home who could be do­ing that job.

Wages

It is ex­tremely un­scrupu­lous, ir­re­press­ible creed, un­just and se­ri­ous mal­ad­min­is­tra­tion that pub­lic of­fi­cers in the LDHS get tax fee al­lowances that are equal to the wages of their col­leagues who have been em­ployed specif­i­cally for this survey yet at end of the month they get their full salaries from their re­spec­tive min­istries.

This dou­ble pay­ment hap­pens at the ex­ploita­tion of other em­ploy­ees of the project as they are paid a wage which is four times lower than the al­lowance of pub­lic of­fi­cers.

To my amaze­ment the prin­ci­pal sec­re­tary does not see any­thing wrong about this as he says his sub­or­di­nates were the ar­chi­tects of this project and he con­sid­ers that to be a mo­ti­va­tion and a way of gain­ing work­ing ex­pe­ri­ence, this in­ci­dent is best ex­plained by a Se­sotho id­iom which says “its’etle Molan­toa khomo ho shoele ea heno!”

In my mind is be­ing very nar­row minded and self­ish­ness be­cause as cit­i­zens of this coun­try we are all BONAFIDE ben­e­fi­cia­ries of pub­lic funds and no one should dou­ble the cake slices yet oth­ers are even look­ing for the crumbs that may be left on the plate.

Dou­ble wages pay­ment has never been ac­cepted in this coun­try, a case in point is that of the then sev­enth Vice Chan­cel­lor of the Na­tional Univer­sity of Le­sotho who paid him­self M100 000 as a project man­ager of Kel­logg Foun­da­tion ca­pac­ity build­ing fund in 2008.

He was sus­pended pend­ing fi­nal­i­sa­tion of the in­ves­ti­ga­tion by the univer­sity coun­cil of which I was a mem­ber by virtue of be­ing the pres­i­dent of the NUL Stu­dents Union.

The find­ings of the in­ves­ti­ga­tion by the panel were that it was im­proper for him (VC) to have been paid twice as a project man­ager and as an em­ployee of NUL.

That was not prece­dence but there are nu- mer­ous cases even in the par­lia­ment of Le­sotho.

It is this quest for al­lowance which makes the chief co­or­di­na­tor mis­man­age the LDHS be­cause she is al­ways in the field and as such enu­mer­a­tors are not paid timeously.

Enu­mer­a­tors who are not pub­lic of­fi­cers are prej­u­diced be­cause their wages are the only source of in­come while their coun­ter­parts are paid on the 25th day of ev­ery month.

The great­est bur­den is that they have to fork-out money for food, san­i­tary needs and dwelling away from home.

One of the crit­i­cal mea­sures of health sta­tus in the LDHS is test­ing io­dine pres­ence on house­hold salt. Th­ese tests have not been done in some house­holds be­cause the test­ing kids were ei­ther not present or in­com­plete.

Un­for­tu­nately, this survey goes into the ru­ral vil­lages of Le­sotho where it will not be easy to re­turn con­sid­er­ing cen­tralised ad­min­is­tra­tion of the min­istry where about 100 ve­hi­cles are kept at the head­quar­ters.

It does not make eco­nomic sense and demon­strates lack of cau­tious­ness by the chief co­or­di­na­tor to al­low teams go­ing too far with­out all ap­pa­ra­tus.

Con­tracts of em­ploy­ment

In­ter­est­ingly, em­ploy­ment re­la­tions in the LDHS are guided by the Labour Code Or­der of 1992 as amended, this makes lit­i­ga­tion in this re­gard sim­pler and cheaper as le­gal rep­re­sen­ta­tives are not re­quired at the Direc­torate of Dis­pute Preven­tion and Res­o­lu­tion (DDPR) as it may be in the High Court of Le­sotho.

Para­dox­i­cally, the MOH does not have the ca­pac­ity to ad­min­is­ter the Labour Code; for in­stance, the code al­lows work­ers to join trade unions and have the right to strike (de­spite its com­plex­ity), pay­ment of wages when due and even pro­duc­tion of payslips but the state does not com­ply.

There are 19 cases be­tween 2007 and 2013 in which the DDPR had been ap­proached by em­ploy­ees to con­cil­i­ate or ar­bi­trate their dis­putes with dif­fer­ent gov­ern­ment min­istries.

The MOH tops the list with eight cases re­ferred. It is fol­lowed by the Min­istry of En­vi­ron­ment, Tourism and Cul­ture with four and the Min­istry of Lo­cal gov­ern­ment with three. One disturbing ob­ser­va­tion is that in the LDHS the con­tracts of em­ploy­ment are kept by the em­ployer and it is cause for con­cern that the em­ployer keeps con­tracts if it is not for ma­li­cious in­tent.

A con­tract of em­ploy­ment is sup­posed to be kept by both the em­ployer and the em­ployee. In my opin­ion, the ab­sence of a con­tract of em­ploy­ment in the cus­tody of the em­ployee is what a lead­ing African labour ex­pert and scholar pro­fes­sor Ed­ward Web­ster calls de­cent work deficit.

And if this un­eth­i­cal con­duct is done by the MOH, what then can be ex­pected from other em­ploy­ers in the pri­vate sec­tor?

Train­ing of Enu

mer­a­tors

Whereas the list of dis­crep­an­cies that oc­curred dur­ing the train­ing is not ex­haus­tive, it is vi­tal to point out some im­por­tant con­cerns which re­late to fi­nances.

About 100 peo­ple par­tic­i­pated in the LDHS train­ing that was to run from 4-30 Au­gust with full ac­com­mo­da­tion.

The train­ing was con­ducted by United States-based con­sul­tants who had their own ac­com­mo­da­tion in the city cen­tre and were trav­el­ling to Thaba-khupa daily.

Pro­fil­gacy seemed to be at its zenith since about 10 pub­lic of­fi­cers were not nec­es­sar­ily re­quired to be present daily but had to do other ad­min­is­tra­tive jobs such as procur­ing LDHS equip­ment or could come at the later stages when they could be fa­cil­i­tat­ing.

On the days they had to be at the of­fice, they would leave in the morn­ing after break­fast but make sure they were present for lunch to re­turn to the of­fice and be back for sup­per.

All trainees were com­pelled to stay at the lodge (Khot­song) ir­re­spec­tive of whether they were stay­ing less than two kilo me­ters from the lodge or could af­ford com­ing daily for fam­ily rea­sons.

Daily foods run out in ev­ery meal and there would be limited choice or none about ten peo­ple were af­fected. On ac­com­mo­da­tion some pairs were squeezed in a sin­gle room with no ba­sic room ameni­ties (a ket­tle and a chair).

There were many dis­crep­an­cies which need to be in­ves­ti­gated by state agen­cies whether pro­cure­ment reg­u­la­tions were fol­lowed or flouted.

Con­clu­sion

The LDHS enu­mer­a­tion process will end on 3 De­cem­ber. I am con­fi­dent the min­is­ter will not be able to make a sig­nif­i­cant decision about the last pay­ment of pub­lic of­fi­cers in the project con­sid­er­ing the ex­plo­sive mat­ter of Tše­pong took her four months to re­solve.

I ap­peal to the prime min­is­ter to act promptly to in­struct the min­is­ter and PS to stop the pay­ment of pub­lic of­fi­cers but en­gage the Direc­torate of Cor­rup­tion and Eco­nomic Of­fenses or po­lice spe­cial in­ves­ti­ga­tion units to eval­u­ate the ad­min­is­tra­tion of the project funds.

The two sce­nar­ios that ex­ist are (1)if their pay­ment are pro­cessed and it is later found that for some em­ploy­ees they have been over­paid for three months an amount over half of their salaries it will be dif­fi­cult to re­im­burse the MOH for the same pe­riod be­fore the end of the phys­i­cal year.

(2)If pay­ments stop and it is found that they have been over paid the next step is to make de­duc­tions of over­pay­ments which I am adamant they will be found.

To ac­com­plish this mis­sion the MOH needed slightly over 115 hu­man re­sources com­pris­ing of co­or­di­na­tors, su­per­vi­sors, driv­ers, enu­mer­a­tors and data ed­i­tors. The majority of the staff com­pli­ment is from the MOH, com­ple­mented by four from the Bureau of Statis­tic (BOS) and another from the Prime Min­is­ter’s of­fice.

Health Min­is­ter Pinkie Manamolela.

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