Min­is­ter out to cure ail­ing health sec­tor

Lesotho Times - - Big Interview -

Fi­nance Min­is­ter, ’ Mam­phono Khaketla, pre­sented her maiden na­tional bud­get be­fore the 9th Par­lia­ment on Fri­day last week and among the high­lights of her an­nounce­ment was M1.7bil­lion for the Health Min­istry — the sec­ond high­est pro­posal to ed­u­ca­tion’s M2.8bil­lion. How­ever, Dr Khaketla ex­pressed con­cern over the “un­sat­is­fac­tory” qual­ity of health ser­vices in the coun­try de­spite the sec­tor claim­ing “a large pro­por­tion of the na­tional bud­get al­lo­ca­tion”.

Dr Khaketla fur­ther said of par­tic­u­lar con­cern was gov­ern­ment’s in­creas­ing con­tri­bu­tion to Queen ‘ Mamo­hato Me­mo­rial Hos­pi­tal’s op­er­a­tional costs, not­ing dur­ing the 2014/15 fis­cal year, the state made an ad­di­tional pay­ment of M74 mil­lion for ex­tra ser­vices pro­vided by the hos­pi­tal, over and above the an­nual uni­tary pay­ment of M500 mil­lion agreed with the pri­vate part­ners (Tše­pong con­sor­tium) run­ning the in­sti­tu­tion.

Gov­ern­ment’s pri­or­ity for the min­istry dur­ing the medium term was to im­prove pri­mary health ser­vice de­liv­ery and was al­ready weigh­ing op­tions to­wards the con­struc­tion of a Maseru Dis­trict Hos­pi­tal to re­duce re­fer­rals to Queen ‘Mamo­hato Me­mo­rial Hos­pi­tal, pop­u­larly known as Tše­pong Hos­pi­tal.

in this wide-rang­ing in­ter­view, Le­sotho Times (LT) re­porter, Lekhetho Nt­sukun­yane, takes the dis­cus­sion fur­ther with Health Min­is­ter, ’Molotsi Monya­mane.

LT: The Min­is­ter of Fi­nance, Dr ’Mam­phono Khaketla, has ex­pressed con­cern over some is­sues in the health sec­tor, which I be­lieve you also heard about dur­ing her bud­get speech. Could you please ex­plain th­ese chal­lenges in de­tail.

Monya­mane: The Hon­ourable Min­is­ter ac­tu­ally in­di­cated that 80 per­cent of the Min­istry of Health bud­get is spent in the cen­tral area of the coun­try, Maseru, and does not flow to the dis­tricts. To be pre­cise, that money is spent at the health head­quar­ters and Tše­pong, which takes half of the en­tire bud­get. So now the in­ten­tion is to go back and look at the agree­ment signed be­tween the gov­ern­ment of Le­sotho and Tše­pong con­sor­tium, which is man­ag­ing the hos­pi­tal. This will be done with the aim of re­view­ing the agree­ment.

LT: But why should the hos­pi­tal be cost­ing gov­ern­ment so much?

Monya­mane: as it stands, the gov­ern­ment is not in con­trol of de­ci­sions made by Tše­pong over which pa­tients should be trans­ferred to South africa for treat­ment. The gov­ern­ment sim­ply finds it­self pay­ing more for those pa­tients while the ex­pec­ta­tion is that the hos­pi­tal is by it­self, a ter­tiary re­fer­ral health in­sti­tu­tion. But it now looks as if it is a fur­row lead­ing wa­ters to South africa.

LT: How much does Tše­pong re­ceive as sub­ven­tion from gov­ern­ment?

Monya­mane: a to­tal of M500 mil­lion goes to Tše­pong as sub­ven­tion; the money is cal­cu­lated in such a way that it equals the bud­get the gov­ern­ment used to run Queen el­iz­a­beth ii Hos­pi­tal (be­fore its clo­sure and re­place­ment by Tše­pong as the coun­try’s main re­fer­ral hos­pi­tal in 2011). That’s the whole phi­los­o­phy around this.

Like i said, the hos­pi­tal was sup­posed to op­er­ate as a ter­tiary re­fer­ral cen­tre, but we are be­gin­ning to won­der if it has the ca­pac­ity to do so. Gov­ern­ment is go­ing to in­ves­ti­gate whether there are med­i­cal prac­ti­tion­ers at the hos­pi­tal skilled enough for it to be called a ter­tiary re­fer­ral cen­tre.

From out­side, we just see or­di­nary of­fi­cers em­ployed at that hos­pi­tal. Their skills are no dif­fer­ent to those of of­fi­cers em­ployed in other health cen­tres through­out the coun­try. But the gov­ern­ment is made to pay as if th­ese of­fi­cers at Tše­pong have spe­cial skills. It is like they are spe­cial­ists. if we have such an in­sti­tu­tion with spe­cial­ists, why are pa­tients still be­ing trans­ferred to Bloem­fontein?

We have some Ba­sotho med­i­cal prac­ti­tion­ers work­ing out­side the coun­try who in­di­cated they could come and help us here. Most of them are out­stand­ing lec­tur­ers in South african uni­ver­si­ties. How­ever, we also need to es­tab­lish whether it is be­cause we do not have a dis­trict hos­pi­tal in Maseru that Tše­pong finds it­self hav­ing to trans­fer pa­tients in large num­bers to Bloem­fontein.

LT: The min­is­ter talked about M74 mil­lion which she noted was apart from the M500 mil­lion sub­ven­tion. Could you tell us how it comes about?

Monya­mane: Gov­ern­ment is be­ing made to pay more money for the ex­tra ser­vices Tše­pong of­fers. We are be­ing pe­nalised un­der the pre­text that we are caus­ing an in­flux of pa­tients at the hos­pi­tal. There is a for­mula which is then used byby the hos­pi­tal man­age­ment to charge us for ex­tra ser­vice. We are yet to fa­mil­iarise our­selvesur­selves with that for­mula and see how best things could be re­viewed. One of the fac­tors of the for­mula is that the gov­ern­ment un­der­took­took to put a max­i­mum of 22, 000 pa­tients foror ad­mis­sion at Tše­pong and 2, 000 in their clin­ics, per year.

If it ex­ceeds those­hose fig­ures, then that’s where they are chargin­garg­ing gov­ern­ment a penalty. The gov­ern­ment ent does not nec­es­sar­ily owe Tše­pong. The M74 mil­lion they are tak­ing is the penalty they would have charged. The way this for­mu­laula was ex­plained to me by the of­fi­cers in thehe min­istry was that for ev­ery ex­tra bed that at is be­yond the 22, 000 limit, it is charged M13 000 per night. and we are ask­ing, M133 000 per night for do­ing what? at? The for­mula is bankrupt­ing pt­ing the min­istry.

LT: So as a min- istry, what are your plans to ad­dress this sit­u­a­tion?

Monya­mane: We have se­cured fun­ders to ex­tend and facelift our dis­trict hos­pi­tals in Maseru,u, TY, Mohale’s Hoek and d Leribe. We are also go­ing to have spe­cial­ists s in th­ese hos­pi­tals so that we are able to re­duce ce the num­ber of pa­tients be­ing re­ferred to Tše­pong. g. and should we have those spe­cial­ists, they will ll also pass some knowl­edgedge to other doc­tors in the he dis­tricts.

We are also go­ingg to take pri­vate doc­tors andnd en­gage them in the public health sec­tor be­cause we would want it ca­pac­i­tated. We will sign an agree­ment with pri­vate doc­tors to have their pa­tients ad­mit­ted at gov­ern­ment hos­pi­tals, and in re­turn, they will be treat­ing our pa­tients while at­tend­ing theirs at the same time.

and their con­ve­nience now will be that the pa­tients are all at a sin­gle premise. They will also be giv­ing some lessons to our doc­tors. it will be an agree­ment where we are not go­ing to pay them be­cause they will also ben­e­fit by hav­ing their pa­tients ad­mit­ted in our fa­cil­i­ties.

apart from the doc­tors, we also have pri­vate nurses who are do­ing a won­der­ful job out there. We should have a for­malised part­ner­ship with th­ese nurses, and also ex­tend this re­la­tion­ship to tra­di­tional heal­ers. We can­not sim­ply ig­nore the scourge of HIV/AIDS in our coun­try, and for us to fight this, we need to se­ri­ously en­gage ev­ery­one. We also have TB as an­other dis­ease threat­en­ing our peo­ple. We are also go­ing to in­tro­duce mo­bile clin­ics through which treat­ment for al­most all the ill­nesses would be ad­min­is­tered.

We have re­alised that there are long dis­tances be­tween com­mu­ni­ties and health­care cen­tres, so with mo­bile clin­ics, we would have solved sit­u­a­tions where pa­tients have to travel long dis­tances be­fore they re­ceive treat­ment. The use of th­ese mo­bile clin­ics will also help us col­lect all the data and bring it to the Min­istry of Health head­quar­ters so that we are able to plan.

LT: In your view, what is also lack­ing in our health­care sys­tem as a coun­try?

Monya­mane: We need nu­tri­tion­ists. Many of the dis­eases we have in Le­sotho to­day are due to lack of proper feed­ing. On this is­sue, the min­istries of health and agri­cul­ture are go­ing to play a piv­otal role in mak­ing sure it is ad­dressed.

Through part­ner­ship, we should find ways of reach­ing our peo­ple at grass­roots level and in re­mote ar­eas by go­ing to them for aware­ness cam­paigns. We should ca­pac­i­tate vil­lage health work­ers for this task. We also want to in­volve church-lead­ers in the com­mu­ni­ties so that they also make sure that be­fore bap­tis­ing any child, they should en­sure he or she has re­ceived med­i­cal in­jec­tions.

Vil­lage chiefs must also be en­gaged to make sure ev­ery ex­pect­ing mother in their com­mu­ni­ties at­tends clin­ics. There should be a record which puts to­gether all this so that as we meet with com­mu­nity lead­ers and dis­trict ad­min­is­tra­tors, we are able to re­ceive all that in­for­ma­tion.

We also want to make use of com­mu­ni­ca­tion op­er­a­tors in the coun­try, who have thou- sands of sub­scribers. We should be able to ap­proach them for so­cial re­spon­si­bil­ity and ask them to pro­vide elec­tronic-learn­ing for health work­ers.

it is very ex­pen­sive to be con­duct­ing health work­ers’ train­ing at ho­tels. But us­ing their mo­bile de­vices for such train­ings will not only cut costs, but also be con­ve­nient. We would rather buy tablet de­vices for them to boost the learn­ing.

We have ob­served that those with new in­fec­tions are young peo­ple of ages be­tween 15 and 35 years. Th­ese are peo­ple us­ing so­cial net­works and we should use the same plat­form to ad­dress them. We are go­ing to have in­for­ma­tion of­fi­cers at ev­ery dis­trict to make this a re­al­ity.

Our peo­ple also need to be taught to be ac­tive and de­mand qual­ity ser­vices from health work­ers. it is their right. as the min­is­ter, and not a politi­cian, i need to dou­ble my ef­forts and prove my­self to my coun­ter­parts, who un­like me, are politi­cians, that i can also bring change.

LT: Do you have plans about mak­ing Queen El­iz­a­beth II Hos­pi­tal fully func­tional once again?

Monya­mane: Def­i­nitely. We are go­ing to build a new Queen ii. We are go­ing to de­mol­ish this one be­cause it is di­lap­i­dated. We are go­ing to in­stall mod­ern ma­chin­ery in the new Queen ii in not too dis­tant a fu­ture.

We want those Ba­sotho med­i­cal prac­ti­tion­ers out­side the coun­try to come back and work here at home. i have al­ready ded­i­cated my­self to pi­lot­ing all th­ese clin­ics in Maseru so that i also col­lect more in­for­ma­tion from pa­tients as i visit them.

This would not be done to con­trol health work­ers, but in the spirit of im­prov­ing the qual­ity of our pro­grammes. it is sup­port­ive su­per­vi­sion.

We are go­ing to re-en­gi­neer our min­istry so that we are able to con­cen­trate on our core func­tion, which is pre­vent­ing dis­eases through early de­tec­tion, early treat­ment, qual­ity ser­vice and ad­her­ence to treat­ment.

Min­is­ter of Health ’Molotsi Monya­mane

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