Dr. Molotsi Monyamane
Finance Minister, Dr ’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, Dr ’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 by the hospital management to charge us for extra service. We are yet to familiarise ourselves with that formula and see how best things could be reviewed. One of the factors of the formula is that the government undertook to put a maximum of 22, 000 patients for admission at Tšepong and 2, 000 in their clinics, per year. If it exceeds those figures, then that’s where they are charging government a penalty. The government does not necessarily owe Tšepong. The M74 million they are taking is the penalty they would have charged. The way this formula was explained to me by the officers in the ministry was that for every extra bed that is beyond the 22, 000 limit, it is charged M13 000 per night. And we are asking, M13 000 per night for doing what? The formula is bankrupting the ministry.
LT: So as a ministry, what are your plans to address this situation?
Monyamane: We have secured funders to extend and facelift our district hospitals in Maseru, TY, Mohale’s Hoek and Leribe. We are also going to have specialists in these hospitals so that we are able to reduce the number of patients being referred to Tšepong. And should we have those specialists, they will also pass some knowledge to other doctors in the districts. We are also going to take private doctors and 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 thousands 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.
