HEALTH Minister, Selibe Mochoboroane, continues to spearhead his transformative agenda for Lesotho’s healthcare sector.
He is leading intense vaccination programs to eradicate ailments like the Human Papilloma Virus (HPV) which causes cervical cancer. He is also spearheading the establishment of the country’s first cancer treatment centre, and addressing issues of mismanagement and alleged patient neglect at the Queen ‘Mamohato Memorial Hospital (QMMH).
In a recent interview with Lesotho Times (LT) senior reporter, ‘Mathatisi Sebusi, Mr Mochoboroane discussed the success of the ongoing HPV vaccination campaign, the construction of Lesotho’s first cancer centre to avoid costly referrals to hospitals in South Africa and India, and the government’s efforts to settle Lesotho’s longstanding debts to South Africa’s Pelonomi and Universitas hospitals for cancer referrals.
Mr Mochoboroane noted with relief that the government had finally put measures in place to curb the abuse of referral services especially for cancer treatment, which had previously led to a ballooning debt due to unathorised and improper referrals by senior government officials including cabinet ministers and principal secretaries. He stated that referrals were now channelled through QMMH after diagnosis by specialist doctors. Lesotho has agreements with Universitas and Pelonomi Hospitals in South Africa to treat its cancer patients. It also had a deal with Apollo hospitals in India, which has since been cancelled due to high treatment costs.
Excerpts:
LT: Is it true that cancer patients are being denied treatment in India and South Africa due to Lesotho’s debts to these countries?
Mochoboroane: Since assuming the role of Minister of Health, we have only sent one patient to India for treatment. In fact, we have discontinued the practice of sending patients to India for cancer treatment altogether. Currently, we do not have any arrangements in place that would result in a patient being sent to India for cancer care.
LT: What is the rationale for discontinuing referring patients to India when we lack our own facilities here?
Mochoboroane: Due to the high costs of treatment in India, we have stopped sending patients there for care. However, the primary reason is our focus on developing the ability to treat our cancer patients right here at home.
To that end, I have already engaged a contractor to build a new cancer treatment centre. By constructing our own facility, we can ensure our patients receive the care they need without having to travel abroad. In the interim, we are sending our patients to South Africa for treatment as we work to establish our own cancer centre.
LT: But there are still concerns that Basotho are being turned away from SA due to outstanding debts?
Mochoboroane: Previously, Lesotho lacked a clear referral policy for health services. Anyone could travel to Bloemfontein, South Africa and access treatment at one of the hospitals Lesotho worked with, and Lesotho would be billed for the costs. This resulted in Lesotho accumulating massive, uncontrolled debt.
At that time, several hospitals in Lesotho – including Queen Elizabeth II, Sankatana, and Queen Mamohato Memorial – were referring patients to South Africa for treatment. Lesotho had to stop this practice and restrict referrals to only the Queen Mamohato Memorial Hospital.
The new referral policy is now very clear – Lesotho will only pay bills for patients who have documentation showing they were transferred by the Queen Mamohato Memorial Hospital. Lesotho has paid off the debt owed to South Africa from the previous uncontrolled referrals.
Even Lesotho nationals working in South Africa, as well as non-Basotho, had taken advantage of the lack of a clear referral policy to access healthcare in South Africa at Lesotho’s expense. Lesotho had to negotiate a new memorandum of understanding with the South African government to address this issue.
As a result, Lesotho’s healthcare bills are now under control and reasonable, unlike in the past when they were difficult to understand….. Lesotho also had to address issues with unauthorized referrals to hospitals in India.
Currently, Lesotho no longer has any arrears owed to South Africa and will only be paying claims that are properly submitted.
LT: Has the ministry of health resolved the issue of incorporating village health workers into the government wage system? Previously, you stated that the ministry was working to include these workers so they could receive monthly pay like other civil servants, rather than the previous quarterly payments. If this has been implemented, have the workers’ allowances also been increased as promised?
Mochoboroane: When was the last time you heard village health workers raising any allowance grievances? We started by taking a headcount and then incorporated the village health workers into the system. They are now being paid a monthly allowance of M800, instead of the previous M400 quarterly. We are also reviewing this allowance, as we have increased their responsibilities. The M800 monthly allowance is not enough. Their duties now include collecting data from villages and sending it to health centres. This was not their original responsibility, but they now gather detailed information on births, maternal cases, TB patients, HIV-positive individuals, and child immunizations, including HPV vaccines for girls. Previously, they would informally report this data. But now, they have been trained on proper data collection procedures and are carrying out these expanded duties with a high level of professionalism. They deserve to be adequately compensated for this expanded scope of work.
LT: Who is paying the village health workers? Is it the government or development partners are also providing assistance?
Mochoboroane: In the three rural regions of Lesotho, 5% of the village health workers are paid by the Global Fund, while the remaining workers are paid by the government.
LT: How far has Lesotho progressed in immunizing girls aged 9-15 for the Human Papilloma Virus (HPV)?
Mochoboroane: Last year, the HPV vaccination campaign in our country achieved great success, surpassing the target. While countries were expected to reach 80% vaccination coverage, we achieved an impressive 94%.
This success even led to a celebration by Gavi, the global vaccine alliance, as they had provided funding support to the Ministry of Health to help with the HPV vaccination efforts. Gavi was pleased to see the funds being well utilized, and the ministry was able to maintain resources for the program despite support from other development partners.
To build a sustainable health system, the country has now integrated the HPV vaccination into the routine immunization schedule. This means HPV vaccination is no longer a standalone campaign but has become a regular part of the country’s immunization program.
Additionally, the government recognized the best-performing districts by giving them awards to appreciate their efforts and achievements in the HPV vaccination rollout.
Overall, the country has made significant progress in immunizing children against HPV, surpassing global targets and transitioning the program into the routine immunization schedule for long-term sustainability.
LT: What change can you say has been brought about by HPV vaccination in girls?
Mochoboroane: The long-term impact of HPV vaccination in girls is not immediately visible, but the benefits will become evident in the coming 10-15 years. As the vaccinated generation reaches adulthood, we expect to see a significant decline, or even elimination, of cervical cancer cases. By integrating HPV vaccination into routine immunization programs, we are working towards a future where cervical cancer is eradicated altogether.
LT: Can you please remind us how many Basotho women are diagnosed of cervical cancer annually?
Mochoboroane: Approximately 300 Basotho women are diagnosed with cervical cancer each year. Last year, we recorded a total of 634 cancer cases, with the majority being cervical cancer. This high rate of diagnosis indicates the importance of promoting cancer prevention through measures like vaccines, which could one day lead to a cervical cancer-free generation.
LT: What do you say about misinformation regarding HPV vaccines, such as claims that it causes high libido in girls resulting in teenage pregnancies? Can such myths affect progress, especially when they are communicated in a public and respected forum like parliament? Legislator Remaketse Sehlabaka made the claims in parliament not so long ago.
Mochoboroane: The truth is, everyone is entitled to their opinions about the vaccine, whether they agree with the Ministry of Health or not. It was important that the issue of HPV was raised in parliament by Mr Sehlabaka, as debating such matters helps people gain a full understanding of what is being discussed.
When he tabled a motion calling for a halt in HPV vaccination, I believed he had scientific evidence to back up his claims. However, during the debate we discovered that he had no scientific evidence to support his assertions about the supposed “dangers” of HPV vaccines. What he had was merely a personal perspective not facts.
LT: What is your response to the allegations of nepotism, maladministration, and malpractice at Queen Mamohato Memorial Hospital? Reportedly, health workers, including doctors and general staff, hold positions that do not align with their qualifications. There are also claims of doctors’ malpractice resulting in patient deaths, as well as an alleged misuse of M3 million in hospital funds. What actions have you taken to address these issues?
Mochoboroane: We have changed the hospital management. The issue was not one of administration per se. The administration was still functioning properly. What prompted me to change the hospital management was a case of incompetence by some doctors from the Democratic Republic of Congo (DRC). I’m not a medical expert, but I reached out to the Lesotho Medical Council for assistance. I tasked them with investigating and providing recommendations regarding these doctors.
There were two incidents where one of the DRC doctors was working at Mapoteng, but after causing trouble, he fled only to be hired at QMMH. We need to understand how he was hired, given that there are three structures involved in the hiring of doctors.
There is a vetting committee for doctors, as well as the medical council. One cannot obtain a certificate to practice medicine without going through these stages and being approved by the medical council.
We are specifically investigating one doctor to determine what led to their hiring. The investigation will also reveal the qualifications of these doctors. We do not expect to hire foreign medical practitioners at the hospital, except for specialists. As this is a referral hospital, we only intend to hire consultants, specialists, and super-specialists. We are very clear on this policy.
