…emphasizes strategic shift to focus on disease prevention
BEFORE Selibe Mochoboroane took over the Ministry of Health after the October 2002 general elections, Lesotho’s health sector was dysfunctional and in complete paralysis. Services at the main referral hospital, Queen ‘Mamohato Memorial Hospital, had grind to a virtual halt amid incessant disputes between the then Moeketsi Majoro government and the Netcare Group, which was then mandated to run the institution. Health workers engaged in endless strikes. Community and village health workers had for long not been paid their wages, among a plethora of challenges.
After assuming the health portfolio, Mr Mochoboroane, the leader of the Movement for Economic Change (MEC), begun the mammoth task of restoring sanity at the then beleaguered ministry. All outstanding wages to community health workers were paid. Services at Tsepong have largely returned to normal. Mr Mochoboroane is now spearheading a huge campaign to vaccinate women and girls for protection against cervical cancer, among many other milestones. Even the most virulent pessimist will agree that the hardworking young minister’s Midas touch is positively impacting health delivery. Of course challenges remain. The high costs of treating cancer patients in neighbouring South Africa has plunged the country into debt, with Lesotho now owing South African institutions in excess of M200 million.
Mr Mochoboroane is determined to reverse that by ramping up local healthcare infrastructure to cater for cancer treatment as well as train specialist doctors to work locally to cut the costs incurred in sending Basotho to foreign countries for treatment. He also wants to ensure widespread vaccination for preventable cancers and other diseases. ‘Prevention is always better than cure’, has become Mr Mochoboroane’s enduring aphorism.
Lesotho Times (LT) reporters Mohloai Mpesi and Mathatisi Sebusi caught up with Mr Mochoboroane on the sidelines of a Chinese Embassy farewell event for a group of Chinese medical doctors who had been helping in Lesotho. He is evidently one of the most competent ministers in government who has impressed in every portfolio in which he has been deployed. Excerpts:
LT: The Ministry of Health has been soliciting health services from neighbouring South Africa which last month demanded a whopping M218 million for services already rendered. How much is it costing the government annually to treat cancer patients outside Lesotho?
Mochoboroane: Yes, it is true that the Ministry of Health solicits health services from South Africa, especially to treat cancer patients who have reached the radiation stage.
We also solicit health services for patients involved in accidents or have gun wounds that somehow affect the spinal cord and must undergo complex surgical procedures.
In the case of surgical procedures, it is usually special cases where our pool of specialists are unable to conduct such operations. To answer your questions, the services solicited in South African come at a high cost as government spends close to M100 million annually.
LT: How can this situation be better addressed? Or perhaps the question should be, are there any plans in place aimed at ensuring that Lesotho takes care of the health needs of its citizens and all surgeries are performed locally?
Mochoboroane: Our intention is to move from that practice where we go to South Africa seeking for medical services. If you are aware, Queen Mamohato Memorial Hospital (QMMH) has a private ward that has 34 beds. Since the establishment of that hospital, that private ward has never been used. So, we have released an advert for expressions of interest to outsource specialist health services so that there’s a private wing offering such inside QMMH.
People who use medical aid seek medical services in South Africa because we don’t have super specialist medical doctors or doctors with rare skills.
It is our contention that opening that private wing, will mean that health services sought in South Africa should be limited to radiation for cancer treatment, while we are working on building our own cancer facility. Trust me when I say that soon we are going to stop soliciting health services from South Africa in high numbers.
LT: In the meantime, what is your ministry doing as a remedial measure to fight cancer which seems to be rife in Lesotho?
Mochoboroane: You will realise that lately we are very aggressive on the cancer prevention part. We are rolling out Human Papilloma Virus (HPV) vaccines to stop cervical cancer in women and girls.
We are going to be very aggressive for screening as we want at least 90 percent of women in Lesotho to be screened. We want again, that 70 percent of males be screened for prostate cancer, while on the prevention part we are ensuring that 90 percent of girls in Lesotho are eligible for vaccines. We need them to be vaccinated.
The aim is for Lesotho to be a cancer free country twenty years from now. It is only by investing in prevention and screening that cancer can be detected and treated. These initiatives will assist us to reduce the rate at which we currently transport patients to South Africa for cancer treatment.
LT: There is a concern that the Ministry of Health is struggling to offer palliative care to people with lung diseases, such as Tuberculosis. Please tell us what the challenge are…?
Mochoboroane: Unless I don’t understand the question… Do we have a problem of providing services for people with lung disease? I ask because to have lung related diseases is when one has probably contracted Tuberculosis, as well as silicosis which is caused by inhaling large amounts of crystalline silica dust from the mines.
For your information, we do treat TB, even the variants which are most resistant to drugs. We have a specialist TB clinic at Lepereng where we provide treatment to people who have lung problems and other related serious illnesses. We have a centre and equipment where they are treated.
The only problem is that as much as we provide treatment for silicosis patients, since they come from the mines, we only treat them when they are in bad condition.
So, we do have equipment to treat lung related diseases. Remember during Covid-19 we lost many patients because we didn’t have oxygen. Covid-19 patients died because they had difficulty breathing. Oxygen supplement was the solution but because we have very limited capacity in that regard, we lost many patients.
But now we have an oxygen plant in Mafeteng. At Sankatana we also have a mini oxygen plant…..
We have piped all the hospitals. Medical gas is no longer stored in cylinders; it comes straight from storage to the wards. Meaning when it comes to treating patients with lung related diseases, there is no problem.
LT: As Minister of Health, are you able to deliver on your mandate to your full capacity? If yes, what are your outstanding achievements that you are proud of? What are the milestones reached since you were appointed a minister in 2022? In a similar breath, what are the challenges?
Mochoboroane: In my first year in office, I was concentrating on problem solving. It was a problem-solving kind of leadership. The first problem that I was able to solve was that; for so many years there were complaints that village health workers (VHWs) were not paid on time.
We successfully resolved that problem last year (2023) and they now get paid well on time. Last year ended without a single village health worker complaining that they have not been paid on time.
Secondly, we managed to headcount the village health workers to ascertain their numbers and build their database. Additionally, we made a request that they be incorporated as part of the public service so that they are included in the system of the government. That means when civil servants are paid every month-end, VWCs also get paid their allowances.
By end of April this year, when I get paid as the Minister of Health, they (village health workers) will be paid at the same time, along with the staff of the Ministry of Health.
This is a big achievement because VWCs are the first point of healthcare at community level. They are the Ministry of Health’s first line of defence. Top of our priority list as the Ministry of Health is to strengthen primary healthcare. At the forefront of primary healthcare are the village health workers. They are our frontline soldiers.
Still on my achievements, when I got into office, there was a doctors’ strike emanating from failure by government to pay their overtime allowances over a good five years. I managed to ensure that those doctors are paid, and the strikes have ended. Doctors have returned to work.
LT: Do you count amongst your achievements the ongoing construction of Lesotho’s first cancer centre?
Mochoboroane: It has been said over many years that Lesotho must build a cancer centre. I have started. This is my second year. In my first year, we were able to build the civil works at Lepereng, platforms have been built. This financial year we start the main construction of the cancer centre. The idea was born ten years ago but it is only coming to life now.
Just today (28-03-24), the tender panel was reviewing recommendations of the evaluation team. It says that in April, a contractor who will do the main construction of hospital will be starting while the contractor doing the platforms will be finishing. But they (platform contractor) will still have to hand over some of the work to the main construction contractor.
I take that as a big achievement because it was one of the difficult things to get off the ground.
LT: What else are you proud of as Minister of Health?
Mochoboroane: One of the things I am proud of is that, for so many years Lesotho didn’t have a supply chain storage facility. We have now built two buildings at Lepereng and they are already complete. We will be officially opening them this month. It is where we will be able to store medications. I take that as an achievement.
One thing that has not happened for so many years, which I was able to do in my time of one year and few months in office, is to change the strategic focus of the ministry to emphasize prevention. There is an expression that goes “prevention is better than cure.”
When you address Basotho about HIV/AIDS, they don’t have much interest. You have to coax them to develop an interest to effectively deal with the problem.
I therefore came up with a new strategy to introduce integrated services where we have an outreach program under which we provide a package of health services for people living with chronic diseases. We work on HIV issues, TB, children who missed their vaccinations, we give out new vaccinations and Outpatient Department (OPD) services, among other things.
That has worked and helped a lot because Lesotho is known to be a country highly burdened with TB. But we have always failed to increase TB notifications and reach a number where we are able to treat our patients.
With this integration strategy we have increased the numbers from 37 percent to 44 percent. In the next five years, we are going to reach 90 percent. That is, Basotho with TB should be under treatment and be TB cured so that we are not among the 30 countries highly burdened with TB.
The same applies with HIV/AIDS, where in the past five years there was a target of 90/90/90 that the country had set itself and achieved. But in the time, I have been in office, we have set a 95/95/95 target: that 95 percent of people living with HIV should know their status, 95 percent should be under treatment and 95 percent should have their viral load suppressed.
We worked very well on the other 95 percent but with the last target of having viral load suppression, we are at 99 percent. We are at 97 percent on treatment and at 92 percent on know your status. I am struggling with this one but we will get there.
LT: Back to VHWs. You have just said they are now being paid timeously but only last week, a complaint regarding unpaid village health workers was raised in parliament? Why is that and how do you explain that contradiction to what you just said…..?
Mochoboroane: Yes, I have about 20 to 27 village health workers from two health centres who were not paid at all. It is one health centre in Maseru and another in Qacha’s Nek. I have been given their names and we are trying to establish why they have not been paid when the rest of the village health workers have been paid.
Investigations conducted thus far have yielded that they’re village health workers who were not included in the system despite being engaged over the years. So, we’re working on resolving the issue.
