. . . as Tšepong shuts down some wards

Minister, PS spat threatens health system

KANANELO BOLOETSE with MNN Centre for Investigative Journalism

MASERU – A three-way spat between Minister of Health Nkaku Kabi, the ministry’s Principal Secretary (PS) ‘Mole Khumalo, and the management of Queen ‘Mamohato Memorial Hospital (QMMH), is threatening to plunge the already poor national healthcare system into deeper disarray.Khumalo, earlier this year, apparently instructed QMMH, commonly known as Tšepong Hospital, to conform to the terms of its contract with government and slash skyrocketing patients’ admissions.

However, in an exclusive interview with MNN Centre for Investigative Journalism on Wednesday, Kabi said he had not been informed that Tšepong had been instructed to limit patients. But when he called the hospital to inquire about the matter hospital management confirmed to him that it was instructed by Khumalo to limit admissions and even promised to share with the minister a copy of the PS’s letter.

The hospital confirmed that it was closing some wards to comply with Khumalo’s instruction. Kabi then told the Centre that Khumalo “acted without the mandate of the ministry”, stressing that there had never been a meeting at which the ministry decided to instruct Tšepong to limit patients and mandate the PS to communicate such a resolution to the hospital. When called by the minister, in the presence of this reporter, Khumalo indicated that he was informed by the hospital that it had closed Ward O because it was owed by government.

“They said they closed Ward O and they might also close Ward C,” Khumalo told the minister. Khumalo said Ward O was private but the hospital had only decided to use it for public patients in order to increase capacity and accommodate more public patients who were desperate for medical services. He added that the hospital had now decided to close the ward to the public as it was unsure government would agree to pay for services the hospital offered in that ward.

On Thursday, in an interview with the Centre, Khumalo said, according to the contract, Tšepong was supposed to have 425 beds, 35 of which were meant for a private ward. “Section 27 of the contract is very clear that the hospital can run the ward at its own costs and risks,” he said. But from the beginning, he added, the private ward never worked as there was congestion at the hospital and management decided to convert the private ward to a public ward.

He said: “The contract also stipulates that the Tšepong management must always keep government abreast of all the developments at the hospital. That is why the hospital submits a report to government each year to which the ministry would always reply: stick to the terms of the contract. This is the usual government response. “Even this year we told them to stick to the terms of the contract like we always do. That is why they have closed that private ward. It is wrong for them to say we said they should close wards.

“The challenge now is that government owes Tšepong for these extra services that were provided in that private-turned-public ward.” Khumalo decided not to answer why the minister was not aware of the latest development at Tšepong regarding closure of some wards.He further told the Centre that the ministry of health was doing everything in its power to strengthen and improve quality of primary healthcare facilities to ensure that potential patients do not bypass the primary healthcare level and enter the system at a higher level.

Tšepong’s spokesperson, Mothepane Thahane, on Thursday this week indicated that there were several wards that the hospital was closing as per the government’s instruction. “It is not Ward O only, there are several others,” Thahane said. She further indicated that referrals to Bloemfotein, South Africa were probably not going to happen in November. Since 2011 Tšepong has referred cancer patients to Pelonomi and Univesitus hospitals, with government footing the bill. QMMH and four primary care clinics that make up the Lesotho health network Private Public Partnership (PPP), have now been operational for seven years.

The state-of-the-art 425-bed hospital opened doors in October 2011 to replace the aging and outdated main public hospital, Queen Elizabeth II, and to upgrade the network of urban filter clinics and serves as the country’s man referral healthcare facility. According to the World Bank, through this health network, the ministry of health is providing much better quality of care.

“It is achieving better health outcomes for a larger number of patients, including providing more advanced medical technologies than were previously available in Lesotho,” the World Bank said in February 2016. The hospital is run by the Tšepong consortium of five companies, namely; Netcare Healthcare Group and Afri’nnai of South Africa, as well as Excel Health, Women Investment and D10 Investments from Lesotho, under an 18-year contract at the end of which the hospital passes into government full ownership.

Government pays the consortium operating the hospital annual unitary payment as part of the contract. The unitary fee under the original tender catered for 16,000 inpatient admissions and 278,000 outpatient visits per year. For the same fee, Tšepong committed to treat 20,000 inpatients and 310 000 outpatients per year. These numbers have been exceeded each year since the PPP became operational, according to the World Bank, with more than 27,000 inpatients and nearly 350,000 outpatients treated in 2015 alone.

“The better quality of care provided through the primary care clinics and QMMH has led many patients seeking treatment directly through the health network PPP, bypassing other hospitals. “As Lesotho provides universal health coverage for its citizens, people pay the same fees for care at QMMH and its clinics as they do at any other hospitals in the country. Given the choice, people are seeking to be treated through the PPP health network,” World Bank said in 2016.

The cost of treating these extra patients has a direct impact on the health budget as treatment of more than these volumes entitles Tšepong to an incremental payment per patient. The charges for excess patients now make up a huge 19 percent of the fees Tšepong charges. In March this year, Deputy Prime Minister Monyane Moleki told Parliament government owed Tšepong M400 million for excess patients.

During a study tour at the hospital on Friday last week, the Centre for Investigative Journalism learnt how district hospitals’ overreliance on referrals to Tšepong sometimes leading to “unnecessary” or “wasteful” referrals was a concern that lay behind the issue of excess patients bleeding government coffers dry. In one case, the Centre learnt, a new-born baby was transferred from Botha Bothe hospital because powdered infant milk formula for babies at the hospital had expired, according to the referral letter.

A 900 grams of stage one starter infant formula for babies aged zero to six months, costs around M150.00. In another case, a baby was transferred from Botha Bothe because the hospital’s wards did not have oxygen and children prescribed oxygen by doctors could not receive it.

Oxygen is an essential medical therapy used not only for pneumonia and other primary lung diseases, according to the World Health Organisation (WHO), but also many other conditions that result in hypoxaemia – an abnormally low concentration of oxygen in the blood – and other neonatal conditions. In a statement in April 2014, Netcare limited said sometimes remote district hospitals dropped an ambulance full of patients at the reception area at night and just disappear.

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