When fully operational, the Sir Ketumile Masire Teaching Hospital (SKMTH) is expected to avert the need for the government of Botswana to refer patients to the Republic of South Africa and other countries like India for high level care, permanent secretary in the Ministry of Health and Wellness, Ruth Maphorisa has said.
SKMTH is expected to be fully operational early next year (2019). The hospital, it is expected will save government millions of Pula, and relieve pressure from Botswana’s major public health care providers, Princess Marina Hospital (PMH) and Nyangabgwe Referral Hospital when it comes to elite patients. The hospital will also come as competition for private hospitals such as Bokamoso Private Hospital and Gaborone Private Hospital.
The hospital, located on the grounds of the University of Botswana campus in Gaborone, is a 450 bed quaternary hospital. The mandate of the hospital when fully functional is threefold: which will be to provide world class medical services at a quaternary level, to work in conjunction with the University of Botswana School of Health Services to provide world class health education, and lastly to act as a hub for health research.
It is hoped that the hospital will attract the best clinical and academic staff in the region, possibly internationally, and will be a destination of choice for clients seeking world class cost effective medical services. The hospital, according to Maphorisa will operate as a quaternary hospital. “It will fit into the apex of a healthcare referral ecosystem that entails the two regional tertiary hospitals, namely PMH and Nyangabgwe Referral Hospitals, which will refer into SKMTH for super-specialized health services.”
For a long time the government has been sending patients to India and South Africa for average and complicated surgeries. A whopping P 627 504 802 was spent on South African hospitals between 2014 and 2017 while Indian hospitals gobbled P13 million from the ministry between 2015 and 2017.
Upon full commissioning, SKMTH will offer broad areas of service like; Critical and Trauma Care, Women and Child Care, Cardiac Care Comprehensive Oncology Care, Nephrology and Transplant Services, Internal Medicine, Surgical Services and Allied Health Services.
Most of these cases have been referred across the borders. Reasons to transfer patients to private facilities outside borders ranged from complicated cases, lack of proper equipment and infrastructure in the local hospitals. Both Marina and Nyangabgwe are said to be lacking capacity in the three components to do the work with diligence. Additionally, Maphorisa says SKMTH will train and produce international standard healthcare professionals for the entire national healthcare system, and beyond.
“Through research, SKMTH will lead in the development of health solutions for its population and community, such as vaccines and new modalities of treating and managing emerging and established health challenges,” she told WeekendPost. Based on on-going project commissioning work, it is reasonably anticipated that official opening of SKMTH will be in March/ April 2019.
The three areas of concern for the local health fraternity has always been Oncology, nephrology and ophthalmology. Oncology is a branch of medicine that deals with the prevention, diagnosis, and treatment of cancer. Nephrology is a specialty of medicine and pediatrics that concerns itself with the kidneys.
An online platform, medical.com defines it as “the study of normal kidney function and kidney disease, the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy (dialysis and kidney transplantation).” Nephrology also studies disease conditions that affect the kidneys, such as diabetes and autoimmune disease; and systemic diseases that occur as a result of kidney disease, such as renal osteodystrophy and hypertension.
On the other hand vision health says Ophthalmology is a branch of medicine and surgery (both methods are used) that deals with the anatomy, physiology and diseases of the eyeball and orbit. The SKMTH project is the first of its kind in Botswana, both in terms of magnitude and complexity. The Vision of the hospital is anchored on providing unmatched regional excellence in the areas of clinical care, education and research.
The painstaking process of procuring and receiving equipment, finalizing the business plan, finalizing and executing an organizational structure and culture that will deliver to the aspirations of the project, developing management operating systems, processes, procedures and quality standards, is one that is being approached with the utmost care and caution, while balancing that with the need for a timely opening to serve the needs of the community/nation.
The capital expenditure has been in the region of 2 billion Pula. Operating costs are still being defined as part of the business plan for effect next Government financial year. The idea to open the facility came as the government wants to position Botswana as one of the leading health centres. The facility was named Sir Ketumile Masire Teaching Hospital (SKMTH) after the late Sir Ketumile Masire, who was the second president of this republic.
Government is currently sitting on 4 400 vacant posts that remain unfilled in the civil service. This is notwithstanding the high unemployment rate in Botswana which has been exacerbated by the recent outbreak of the deadly COVID-19 pandemic.
Just before the burst of COVID-19, official data released by Statistics Botswana in January 2020, indicate that unemployment in Botswana has increased from 17.6 percent three years ago to 20.7 percent. “Unemployment rate went up by 3.1 percentage between the two periods, from 17.6 to 20.7 percent,” statistics point out.
Leading commercial bank, First National Bank Botswana (FNBB), expects the central bank to sharpen its monetary policy knife and cut the Bank Rate twice in the last quarter of 2020.
The bank expects a 25 basis point (bps) in the beginning of the last quarter, which is next month, and another shed by the same bps in December, making a total of 50 bps cut in the last quarter. According to the bank’s researchers, the central bank is now holding on to 4.25 percent for the time being pending for more informed data on the economic climate.
An audit of the accounts and records for the supply of food rations to the institutions in the Northern Region for the financial year-ended 31 March 2019 was carried out. According to Auditor General’s report and observations, there are weaknesses and shortcomings that were somehow addressed to the Accounting Officer for comments.
Auditor General, Pulane Letebele indicated on the report that, across all depots in the region that there had been instances where food items were short for periods ranging from 1 to 7 months in the institutions for a variety of reasons, including absence of regular contracts and supplier failures. The success of this programme is dependent on regular and reliable availability of the supplies to achieve its objective, the report said.
There would be instances where food items were returned from the feeding centers to the depots for reasons of spoilage or any other cause. In these cases, instances had been noted where these returns were not supported by any documentation, which could lead to these items being lost without trace.
The report further stressed that large quantities of various food items valued at over P772 thousand from different depots were damaged by rodents, and written off.Included in the write off were 13 538 (340ml) cartons of milk valued at P75 745. In this connection, the Auditor General says it is important that the warehouses be maintained to a standard where they would not be infested by rodents and other pests.
Still in the Northern region, the report noted that there is an outstanding matter relating to the supply of stewed steak (283×3.1kg cans) to the Maun depot which was allegedly defective. The steak had been supplied by Botswana Meat Commission to the depot in November 2016.
In March 2017 part of the consignment was reported to the supplier as defective, and was to be replaced. Even as there was no agreement reached between the parties regarding replacement, in 51 October 2018 the items in question were disposed of by destruction. This disposal represented a loss as the whole consignment had been paid for, according to the report.
“In my view, the loss resulted directly from failure by the depot managers to deal with the matter immediately upon receipt of the consignment and detection of the defects. Audit inspections during visits to Selibe Phikwe, Maun, Shakawe, Ghanzi and Francistown depots had raised a number of observations on points of detail related to the maintenance of records, reconciliations of stocks and related matters, which I drew to the attention of the Accounting Officer for comments,” Letebele said in her report.
In the Southern region, a scrutiny of the records for the control of stocks of food items in the Southern Region had indicated intermittent shortages of the various items, principally Tsabana, Malutu, Sunflower Oil and Milk which was mainly due to absence of subsisting contracts for the supply of these items.
“The contract for the supply of Tsabana to all depots expired in September 2018 and was not replaced by a substantive contract. The supplier contracts for these stocks should be so managed that the expiry of one contract is immediately followed by the commencement of the next.”
Suppliers who had been contracted to supply foodstuffs had failed to do so and no timely action had been taken to redress the situation to ensure continuity of supply of the food items, the report noted.
In one case, the report highlighted that the supplier was to manufacture and supply 1 136 metric tonnes of Malutu for a 4-months period from March 2019 to June 2019, but had been unable to honour the obligation. The situation was relieved by inter-depot transfers, at additional cost in transportation and subsistence expenses.
In another case, the contract was for the supply of Sunflower Oil to Mabutsane, where the supplier had also failed to deliver. Examination of the Molepolole depot Food Issues Register had indicated a number of instances where food items consigned to the various feeding centres had been returned for a variety of reasons, including food item available; no storage space; and in other cases the whole consignments were returned, and reasons not stated.
This is an indication of lack of proper management and monitoring of the affairs of the depot, which could result in losses from frequent movements of the food items concerned.The maintenance of accounting records in the region, typically in Letlhakeng, Tsabong, and Mabutsane was less than satisfactory, according to Auditor General’s report.
In these depots a number of instances had been noted where receipts and issues had not been recorded over long periods, resulting in incorrect balances reflected in the accounting records. This is a serious weakness which could lead to or result in losses without trace or detection, and is a contravention of Supplies Regulations and Procedures, Letebele said.
Similarly, consignments of a total of 892 bags of Malutu and 3 bags of beans from Tsabong depot to different feeding centres had not been received in those centres, and are considered lost. These are also not reflected in the Statement of Losses in the Annual Statements of Accounts for the same periods.