RUNNING THE SHOW: Ministry of Health Permanent Secretary, Kolaatamo Malefho
The Council for Health Service Accreditation of Southern Africa (COHSASA), the only internationally accredited quality improvement and accreditation body for healthcare facilities based in Africa, has been for past four years trying to accredit Botswana hospitals, but with zero success.
Ministry of Health pays COHSASA P1 million for every visit they undertake to the country and this has been ongoing for 48 months. At one stage, Healthshare, a South African consulting company was engaged to do a baseline on accreditation, but it is not clear what became of its report which was handed to the permanent secretary, Kolaatamo Malefho.
The past 19 or so years have seen over 600 facilities throughout the continent enter the COHSASA programme to improve the quality and safety of the healthcare services they provide to patients, but the vast experience of this organisation has been short played by Botswana’s Ministry of Health. Several recommendations made towards the improvement of the health facilities in the country have been shoved under the carpet, and many believe poor decision making on spending is letting hospitals down.
“Through its integrated and system strengthening process, COHSASA assists a range of healthcare facilities in Southern Africa to meet and maintain quality standards. This range includes hospitals, clinics, general and family practitioners, rehabilitation centres, hospices and laundries with standards being developed for many other services. There is a strong focus on building capacity to help healthcare professionals measure themselves against the standards,” an extract from COHSASA website explains.
Strictly applied quality improvement methods can improve patient safety and the quality of care by identifying deficiencies, guiding interventions and monitoring progress. COHSASA's web-based information system identifies deficiencies and weaknesses in healthcare facilities and creates prioritised quality improvement plans to overcome them. The data generated helps authorities to provide cost-effective interventions. The Ministry of Health officials were asked questions below and did not respond to our questionnaire which was with them for seven days:
For how long has COSASSA been engaged in the accreditation process of local hospitals?
How much has the Ministry spent so far on COSASSA since the commencement of this task?
When do you expect them to finish the accreditation process?
What are the initial recommendations from COSASSA and what has been your response?
Is it true that Healthshare was once engaged to do the same job and their recommendations were ignored and COSASSA was engaged instead?
How many hospitals are on the verge of accreditation so far?
Do the impediments to accreditation have much to do with hospital administration or are they much dependent on actions and decisions by the Ministry of Health eg hospital staffing, shortage of equipment…etc
Healthshare report was sent to hospitals and it became clear to hospital managements around the country that the recommendations were far beyond their mandates. They opined that the Ministry of Health headquarters was based placed to act on the recommendations since their bordered more on budgetary issues. Instead on acting on those recommendations, the Ministry officials chose to engage another organisation, COHSASA to do a baseline on accreditation.
With hospitals there were a number of recommendations which could have helped improve the status, among some of the issues raised were poor maintanance, shortage of health and support staff, overcrowding, lack of resources and equipment, among others challenges.
The report also noted that health in Botswana is too centralised, with all decisions coming from Ministry headquarters. The top down approach has led to situations where hospital management can’t even make basic decisions on recruitment without a word from the permanent secretary. C band and cadres above are all hired from the Ministry headquarters. Hospital management can only hire those on A and B bands, and these posts are frozen to date.
PRINCESS MARINA DOWNGRADED The Princess Marina Referral hospital was at one stage graded to 78 percent by COHSASA but only to be downgraded the following because of its deteriorating status. The hospital has a bed capacity of 565 but on average it admits 750 patients, which far exceeds its capacity without any additional resources or staffing provided.
The issue has been raised with the Ministry of Health but to no avail, health workers at the hospital have in the past indicated that the resources are stretched at Marina. The overcrowding affects staff-patient ratio while dragging down the patient care as well.
WeekendPost has established that Princess Marina has no isolation ward, where it can keep infectious patients; instead the isolation ward was handed over to the Spinalis section at the instruction of permanent secretary Kolaatamo Malefho. This publication has also established that infectious cases are taken to private wards. “If patients at Marina were litigious people, they would sue almost every day,” said a Medical Officer at the hospital.
Princess Marina Hospital responds
What is the bed capacity of Princess Marina Hospital? Bed capacity is 567
On average how many patients do you admit at the hospital? Average 750
How often do you have a mismatch between bed capacity and admission figures? During the year Princess Marina Hospital experience about 750 bed occupancy against the 567 official bed capacity. Usually during the festive season most people go to their home villages and the hospital experiences lower patient volumes with an average occupancy of about 450, so it’s usually less hectic during festive season but the services go on as usual.
Does the much talked about overcrowding have impact on patient/nurse ratio? Yes the ratio increase leading to increased workload for nurses.
What measures do you put in place when the hospital is stretched in terms of resources? The hospital has relocated some of its services to the nearby facilities as follows;
Princess Marina Hospital has relocated some of its services to the nearby facilities. For example Eye Clinic and Open Heart Surgery services as well as stable neonates (premature babies) has been relocated to Scottish Livingstone Hospital. Princess Marina Hospital has also relocated the diabetic clinic to block 6 clinic.
We have also introduced block booking whereby patients see doctors on appointment- for Out Patient Department Clinics e.g. gynaecologist, ENT(Ear Nose and Throat) Clinc, surgical and oncology among others.
In addition to that, PMH has also outsourced a 24hrs laundry service so that healthcare workers can concentrate on their core duties.
Rumatology Services (Joints) patients are seen at Extension 2 Clinics on Fridays and on Tuesday mornings and Thursday afternoons at PMH.
Dermatology (Skin condition patients) Services has been relocated to Broadhurst 3 Clinic. Patients are attended at Princess Marina Hospital on Tuesdays, Wednesday and Fridays only. So basically by relocating these we are trying to decongest the hospital.
What is the capacity of Marina’s Intensive Care Unit (ICU)? Is it adequate for the load Marina is currently experiencing? PMH has an 8 bedded Intensive Care Unit and definitely it is not adequate looking at our patient volumes. Some of our patients are transferred to Scottish Livingstone Hospital in Molepolole. We also outsource ICU services at Bokamoso and Gaborone Private Hospitals.
Does Princess Marina Hospital has an Isolation ward? If no, where do you house infectious patients? We don’t have an isolation ward however we have isolation rooms for infectious disease patients.
Is it true that the Isolation ward was handed to Spinalis section in 2012? Yes it is true that it was handed over to Spinalis to cater for the rising road traffic accident injuries. We will continue to priorities our facilities where necessary.
Are you involved in the budgeting process for the hospital? Is it need and output based? PMH is involved in budgeting, and yes it is need and out based but with the country not out of the recession yet, we cannot get all that we need. Ministry of Health is however very supportive.
Does the hospital management do any recruitment of health workers such as nurses and medical officers or all is done by the Ministry of Health? No, we don’t do recruitment however we present our human resource needs and submit to Ministry of Health who in turn does the recruitment.
Are you happy with the morale of the health workers in your hospital? Yes we are happy with our staff morale however we feel we need to do more in terms of staff welfare issues. We are currently planning award ceremonies to reward high performance culture, we also have staff welfare committee which looks into the welfare of our employees, and we have staff sports games to improve fitness of our employees and bonding. We really thank our staff for working very hard under the current working conditions.
While it takes a lot to penetrate and thrive in the male dominated political space in Botswana, Block 3 Ward councillor Motamma Horatius, is one of the few females defying the odds.
Driven by passion, Horatius has always worn many hats and today she has become one of the few women who are thriving in the political space in Botswana. Prior to pursuing politics, she was an active participated in the creative space.
Horatius, a beauty queen, notably famous for her reign as Miss World Tourism Botswana represented Botswana in a television show famously known as Big Brother Africa. During her stay in the house, she got termed darling of the continent for an outstanding performance that promoted unity, humility and culture.
After serving for some time in public space, and making a name for herself as well as serving as a brand ambassador she decided to step in a career that will forever challenge her. This was after she had travelled the world and demonstrated her unique leadership skills and brilliance.
“I stopped and asked myself why am I not incorporating this brilliance back home. And wherever you go worldwide Botswana with all her faults is a beacon of hope in everything. And even successful countries came here to benchmark and implemented our policies and are flourishing such as Rwanda. So I decided to join active politics and go straight to the ruling party to add a youthful feel to an already existing force and help modernise it to serve better not from afar but from within,” she clarified.
“So my ample experience in civic leadership across countries around the world catapulted me to join active politics because I wondered, if I can do as much as an individual even across nations, how much can I do whilst in office, locally. And I chose to start from the ground up, in order to avoid leaving the locals behind.”
The stern and tenacious young leader, currently sit as the Chairperson of Finance Committee at Gaborone City Council, and also chairs Performance Monitoring Committee.
While a typical girl would dream of becoming either a nurse or choose a ‘girl’ orientated deemed career, she had a heart for politics from a very young age. By the time she left the creative space, she had already made a name for herself, that she needed no introduction.
“I had to acknowledge first that I am a woman, and being a woman means you have to work 200 percent more than your male counterparts. So it took sleeplessness nights, and a massive amount of working smart to win legitimately,” she said.
She acknowledges that she faced a lot of challenges during the 2019 elections which she had to overcome through the assistance of her loved ones and family.
“Politics is expensive but I managed by God’s grace, family, friends, acquaintances and good Samaritans but my mind helped. I am a very good planner when it comes to execution,” she said.
“Another hurdle is, being a young woman, I had conceived during the time of primary elections; so campaigning whilst expectant, managing your emotions through betrayals, insults, stress, house-to-house then giving birth and having to hit the ground in less than two weeks having given birth via C-section, was a hurdle I overcame by God’s mercy and I am thankful to my family for helping me with the kids because politics means a lot of time away from home.”
“Another hurdle was to portray an all rounded culturally grounded Motswana woman soft but yet stern, respectful but can articulate issues well. Because even though we are civilized our society still upholds unwritten yet practiced values of what a woman is and what a man is, and if you defy societal expectations, it judges you harshly. But thankfully I remained focused on who I was and didn’t try alternate anything When I lost some of the original members of my campaign team. The pain was deep. But I wiped my tears. Soldiered on, and God increased twice the initial number.”
At some point she had to face demeaning words from other male contestants, but the best to do at the time was to shun negativity and stay focused. Male intimidation never tugged her down.
“My experience with 2019 elections was rather inclined to learning as it was my first time running for office as a politician, so I wanted to see if really hard work has results because I always hear stories of how people are bought,” she said.
“So since I was not buying anyone, I was on a learning curve to test my hard work style of delivery against what is believed out there. So it was exciting and again I say it was a learning curve as most NGOs fighting to increase women participation in politics were continuously training us.’
Despite everything she feels women political participation in Botswana is still low. She has pleaded with the media to cover them more often as she believes maybe it will help more women to run for office.
Botswana has few women in parliament, giving men dominance in policy decisions. In a 63-seat parliament, Botswana has only seven female MPs, four of them being specially elected lawmakers.
According to the 2019 edition of the biennial Inter-Parliamentary Union (IPU) Map of Women in Politics. Among the top African countries with a high percentage of women in ministerial positions are Rwanda (51.9%), South Africa (48.6%), Ethiopia (47.6%), Seychelles (45.5%), Uganda (36.7%) and Mali (34.4%).
The lowest percentage in Africa was in Morocco (5.6%), which has only one female minister in a cabinet of 18.
Other countries with fewer than 10% women ministers include Nigeria (8%), Mauritius (8.7%) and Sudan (9.5%).Other African countries with high percentages of women MPs include Namibia (46.2%), South Africa (42.7%) and Senegal (41.8%), according to the report.
Though a slight increase, Botswana is still lagging behind when it comes to women political participation.
According to a report made by IEC for the 2019 elections, there is 11.1% women representation in parliament. There has been a 1.6% slight increase from the 2019 election compared to the 2014 elections.
According to United Nations, there are two main obstacles that prevent women from participating fully in political life.
These are structural barriers, whereby discriminatory laws and institutions still limit women’s ability to run for office, and capacity gaps, which occur when women are less likely than men to have the education, contacts and resources needed to become effective leaders.
As it stands though, Botswana has continued to recognize gender equality as central to socio-economic, political and cultural development through its National Vision 2036.
Following the adoption of the National Policy on Gender and Development in 2015, the National Gender Commission was established in September 2016, to monitor implementation of the policy.
Government ministries and departments have moved to cut expenditure in the last quarter of financial year in order to survive the economic hardship occasioned by the covid-19 pandemic. Since the outbreak, Government and the private sector have been hard hit financially due to limited economic activity brought about by government response to fighting the pandemic.
In an urgent savingram by the Permanent Secretary in the Ministry of Local Government and Rural Development, Molefi Keaja addressed to all council secretaries and town clerks, the government informs that it is facing unprecedented budgetary challenges for Financial Year 2020/2021.
“This has necessitated measures to be put in place to conserve cash and ensure that government is able to honour its financial obligations in the remaining (3) months of the financial year,” said the savingram dated 24 December 2020.
The Government has cut all travel by Ministries, Departments and Agencies (MDAs) including State owned entities (SOEs) and Local Authorities until the next financial year in April 2021. It has also taken a decision that all meetings, interviews, seminars, workshops, conferences, retreats, annual ceremonies and hospitality events should be conducted virtually, which save on the cost of securing venues, conference facilities and meals/refreshments.
“No replenishment of refreshments for the Executive Cadre (E2 salary scale and above) until the end of the financial year,” Keaja directed. Last year government also resolved that due to the financial effects of Covid-19 the government will no longer recruit for any jobs during the 2020/2021 financial year.
The Cabinet directed that the 2020/2021 provision for vacancies be withdrawn from Ministries, Departments and Agencies recurrent budgets to cater for supplementary estimates. According to the saving gram then by the Directorate on Public Service Management (DPSM) said the country faces fiscal challenges which have been accentuated by the emergence and the spread of the COVID-19 pandemic.
Amongst key ministries and departments affected were the Botswana Defence Force, National Strategy Office, Directorate of Intelligence and Security (DIS), Commissioner of Police, Commissioner of Prisons, Clerk of National Assembly and the Directorate on Corruption & Economic Crime (DCEC).
It further deliberated that all various institutions that had begun recruitment for existing vacant positions be frozen for the remaining period of the 2020/2021 financial year. “Since funds for the vacancies will only be recruited in the next financial year 2020/20121, Ministries, Department and Agencies are advised to discontinue recruitment into such vacancies until 1st April 2021. Those who are already at an advanced stage of recruitment process are advised to withhold appointments until further notice.”
The Director of Directorate on Public Service Management (DPSM), Goitseone Mosalakatane, told the parliamentary Public Accounts Committee (PAC) in September that despite the high unemployment rate, they cannot hire for the posts because part of the funds have been withdrawn to fight the Coronavirus.
With just a few days into the New Year, Covid-19 seems to be taking its toll and its effects will be felt vastly in the long run. Countries worldwide, including Botswana are injecting in millions of money in the fight against the deadly virus therefore placing immense uncertainty on country’s economy.
When delivering his speech at last year’s State of Nation Address President Mokgweetsi Masisi said during 2020, the domestic economy was expected to contract by 8.9 percent indicating that this is attributed to an expected sharp decline in major sectors such as mining, (minus 24.5 percent); trade, hotels and restaurants (minus 27.4 percent); construction (minus 6 percent); manufacturing (minus 3.9 percent); and transport and communications (minus 2.5 percent).
However, he assured that the economy is expected to rebound during 2021, with overall growth projected at 7.7 percent. The anticipated recovery will be driven by a rebound in growth of some major sectors such as mining (14.4 percent), trade, hotels and restaurants (18.8 percent), and transport and communications (4.2 percent).
Furthermore, Masisi pointed out that the recovery will also be supported by the Economic Recovery and Transformation Plan currently being implemented by Government. “It is critical to note that these projections are dependent on, among others, the duration of the COVID-19 pandemic and related restrictions.
These containment measures have the effect of reducing spending by firms and households and causing supply-chain disruptions. Beyond this, the recovery phase will be influenced by confidence effects on households and businesses; sectoral transformation and changes in work patterns; as well as prospects for the recovery of global financial markets and commodity prices.”
Emphasising this, he explained that despite the challenges of COVID-19 there still remains the delicate balance of opening the economy whilst containing the disease burden. “Inflation according to the latest data from Statistics Botswana, inflation fell significantly from 2.2 percent in September 2019 to 1.8 percent in September 2020, remaining below the lower bound of the Bank of Botswana’s medium-term objective range of 3 to 6 percent,” he said.
The significant decline in inflation mainly reflects the downward adjustment in fuel prices in June 2020. However, inflation may rise above the current forecasts if the international commodity prices increase beyond current projections and in the event of upward price pressures occasioned by supply constraints due to travel restrictions and lockdowns.
The Botswana Democratic Party (BDP) last year had to cancel its elective congress due to the strict measures that had to be put in place due to Covid-19 pandemic outbreak.
Two other party events Women’s Wing Congress including the much anticipated victorious election celebration were also postponed due to the pandemic as gatherings were cancelled indefinitely. However the BDP is adamant that the party will be able to hold its National Congress and all other events that had been frozen this year.
Speaking to this publication chairman of BDP Communication & International Relations Sub-Committee Kagelelo Kentse said that the party was readying itself for the congress with the main objective being to review resolutions that were taken at their 38th National Congress in Mochudi in 2019. Emphasising this, Kentse said it was commendable that most of the resolutions taken in 2019 have by far been fulfilled.
Moreover, he said it would mean a lot for the party to be able to meet at the congress, this he said would give them the opportunity to introspect and reflect with regards to their manifesto. In 2019 the BDP made about eleven resolutions of which five of these were resolved and gazetted. The abridged resolutions were that the amendment of the law to allow agricultural land owners to use up to 50 percent of their land for non-core purposes, to amend the law to cancel transfer duty on property transferred between the spouses.
President Masisi also passed a law to allow married couples to be independently allocated land and increase threshold for non-payment of transfer on property acquired from P250k to P750k. On the resolution in the tourism sector, Kentse said efforts are very advanced to have local play a part. He said there is ongoing work with the Ministry of Lands on concessions that will be allocated to citizens.
According to the BDP communications chair the Ministry of Tourism has availed more opportunities in dams for tourism thus far, having already issued expression of interest for Letsibogo, Dikgatlhong, and Gaborone dams. Citizens are said to have applied for tenders which are currently under evaluation. There are about 45 campsites set aside for citizens in game reserves and forest reserves for tourism.
The resolution on the declaration of assets and liabilities law which was passed and amended this year, was supported by all legislators including those from opposition. Emphasising this he explained that contentions were on issues to do with valuations, and leaders have started declaring.
With the Congress comprising of the elective congress, the BDP is yet to embark on it an objective Kentse said is on their to do list this year even though the calendar of events has not yet been made. The elective congress has aroused interest, especially the Secretary General position which has attracted a number of participants of which observers believe will accord the incumbent, Mpho Balopi, the current secretary general, the opportunity to buy time if at all he will seek re-election in the position.