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Hospital accreditation: MoH pays COHSASA P1 million for every visit

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.

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“With the Information and Communication Technology (ICT) equipment and job training skills, we will be able to help the students living with disabilities to do e-learning and to better their education and job training,” said Chull-Joo Park.

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Tlamelong Rehabilitation serves the marginalized and underserved less privileged persons living with disability in Botswana. The center offers boarding services, vocational training, social services, physiotherapy and rehabilitation services for young people living disabilities aged 18-35 from across the country over a period of two (2) years per cohort which has a maximum intake capacity of 35. BRCS through International Federation of the Red Cross and Red Crescent Societies (IFRC) have managed to create great working synergy with the South Korean Embassy in Pretoria based in South Africa to support or augment the National Society’s Rehabilitation Centre’s learning challenges.

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