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.
Presidential Commission of Inquiry into the Review of the Constitution held a meeting in Serowe this week. The meeting was to accord Bangwato, just like other tribes, a platform to give their opinions, contributions and what they think is the horse power and limitations of the current Constitution of Botswana.
Bangwato Regent, Kgosi Serogola Seretse said, he is of the understanding that the Commission has not come for anything apart from getting their opinions on how things could be made better. His contribution was that he solely knows of only two social positions in the world; Dikgosi and Pastors. He said other positions are just benedictions. He further urged that, Batswana should respect God’s ordained protocols such as Dikgosi and Pastors.
Seretse pointed out the importance of acknowledging and appreciating Dikgosi as nation builders. He cautioned and warned that, the Commission should ensure that their dealing with Dikgosi is harmonious. He called for an amendment to be made on the ‘National Order of Precedence’ noting that Dikgosi are put at number 11, but should at least be taken a little higher to number 7.
One resident, Tshepo Moloi while giving his contribution said there must be provisions of Social Justice that ensure equal distribution of resources to all citizens. He said this provision should entail an obligation that all citizen have equal opportunities to different Government Initiatives. Moloi substantiated that, all ‘Presidential Commissions’ be engraved on the Constitution
Alfred Thogolwane who is as well a resident of the biggest village in the Central District, pointed out the need for preservation of the country and resources thereof, saying “it must dawn onto all that, the calabash that fetches water for the family cannot fixed once its broken.” Another resident, Keikantsemang Sebedi advocated for Polygamous marriage, saying that men should marry as many wives as they please. She said there is no need for any socioeconomic assessment done on men who wish to marry more than one wife.
She advised that, the country should benchmark from the Zezuru culture that does it, with no complexities. On the other hand, Sebedi said that, there must be considerations done on the Old Age Pension. She said people who earned P4000 should not receive the old Age Pension upon their fullness of age. Forshia Koloi called for amendments on Section 77 and all the provisions that speaks to the subject of Bogosi and the powers infested in them. He said they should be made more detailed and avoid ambiguity in clauses.
Mr Tlhaodi said there must be Land Audits done in the country. Citing an example of the Tati Land as one that should be thoroughly audited. He further advised that, Election Day be put on the Calendar. He said, if it happens that the day be a Saturday, there should be some special dispensation for the 7th Day Adventist Church members to take part in voting without compromising on their day of worship. Tlhaodi added that there must be People’s Complaint Commission in the country.
Speakers emphasized the need for the country to review the exercise of ‘Political Party Funding’. They articulated that lack of funding political parties’ results in political parties resorting to finding funds for themselves. They reiterated that sometimes going to the extent of getting funds through illegal means. Bangwato agreed in one accord that they want the President be tried whilst in office if suspected of any criminal offences. This was revealed in their contributions. They pointed out that, the law should not to wait until the end of their tenure.
For his part, the Deputy Chairperson of the Commission Johnson Motshwarakgole expressed gratitude to the residents of Serowe. He applauded women for their kindness saying it is only them, who always take responsibility for doing things amicably in the society.
Parliament has revealed that it plans to rollout a Community Score Card (CSC) exercise as part of sweeping reforms to its role and mandate among others.
The planed shakeup, along with the rollout of CSC will see creation of new Parliamentary Portfolio Committees on Health, HIV&AIDS, Education and Skills Development, Trade and Economic Development, Agriculture, Lands and Housing and Local Governance and Social Welfare. Parliament informed government ministries and departments that the CSC is a participatory, community based monitoring and evaluation tool that enables citizens to assess the quality of public services and interact with services providers to express their concerns.
According to Parliament, the CSC will assist to inform community members about available services and their entitlements and to solicit their opinions about the accessibility and quality of certain services related to the portfolio committees mentioned. It said the main objective is for Parliament through identified oversight committees is to conduct a participatory monitoring and evaluating process that puts ownership and responsibility for delivery of services in the hands of both the Government and the service recipients.
“Through scorecards developed around identified sectors and services, communities and implementing departments remain in touch with progress made through the programme delivery cycle and are able to respond timely to bottlenecks,” the National Assembly said. Some of the measurements and expected outcomes for the rolling out of the CSC include among others, improved monitoring and economic evaluation, to determine the impact of spending, so as to be able to direct resources from where they having the least benefit to those projects and programmes where they will have a larger positive impact.
The National Assembly explained further that this could result in a willingness to close down ineffective programmes and institutions and not to implement projects that do not deliver adequate returns, improved productivity in the public services, especially given the substantial pay increases.
The National Assembly believes that the rolling out of CSC is also expected to result in efficiency savings: many public services and programmes could be delivered more effectively at lower costs, by improving management and accountability, and making use of e-services. “This would yield financial savings that could be used for development programmes or reducing the deficit,” the National Assembly said.
The exercise is also expected to result in “Careful scrutiny of subsidy schemes and termination of those that do not address market failure or assist truly needy Batswana.” The National Assembly revealed that proposed Parliamentary Portfolio Committee on Health and Wellness has been established in accordance with the Standing of National Assembly of Botswana. It explained that the mandate of the Committee is mainly to exercise Parliamentary oversight and scrutiny over Government Ministries, Departments and Agencies with portfolio responsibilities in respect of Health and HIV/AIDS.
“There is need to identify reasons for inefficiency and poor outcomes and ensure that health system reform improve productivity and value for money. Key areas of focus for scorecard, availability of drugs, staffing ratios, accessibility of health services, speciality care and services and sexual reproductively health,” the National Assembly said.
Another proposed Committee is on Local Governance and Social Welfare. The mandate of the Committee is mainly to exercise Parliamentary Oversight and Scrutiny over Government Ministries. Departments and Agencies with Portfolio responsibilities in respect of Local Governance and Social Welfare.
“Strategies under NDP 11 to improve outcomes of social uplifment include; diversiﬁcation of rural economies, development and support of small businesses, provision of social safety nets, eradication of absolute poverty, provision of quality and equitable education and harmonisation of social protection programmes,” said the National Assembly. It said social nets need to be improved so as to target these most in need (at present some social safety nets benefit many people who are not the most needy, but also miss out some of those who are needy).
“Some social development policies more broadly should also aim to reduce household vulnerability to shocks such as those arising from fluctuations in agriculture, climate change, incomes and employment and improve their ability to handle shocks, thereby building household resilience,” the National Assembly said.
Another Committee established is on Agriculture, Lands and Housing. The mandate of the Committee is mainly to exercise Parliamentary oversight and scrutiny over Government Institutions, Departments and Agencies with portfolio responsibilities in respect of Agriculture, Lands and Housing.
The National Assembly said the average growth rate of the agricultural sector since the beginning of National Development Plan 11 (NDP11) (i.e. during the 2017/2018 and 2018/19 financial years) was 2.5 percent, making it the slowest growing sector of the economy, in line with its historical performance.
“Over the same period, its share of GDP has been stagnant at around 2 percent. The sector also contributes job opportunities for about 80 000 adults. Food security has become paramount since the onset of the corona virus pandemic,” the National Assembly said. The National Assembly said the Government realises the need to increase food production for products in which Botswana has a cooperative advantage such as beef, grains and other horticulture products.
The Committee on Finance, Trade and Economic Development has also been established. One of the mandates of Committee would be to exercise Parliamentary oversight and scrutiny over government ministries, departments and agencies with portfolio responsibilities in respect of Finance, Development, Trade and Industry.
“The sector is at the core of industrialisation aspirations and strategies for economic development in Botswana. Manufacturing in particular can be the driver of economic growth through technological improvements and innovation,” the National Assembly said. Hence, it said, the development of the sector could also foster export diversification and export led-growth in Botswana while benefitting from the African Continental Free Trade Area (AFCFTA).
Two senior members of Directorate on Corruption and Economic Crime (DCEC) have threatened legal action against Directorate of Intelligence and Security (DIS), it has transpired. The threat is contained in an answering affidavit of Director General of DCEC, Tymon Katlholo in which he is seeking an interdiction from High Court to stop the DIS from accessing investigation files at his office.
After the DIS detained DCEC officials Joao Salbany and Tsholofelo Bareetsi on December 16, 2021, they filed an official complaint against DIS and some officials. They complained about abuse of office by DIS and five officers. Salbany and Bareetsi also complained about unlawful detention by DIS and unlawful dissemination of classified information contrary to Section 44 of Corruption and Economic Crime Act. “The DIS interviews were premised on information divulged during the course of official DCEC work product, that is the Monday media brief meeting,” they wrote.
They further requested leave to institute a civil suit against the DIS and its officers, and invariably the State for inhuman and degrading treatment they suffered and unlawful detention. They also pondered a declaratory seeking a sanction against the DIS and Botswana Police Service (BPS) and clarification of the role of BPS officers seconded to DIS.
“The envisaged suit against BPS and DIS officers and the DIS will inevitably centre on investigations done by the DCEC and the scope of the protection availed to DCEC officers for conduct done in the course and scope of DCEC official duties.” The duo said it was self-evident from the conduct of the DIS officers that there was nothing urgent about the information required by the DIS, justifying their detention at its Sebele facility from 08:30 hours on December 16, 2021 until 02:00 hours on December 17, 2021.
They reasoned that the information required by the DIS could have been obtained by a simple request to DCEC Director General. “What the DIS did was to seek to intimidate officers of the DCEC whom they knew were carrying out investigations against some of the DIS officers who were part of their investigation team. This turn of events has a chilling effect not only on the functioning of the DCEC but also on the official conduct of officers of the DCEC as to how they conduct their official duties.”
They concluded by stating that in the event the request is granted, they would further request to be advised as to the provision of legal representation as the unalwful detention and the degrading and inhuman treatment by the DIS was in relation to matters conducted by and on behalf of the DCEC.