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.
In a classic and shocking case of disgrace and dishonour to this country, the law enforcement agencies are currently struggling to cover up a damaging and humiliating scandal of having conspired to forge the signature of a Palapye Chief Magistrate, Rebecca Motsamai in an unlawful acquisition of the much-publicised 2019 warrant of arrest against Isaac Kgosi, the former director of the Directorate of Intelligence Services (DIS).
The cloak-and-dagger arrest was led by the DIS director, Brigadier Peter Magosi supported by the Botswana Police, Botswana Defence Force (BDF), with the Botswana Unified Revenue Services (BURS) which accused Kgosi of tax evasion, in the backseat.
Umbrella for Democratic Change (UDC) constituent members are struggling to reach an agreement over the allocation of wards for the imminent ward by-elections across the country.
Despite a Memorandum of Understanding (MoU) between Umbrella for Democratic Change (UDC), Botswana Patriotic Front (BPF) and Alliance for Progressives (AP) are said to be active, but the nitty-gritties are far from being settled.
The eight bye-elections will be a precursor of a somewhat delayed finalisation of the brittle MoU. The three parties want to draw a plan on how and who will contest in each of the available wards.
This publication has gathered that the negotiations will not be a run off the mill because there is already an impasse between the Botswana Congress Party (BCP) which is a UDC constituent and AP (currently negotiating to join umbrella).
The by-elections joint committee met last week at Cresta President Hotel in a bid to finalise allocation but nothing tangible came out of the gathering, sources say.
The cause of the stalemate according to those close to events, is the Metsimotlhabe Ward which the two parties have set their eyes on.
In 2019, he ward was won by Botswana Democratic Party’s (BDP) Andrew Sebobi who unfortunately died in a tragic accident in February last year.
Sebobi had convincingly won by 1 109 votes in the last elections; and was trailed by Sephuthi Thelo of the UDC trailed him with 631 votes; while Alliance for Progressives’ Innocent Moamogwe got 371 votes.
Thelo is a BCP candidate and as per UDC norm, incumbency prevails meaning that the BCP will contest since they were runners up. On the other hand, AP has also raised its hand for the same.
“AP asked for it on the basis that they have a good candidate but BCP did not agree to that request also arguing they have a better contestant,” one UDC member confided to this publication.
Notwithstanding Metsimotlhabe Ward squabble, it is said the by-election talks are almost a done deal, with Botswana National Front (BNF) tipped to take Boseja South ward in Mochudi East constituency. Botswana Patriotic Front (BPF) will be awarded Tamasane Ward in Lerala/Maunatlala constituency, sources say.
“But the agreement has to be closed by National Executive Committee (NEC),” emphasized the informant.
The NEC is said to have been cautioned not to back the wrong horse but rather rate with reason and facts.
UDC President, Duma Boko has told this publication that, “allocation is complete with two wards already awarded but with only one yet to be finalized,” he could not dwell into much details as to which party got what and the reasons for the delay in finalisation.
Chairperson of the by-elections committee, Dr. Phenyo Butale responded to this publication regarding the matter: “As AP we contested and as you may be aware we signed the MoU with UDC and BPF to collaborate on bye-elections. The opposition candidate for all bye-elections will be agreed by these parties and that process is still ongoing,” he said when asked if AP is interested on the ward and how far with the talks on bye-elections.
Butale, a former Gaborone Central Member of Parliament, who is also AP Secretary General continued to say, “As the chairperson of the bye-elections committee we are still seized with that matter. We should also do some consultations with the local structures. Once the process is complete we will issue a notice for now we cannot talk about the other two while the other is still pending the other one”.
Butale further clarified: “There is no such thing as AP and BCP not in agreement. It is an issue of signatories discussing and determining the opposition candidates across the three wards.”
Apart from the three wards, there are five more council wards that UDC is yet to allocate to cooperating partners.
FROM PALAPYE MEET: BPP CAUTION NEC MEMBERS
With the UDC cheerful from last weekend’s meeting in Palapye, the meeting however was very tense on the side of both BCP and BNF, with only BPP flexing its muscle and even lashing out.
BCP going into the meeting, had promised to ask difficult questions to the UDC NEC.
BCP VP and also acting Secretary General, Dr. Kesitegile Gobotswang, presented their qualms which were addressed by UDC Chairperson Motlatsi Molapisi, informants say.
It is said Molapisi is fed up and concerned by some UDC members especially those in the NEC who ‘wash party’s dirty linen in public’.
Insiders say the veteran politician cautioned the NEC members that they “will not expel any party but individuals who tarnish the image of the UDC.”
It is not the first time BPP play a paternalistic role as it once expressed its discontent with BCP in 2020, saying it should never wash UDC linen in public.
At first it is said, BPP, the oldest political formation in Botswana, claims disappointment on BCP stance that UDC should be democratised especially by sharing their stand with the media. Again, BPP was not happy with BCP leader Dumelang Saleshando’s decision to air his personal views on social media regarding the merger of UDC party.
Botswana Police Service (BPS) Commissioner, Keabetswe Makgophe, has of late been dousing raging fires from various quarters of society following the infiltration of the police fingerprint system by the Directorate on Intelligence and Security (DIS), WeekendPost has learnt.
Fresh information gleaned from a number of impeccable sources, points to a pitiable working relationship between the two state organs. Cause of concern is the DIS continuous big brother role to an extent that it is now interfering with other institutions’ established mandates.
BPS which works closely with the DIS has been left exasperated by the works of the institution formed in 2008. It is said, the DIS through its Information Technology (IT) experts in collusion with some at BPS forensics department managed to infiltrate the Fingerprint system.
The infiltration, according to those in the know, was for the DIS to “teach a lesson” to some who are on their radar. It is said the DIS is playing and fighting dirty to win the fights they have lost before.
By managing to hack the police finger print system, a number of renowned businessmen and other politically exposed persons found their fingers in the system. What surprised the victims is the fact that they have never been charged of any wrongdoing by the police and they were left reeling in shock to learn that their fingers are on the data-base of criminals.
In fact, some of those who their fingerprints were falsely included in the records of those on the wrong side of law learnt later when other errands demanded their fingerprints.
“We learnt later when we had to submit and buy some documents and we were very shocked,” one politician who is also a businessman confided to this publication this week.
“We then learn that there are some fabricated criminality recorded for us, as to when did we commit those remained secret to the police, but then we had to engage our lawyers on the matter and that is when we were cleared,” said the politician-cum- tenderpreneur.
The lawyers have confirmed engaging the police and that the matters were settled in a gentlemen’s agreement and concluded.
All these happened behind the scenes with the police top brass oblivious only to be confronted by the irked lot, police sources also add. The victimized group who most of them have been fighting lengthy battles with the DIS read malice and did not blink when it was revealed that these were done by the DIS.
“And it was clear that they (DIS) are the ones in this dirty war which we don’t understand. Remember when we sue, it will be the Police at the courts not the DIS and that is why we agreed to a ceasefire more so they also requested that be kept under carpet,” said the victim.
Nonetheless, the Police through its spokesperson Assistant Commissioner, Dipheko Motube, briefly said: “we do not have any system that has been hacked.” On the other hand DIS mouthpiece Edward Robert was not in office this week to comment on the matter.
Reports however say DIS boss, Peter Magosi, who most of the victims accuse of the job, is said to have met his police counterpart Makgophe to put the matter to bed.
COVID-19 RAVAGES POLICE
As frontline workers, Police have not escaped the wrath of Covid-19. Already the numbers of those infected has reached the highest of high and they suggest that they be priorities on vaccine rollout.
“Our job is complicated, firstly we arrest including those who are non-compliant to Covid protocols and we go to accidents and many more. These put us at risk and it seems our superiors are not bothered,” said one police officer this week.
The cops further complain about that working spaces are small, as such expose them to contact the virus.
“Some tests positive and go for quarantine while the rest of the unit will be left without even test carried out. If at all the bosses are serious all the police officers should every now and then be subjected to testing or else we will be no more because of the virus,” added another officer based in Gaborone.
The government has since placed teachers on the priority list for the vaccines, it remains to be seen whether the police, who also man road blocks, will be considered.
“But our bosses should convince the country leadership about this, if not then we are doomed,” concluded a more senior officer.