South African company does referrals for local hospitals
The Ministry of Health Strategy office’s decision to outsource referrals to a South African company is said to have ballooned costs associated with the exercise. Hospitals were bullied into giving up conducting referrals by a newly set up Strategy Office in the Ministry in 2012.
Today Princess Marina Hospital has to conduct its referrals through a South African based company, Healthshare which was awarded the tender four years ago, and it has not been a merry go round exercise. Sources reveal that patients have had to wait for many days to secure appointments, even in cases where specialists are available in Botswana at the two private hospitals, Bokamoso Private Hospital and Gaborone Private Hospital.
Bookings for local and foreign patients to be referred to South Africa are done in that country by Healthshare. Initially Marina even conducted foreign referrals. When government decided to go the outsourcing route, hell broke loose with every little function being tossed from the employed cadres of the hospitals.
Weekend Post has established that Healthshare is paid P319 000 per month by the Ministry of Health. Annually the company raked P3 828 000 from the Ministry. The figure is a flat rate and it does not consider if there were transactions or not. The company was paid P15 312 000 in the last four years.
Referrals are done when there is no equipment to handle a particular medical condition, or when there is no expertise available locally, or there is need for an urgent service, and sometimes when the Marina Hospital Intensive Care Unit (ICU), which has a capacity of eight (8), is full.
“It is shocking that even in cases where there is one known specialist at a private hospital like Bokamoso; we have to wait for the Healthshare representatives based in South Africa to make a call to that doctor before we can take a patient there. Sometimes the process takes too long and some patients deteriorate further and I have heard of a few cases where some lost lives,” said a Medical Officer who used to work at Marina Hospital.
Challenges relating to the Healthshare contract have been communicated to the Ministry of Health’s permanent secretary, Kolaatamo Malefho but there has not been any movement on his side. Malefho has been described as a “My way or the High Way” kind of supervisor and his juniors crumble at his feet. “Some of the issues about Healthshare he would know, some he wouldn’t because people are not open to him. Our bosses are just happy with cooked up figures submitted to President Lt Gen Ian Khama, which falsely state that the Ministry is performing well when all is in tatters,” said an official at the Ministry headquarters.
Accommodation of patients in South Africa has also become a teething problem. Costs have gone up because patients take long waiting to see specialists. Deputy Permanent Secretary – Clinical Services is responsible for this portfolio and has been noticed about the condition of a lodge which was awarded a tender to host patients from Botswana before Healthshare ensures that they see specialists. There have been complaints about the hygiene at the hotel, the person who does landscaping, also prepares meals for patients.
HEALTHSHARE RESPONDS Dr Tony de Coito, Managing Director of Healthshare pointed out that the accusations levelled against his company are incorrect. He shared that they charge the Ministry of Health a flat monthly rate which he could not share because they are currently involved in a bidding process and his competitors could pick on the prices.
Tony pointed out that four years ago the Botswana Ministry of Health was paying 40 percent more than they are paying today. He said they were involved in a tender process when they got the job and their case management skills have helped Botswana reduce costs by over 70 percent.
“We are giving the Ministry of Health value for money. You must note that there are more specialists in South Africa than Botswana hence our involvement,” he said.
According to Tony, Botswana should increase the skills levels in the country if there is to be a reduction in referrals and the costs involved. He said flatly there are no skills in Botswana; hence South Africa is the ultimate destination for specialist needs from Botswana hospitals. He dismissed suggestions that they delay to book or respond to requests from Marina Hospital. He stated that they give feedback every day; the only delay could be finding a slot with the specialist because sometimes it takes about a week or two to get a booking. “It also depends on specific cases, some patients need highly specialised medical experts and it may be difficult to get an immediate booking,” he said.
The Healthshare Managing Director is of the view that the fact that they are currently involved in the process of tendering to get a renewal of this very tender might have evoked some local politics. He said there is also competition to get the job.
Tony is a medical doctor who is passionate about business. Apart from being on the Healthshare Board of Directors, his main contribution is in operations, but Tony also contributes at a strategic level.
Princess Marina Hospital spokesperson, Donnel Kutlapye referred all questions to the Ministry where the Healthshare account is managed. He explained that the hospital was consulted when the decision to outsource was taken. He further pointed out that if there is anything relating to referrals it is communicated to the Ministry’s Strategy Office; hence the Ministry should be in a position to respond to queries from this publication.
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.