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.
An international report complied in South Africa dubbed ‘Legal Gender Recognition in Botswana’ says that the transgender and gender non-conforming people in Botswana live a miserable life. The community experiences higher levels of discrimination, violence and ill health.
In this report, it has been indicated that this is because their gender identity, which does not conform to narrowly define societal norms, renders them more vulnerable. Gender identity is a social determinant of health, which means that it is a factor that influences people’s health via their social context, their communities and their experiences of social exclusion. The Ministry of Health and Wellness has recognized this, and transgender people are considered a vulnerable population under the Botswana Second National Strategic Framework for HIV and AIDS 2010-2017.
In a recent study that shed light on the lived experiences of transgender and gender non-conforming people in Botswana, transgender persons often experience discrimination because of their gender identity and expression. The study was conducted by the University of Cape Town, LEGABIBO, BONELA, as well as Rainbow Identity Association and approved by the Health Ministry as well as the University of Botswana.
Of the 77 transgender and gender non-conforming people who participated in the study, less than half were employed. Two thirds, which is approximately 67% said that they did not have sufficient funds to cover their everyday needs. Two in five had hidden health concerns from their healthcare provider because they were afraid to disclose their gender identity.
More than half said that because of their gender identity, they had been treated disrespectfully at a healthcare facility (55%), almost half (46%) said they had been insulted at a healthcare facility, and one quarter (25%) had been denied healthcare because of their gender identity.
At the same time, the ‘Are we doing right’ study suggests that transgender and non-conforming people might be at higher risks of experiencing violence and mental ill-health, compared to the general population. More than half had experienced verbal embarrassment because of their gender identity, 48% had experienced physical violence and more than one third (38%) had experienced sexual violence.
The study showed that mental health concerns were high among transgender and gender non-conforming people in Botswana. Half of the transgender and gender non-conforming study participants (53%) showed signs of depression. Between one in four and one in six showed signs of moderate or severe anxiety (22% among transgender women, 24% among transgender men and 17% among gender non-conforming people).
Further, the study revealed that many had attempted suicide: one in three transgender women (32%), more than one in three transgender men (35%) and three in five gender non-conforming people (61%).
International research, as well as research from Botswana, suggests that not being able to change one’s gender marker has a negative impact on access to healthcare and mental health and wellbeing. The study further showed that one in four transgender people in Botswana (25%) had been denied access to healthcare. This is, at least in part, linked to not being able to change one’s gender marker in the identity documents, and thus not having an identity document that matches one’s gender identity and gender expression.
In its Assessment of Legal and Regulatory Framework for HIV, AIDS and Tuberculosis, the Health Ministry noted that “transgender persons in Botswana are unable to access identity documents that reflect their gender identity, which is a barrier to health services, including in the context of HIV. In one documented case, a transwoman’s identity card did not reflect her gender identity- her identity card photo indicated she was ‘male’. When she presented her identity card at a health facility, a health worker called the police who took her into custody.”
The necessity of a correct national identity document goes beyond healthcare. The High Court of Botswana explains that “the national identity document plays a pivotal role in every Motswana’s daily life, as it links him or her with any service they require from various institutions. Most activities in the country require every Motswana to produce their identity document, for identification purposes of receiving services.”
According to the Legal Gender Recognition in Botswana report, this effectively means that transgender, whose gender identity and expression is likely to be different from the sex assigned to them at birth and from what is recorded on their identity document, cannot access services without risk of denial or discrimination, or accusations of fraud.
In this context, gays and lesbians advocacy group LEGABIBO has called on government through the Department of Civil and National Registration to urgently implement the High Court rulings on gender marker changes. As stated by the High Court in the ND vs Attorney General of Botswana judgement, identity cards (Omang) play an important role in the life of every Motswana. Refusal and or delay to issue a Motswana with an Omang is denying them to live a complete and full-filing life with dignity and violates their privacy and freedom of expression.
The judgement clarified that persons can change their gender marker as per the National Registrations Act, so changing the gender marker is legally possible. There is no need for a court order. It further said the person’s gender is self-identified, there is no need to consult medical doctors.
LEGABIBO also called on government to develop regulations that specify administrative procedure to change one’s gender marker, and observing self-determination process. Further, the group looks out for government to ensure members of the transgender community are engaged in the development of regulations.
“We call on this Department of Civil and National Registration to ensure that the gender marker change under the National Registration Act is aligned to the Births and Deaths Registry Act to avoid court order.
Meanwhile, a gay man in Lobatse, Moabi Mokenke was recently viciously killed after being sexually violated in the streets of Peleng, shockingly by his neighbourhood folks. The youthful lad, likely to be 29-years old, met his fate on his way home, from the wearisome Di a Bowa taverns situated in the much populated township of Peleng Central.
CEO of Khato Civils Mongezi Mnyani has come out of the silence and is going all way guns blazing against the company’s adversaries who he said are hell-bent on tarnishing his company’s image and “hard-earned good name”
Speaking to WeekendPost from South Africa, Mnyani said it is now time for him to speak out or act against his detractors. Khato Civils has done several projects across Africa. Khato Civils, a construction company and its affiliate engineering company, South Zambezi have executed a number of world class projects in South Africa, Malawi and now recently here in Botswana.
About ten (10) Umbrella for Democratic Change (UDC) parliamentary candidates who lost the 2019 general election and petitioned results this week met with UDC Vice President, Dumelang Saleshando to discuss the way forward concerning the quandary that is the legal fees put before them by Botswana Democratic Party (BDP) lawyers.
For a while now, UDC petitioners who are facing the wrath of quizzical sheriffs have demanded audience with UDC National Executive Committee (NEC) but in vain. However after the long wait for a tete-a-tete with the UDC, the petitioners met with Saleshando accompanied by other NEC members including Dr. Kesitegile Gobotswang, Reverend Mpho Dibeela and Dennis Alexander.