Public health system crumbling
Ntsoaki Motaung and Seabata Mahao
The country’s health system is teetering on the brink of collapse threatening to erode previous health gains, Newsday can report.
Last week Lesotho Medical Association (LMA) announced that the doctors would stop taking calls from Wednesday this week citing nonpayment of call allowances.
Doctors are required to be on call from 5 pm to 8 am the following day on weekdays, and the whole day on weekends and holidays, during which they can be summoned to attend emergencies.
On Monday this week, “a high rate of suicide” among workers at the Queen ‘Mamohato Memorial Hospital (QMMH) came to light during a somber prayer session at the hospital.
With three workers having killed themselves since 2021, the workers at the hospital acknowledged they have a problem – poor working conditions are taking a toll on their mental health.
Yesterday the workers went on a go-slow to protest against late pay for their February salaries.
Several sections of the hospital including the pediatrics outpatient department (OPD), medical OPD, ears, nose, and throat (ENT) department, and surgical OPD completely stopped offering medical services and patients were left to their own devices.
The Minister of Health, Selibe Mochoboroane, had to rush to the hospital to address the workers and their salaries were subsequently paid.
The workers have since resume work, the Ministry of Health and the hospital confirmed yesterday.
While unpaid salaries at QMMH and overdue doctors’ call allowances seemed immediate crises this week, there are other lingering issues that if not resolved soon, will threaten the health and well-being of the public.
LMA last week said hospitals across the country were poorly staffed and had an extremely low doctor-to-patient ratio “yet there are unemployed Basotho doctors”.
It said the hospitals were also poorly equipped making it impossible for patients to receive the best possible care and there is “collapsing service delivery on a large plane scale within our health sector”.
QMMH workers on Monday said they work under appalling conditions; some of them allegedly do not have work contracts, work long hours, and are allegedly poorly, among others.
They grin and bear the appalling conditions hoping for the best, they said. This leads to unusually high-stress levels.
QMMH serves as the country’s main referral healthcare facility.
The 425-bed hospital together with a network of refurbished filter clinics, were built through a public-private partnership (PPP) initiative, with the Tšepong consortium as the principal contractor in the PPP agreement.
QMMH and four primary care clinics opened doors to patients in 2011 to replace the run-down 100-year-old Queen Elizabeth II hospital.
It features eight operating rooms, a maternity wing including a 40-bed nursery, a 10-bed adult Intensive Care Unit (ICU), and an ophthalmology unit.
Netcare Hospital Group was subcontracted to manage the hospital, providing all clinical services required to operate the hospital and the primary care clinics on behalf of the consortium.
The 18-year contract was terminated by the government in 2021 accusing the Tšepong consortium of breaching its contractual obligations in terms of the PPP agreement.
This move, although it was applauded by the public which said it was long overdue, seems to have plunged the hospital into deep disarray.
One of the workers, Nteboheleng Ntela, on Monday said three workers had killed themselves since 2021 when Netcare left.
Ntela said another staff member died from depression on February 23, this year, increasing the total number of deaths caused by depression and stress since 2021 to seven, three of which were suicides.
All too often, the Ministry of Health employs short-term solutions to the challenges in the public health sector.
Yesterday the Ministry of Health’s public relations specialist, ‘Mamolise Falatsa, told this publication that the ministry had a meeting with LMA on Tuesday and assured them that the overdue call allowances will be paid.
As a result, she said, the association agreed that the doctors will take calls. That is, they would work at night, on weekends, and holidays.
But the association’s president, Mojakisane Ramafikeng, yesterday denied this. Ramafikeng said during the meeting with the ministry, they only promised to consult their members and agree on a forward.
“The doctors said they are continuing with the strike. They will not be taking calls,” he said.
The doctors have already previously suspended their strike.
In December last year, doctors at the Motebang Hospital agreed to suspend their industrial action after Mochoboroane had a meeting with them and convinced them to suspend their strike the day it was supposed to start.
The doctors had said they would stop carrying out on-call duties with immediate, effect citing nonpayment of their allowances.
On October 27, last year, 14 doctors wrote a letter to the LMA asking it to ensure that all arrears for call allowances were paid by the ministry of health.
“As members of the LMA, we would like your leadership to intervene in the following issues unaddressed by the ministry of health; unpaid call allowances for medical doctors over the years without any explanation whatsoever from the employer…,” read the letter.
The doctors also complained about “the lack of documents that explain terms and conditions of our work, benefits, rights, wellbeing and bilateral channel of handling grievances without doctors being victimized as is a common practice in the ministry”.