Why Tšepong is overcrowded

Why Tšepong is overcrowded

MASERU – QUEEN ’Mamohato Memorial Hospital (Tšepong) is grappling with overcrowding after some government officials and politicians allegedly forced it to admit undeserving patients.
Health Minister Nkaku Kabi told a press conference last Saturday that top government officials and politicians put pressure on the national referral hospital management to take in patients who don’t have referral letters from district hospitals.

The agreement between Tšepong and the government is that the hospital will only deal with referral cases.
The idea was that as a referral hospital Tšepong should take major cases that can not be handled by district hospitals and clinics. District hospitals themselves deal with referral cases from clinics which they can escalate to the Tšepong.

The ultimate goal was to allow Tšepong to concentrate on providing secondary health care.
But over the years that system has been corrupted, resulting in the hospital taking minor cases normally treated at district hospitals and village clinics.
By last week the situation at Tšepong was so bad that the maternity ward of 40 beds had 60 mothers. Some mothers have been allocated to general wards.
“When the hospital refused to admit them they would come to our offices and we would take the phone and instructed the management to admit them,” Kabi said, adding that the ministry was reacting to public pressure.

He said sometimes the patients would be coming from hard-to-reach areas and have to be admitted out of pity even if their illnesses could be treated in the district hospitals.
Kabi gave an example of a patient who came to Tšepong “for just a minor treatment of a nail”.
“We as the ministry do take the blame for this crisis,” he said.

The minister said the problem is not that the health system is broken but that people are deliberately bypassing their local hospitals and clinics from which they are supposed to be referred to Tšepong. The result, Kabi said, is that Tšepong has now been turned into both a referral and transfer hospital.
That means it is playing the role of even a small clinic in the rural areas.

And there is little Tšepong can do to stop the influx of undeserving patients because it is under immense political pressure to treat everyone who comes through its doors.
Doctors at Tšepong now find themselves handling cases of headaches, common colds and fever.
Kabi said apart from Maseru’s three filter clinics run by Tšepong, a consortium managing the hospital, tens of other health centres in the district refer patients to the hospital because Maseru does not have a district hospital.

Queen Elizabeth II Hospital, reopened to the public in 2014 after a three-year closure, is supposed to serve as the district hospital but offers limited services.
It only serves as a clinic for outpatients and some lab tests. The three Maseru filter clinics that are under Tšepong are Mabote Filter Clinic, Likotsi Filter Clinic and Gateway, which is situated at the Queen ’Mamohato Memorial Hospital’s main entrance. Patients from all these clinics, including Queen Elizabeth II Hospital, are referred to the hospital for more serious illnesses.
There are also five public clinics scattered around the Maseru City that refer their patients to Tšepong.

This is in addition to other clinics in the rural areas of the Maseru district that refer their patients to the hospital.
Other clinics in the district refer their patients to St Joseph’s Hospital in Roma and Scott Hospital in Morija, which also rely on Tšepong.
Being the national referral hospital, Queen ’Mamohato also caters for patients referred privately-owned hospitals.
Kabi said under the agreement the government and the hospital, only patients referred by district hospitals should be admitted.

“It is not a secret that patients come from as far as Quthing without any referral letter and want to be admitted at Tšepong,” Kabi said.
“They jump over their area clinics and district hospitals and come to Tšepong for minor illnesses that can be treated at clinic level.”
Kabi said such patients easily attract media attention when the hospital refuses to admit them and many a times the ministry is under pressure to force the hospital’s hand.
The hospital is said to employ 819 staff members and directly serves a population of over 500 000 in Maseru district.
The hospital opened its doors in October 2011.

In 2012, its first year of operation, 404 400 outpatients and 24 247 inpatients received healthcare through it.
A total number of 6 458 births were recorded and 6 502 surgical procedures were performed.
The Queen ’Mamohato Memorial Hospital forms the pinnacle of an innovatively structured, landmark Public Private Investment Partnership (PPIP) between the Lesotho Government and Tšepong, a regional consortium led by Netcare.

The project involved the building of the 414-bed hospital and the refurbishment of the Mabote, Qoaling and Likotsi semi-urban filter clinics, which opened to the public in May 2010.
The hospital, which cost M1 billion, has eight operating rooms, a maternity wing including a 40-bed nursery, a 10-bed adult Intensive Care Unit, an ophthalmology unit and a well-trained, privately-managed cadre of health care professionals.

The hospital is part of a wider health care network Lesotho has developed with support from the World Bank Group.
The World Bank provided Lesotho with a US$6.25 million (about M90 million) grant from the Global Partnership for Output-based Aid.
The International Finance Corporation advised Lesotho’s government on its partnership with the Tšepong consortium, led by South African health care investment holding company Netcare.
Under the partnership, Lesotho’s government contracted Tšepong to build, manage and operate the new public hospital without increasing costs to patients.
The Health Ministry’s Director General Dr ’Nyane Letsie said the overcrowding has reached a crisis level to an extent that the hospital has stopped admitting patients without referral letters.
This started last weekend.

Dr Letsie said patients should start at local hospitals. “It is the hospitals that will refer patients to Tšepong. No patient is expected to go to Tšepong without having been referred,” Dr Letsie said.
“This is meant to relieve Tšepong of the burden so that it can carry out its mandate of attending to special cases that cannot be treated at the level of the district hospital,” she said.
Dr Letsie said those who are close to Mafeteng will be referred to the Mafeteng Hospital while others will be referred to Berea Hospital – two districts sandwiching Maseru.
Kabi said some patients will be taken to private hospitals in Maseru under a special arrangement between the government and the hospitals.
He said there are 19 clinics that will offer natal services and “they will be staffed and equipped accordingly”.

“This arrangement was supposed to have started on September 1 but due to unforeseen circumstances it was delayed a little bit,” Kabi said.
Dr Letsie said only high-risk pregnancies will be allowed delivery at Tsepong.
In an interview with thepost Kabi refused to say how much the overcrowding will cost the government. He however said the cost of taking patients to private hospitals will be less than keeping them at Tšepong.

That indicates that despite being a government hospital Tšepong is charging more that private hospitals. The only difference is that at private hospitals it is the patients who pay while at Tšepong it is the government that picks the bill. A 2014 report by Oxfam, a confederation of 20 independent charitable organisation, warned that there was a danger that Tšepong would gobble the bulk of Lesotho’s health budget.

The report said Tšepong was likely to be viewed as a centre of excellence and therefore get much of the resources at the expense of primary health centres in the districts and villages.
That seems to be the case now as government has been grumpy about the charges it says are not justifiable.
The huge influx of patients is likely to translate into a huge bill for the government.
There are however other reports that show that Tšepong is a significant improvement on Queen Elizabeth II, its predecessor.

Staff Reporter

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