THIS is an open appeal to the partners of Queen Mamohato Memorial Hospital (QMMH), the Government and Tsepong Consortium, to refrain from the sustained non-constructive negative publicity the hospital has been subjected to ever since it opened.
This publicity relates largely to internal issues that should be solved quietly and amicably between the parties through deliberative negotiation rather that myopic posturing where each party appears to be playing to the gallery.
Since its opening QMMH, with its modern facilities and state-of-the-art equipment,has delivers affordable high quality health care services to many Basotho, especially the poor who cannot afford such expensive services in private hospitals in South Africa.
Yet QMMH has been plagued by negative publicity caused and fueled by disagreements among private shareholders of Tsepong Consortium. Instead of renegotiating the PPP Contract, the government itself appears to be joining in this destructive publicity.
Several pertinent questions should now be asked with a clear mind to understand the implications of what is happening.
What will Netcare do if this negative campaign continues? We should remember that Netcare has alternatives and is enjoying better environment in other countries.
Where should it run for cover with its wide experience of running large hospitals in South Africa, United Kingdom and elsewhere in the world? How should the many dedicated health care professionals it employs react to the bashing in the media? They can simply leave the toxic environment created because they have alternatives.
What will happen to the hospital if Netcare were to write offits investment in QMMH to reduce its reputational risk and walk away? Who will be the loser? QMMH is our highly prized national asset that delivers high quality health care services to all Basotho regardless of their economic or social status. We must protect, cherish and improve it instead of trashing it unfairly in the media.
This negative publicity is demoralizing and demotivating to the management their dedicated professional and non-professional staff. The media always gives wide coverage to the disputes between the partners and seldom find time orspace to write about the fantastic work that is being done daily to save lives and care for the sick.
QMMH was designed, built and financed through an eighteen (18) year Contractual Agreement between the government of Lesotho and the private consortium of Tsepong (Pty) Ltd. The Tsepong private consortium contributed funds as well as business, clinical and operational expertise to the project to ensure that government got value for money from the investment despite its limited resources. The Tsepong consortium is led by Netcare (Pty) Ltd,an experienced international company with successful hospital management and operations in the United Kingdom and South Africa.
In South Africa, Netcare operates Public-Private Partnership hospitals of Universitas and Pelonomi in Bloemfontein to which the old Queen Elizabeth ll Hospital used to refer patients. Netcare has an excellent 24 hour national Emergency and Evacuation services across South Africa and Africa. Private sector companies make extensive use of these services.
With Netcare as our partner, why can’t we negotiate and leverage these services rather than fight to a point where the company will walk away? Tsepong shareholders are diverse: Netcare (40 percent), Excel Health (Basotho Doctors in Lesotho) (20 percent), Afrinnai (Basotho Doctors in South Africa) (20 percent), Women Investment Company (10 percent) and Lesotho Chamber of Commerce (10 percent).
The contract says after three years Netcare will start giving the management to some of the locals and will begin diluting its shareholding after five years.
The capital expenditure for QMMH was about US$120 million (or M1.8 billion at today’s exchange rate). The government contributed 37.7 percent while Tsepong paid 62.3 percent made possible by Netcare’s guarantees and the government of Lesotho to Development Bank of South Africa which provided the loans. These financing arrangements demonstrate the positive contribution of the private sector under the PPPmodel.
Without this PPP arrangement, Lesotho would have found it difficult to finance QMMH project.
It is important to point out that because of the PPP arrangement construction of QMMH was completed on time and within budget. This also shows the efficiency benefit of involving the private company in the PPP compared to the traditional government construction projects which almost always experience delays and cost overruns. The private entity has been contracted to maintain the facilities and hand them back to government when the contract ends. Maintenance is the bane of government projects.
Three filter clinics at Ha Mabote, Qoaling, and Likotsi were also constructed/upgraded to reduce pressure on QMMH. It was recognised at that time that Maseru will need its own district hospital. Another Gateway Clinic was built outside QMMH to triage patients who come directly to the hospital rather than go to the clinics nearest to their homes.
The government’s programme envisaged that, after 2 or 3 years of operational experience with QMMH under PPIP (Public-Private Integrated Partnership) three district referral hospitals, in Mohale’sHoek, Leribe and Maseru, would be rehabilitated/upgraded or new ones constructed through PPP arrangement. However, given this sustained negative publicity and apparent loss of trust between government and the private partners it may prove difficult to attract credible private sector operators for the three district hospitals. The private sector looks for stable predictable contractual arrangements including a clear legal and investment framework.
The question that is difficult to answer is: Why has the project generated so much controversy and negative publicity in Lesotho and so much praise from the international health practitioners and researchers?
Equally difficult to answer is why there seems to be a sustained effort to paint the hospital in bad light despite that it’s an excellent project that has been built in time, within budget and has saved government so much money in capital expenditure. Do the local media fully understand the project, its cost and benefits?
QMMH has been plagued by negative publicity and comments from people who know very little about PPPs and from people who should know better. It’s sad that people who should lead in finding solutions through quiet negotiations are now adding fuel to the raging fire.
This negative publicity began with personal accusations and recriminations because of broken trust and relationships among the Tsepong board members. The conflict even escalated to the courts.
Yet, the government which has been given ultimate responsibility for delivery of high quality health care to Basotho by the electorate, stood by and waited to see which of the parties would win, unaware that in that event, there may not be a partnership left but huge liabilities and legal fees to pay. This is how the cookie will crumble unless the government jumps to take its responsibility and seriously force the parties to resolve their differences.
By signing a PPP agreement, a government does not sign away its responsibility or national mandate to ensure that high quality health care services are accessible to all. Its priority remains that of ensuring that health care services are provided affordably and efficiently especially to the poor. Therefore if the disagreements among the parties are likely to affect the performance and delivery of these services, government has a duty to act decisively to bring the parties together and find a mutually satisfactory solution.
Much of the negative publicity that has befallen on QMMH can be traced back to some issues that can be resolved through dispute resolution mechanisms of the laws of Lesotho and in the precedents of a large body of international experiences with PPP’s. There are disagreements among board members of Tsepong (Pty) Ltd regarding the payment of dividends before they are earned. There is the managerial actions affecting individuals, whether professionals or auxiliaries, about their pay or their treatment by their supervisors for their inability to adhere to standards of performance. We also have individual patients who received poor services or care and relatives of patients who died at the hands of some professionals.
These issues have been generalized to the whole hospital as if they are the operational norm of the hospital. Even in the best hospitals in the world, some patients still, unfortunately, die because medical science cannot help them. This is not to say that there are no cases of negligence that management should address and that the Lesotho Medical Council should be on the lookout for.
The last of the main cause of this adverse publicity is the Oxfam Advocacy Report whose methods of data collection were questionable. The authors failed to interview those ministers who were at the centre of the decision-making processes in the rationale, selection, design, preparation, financing, tendering, construction, completion, and operation of Queen Mamohato Public Private Integrated Partnership hospital.
The report was distributed to all Oxfam offices in over 183 member countries of the World Bank group and the NGO community. No effort was made to sit down with us to discuss the financial model used or the managerial lapses in contract’s management by the government and the delays by the International Finance Corporation (IFC) to help Lesotho establish proper institutional Units to administer a large PPIP project like QMMH.
The goal of the Oxfam Report was not to help Lesotho fix any mistakes or weaknesses in the PPIP Contract but to fight its ideological battle with the World Bank and other donors. The motive is to keep the private sector out of the health care business even though PPP have been extensively used in the developed world and other developing countries. They want to see the globalization of the British National Health System, which has some very good points but is not affordable to poor countries like Lesotho.
The report tried to achieve this by using QMMH to allege that IFC imposed this costly project on the government. The government presumably did not know what it wanted or how it wanted to go about it.
The report however conveniently ignored that since the 1990’s PPP’s have been used in the United Kingdom, USA, Australia, continental Europe and Latin America to finance infrastructure including roads, bridges, power, airports, schools, hospitals and telecommunications.
The total value of PPP investment in Europe from 1990 to 2006 totaled GBP 182.2 billion(or —in today’s exchange rate) in Europe and US$794.1 billion (or in today’s exchange rate) in developing countries. This shows the extensive experience globally that Lesotho drew on and could always draw on to resolve any problems it may have with its PPIP.
It is totally incorrect to say that the project was imposed on the Cabinet and government. The project was identified, selected, designed (approved), prepared, financed, constructed and launched by the democratically elected Basotho Congress Party (BCP) government in 1993.
BCP took power from the Military Junta that ruled Lesotho since 1986. The commitment to provide high quality care to all citizens and the replacement of the old Queen Elizabeth ll Hospital had been a key campaign platform of the BCP and it won all the seats in parliament except one.
But the project could not be built due to lack of funds. It remained on the books, unfunded until 2002.The Lesotho Congress for Democracy (LDC) government in 2002 decided to implement it.
As the new Minister of Finance and Development Planning I had to find funds. I recommended to Prime Minister Dr. Pakalitha Mosisili that we use the PPP model to leverage the limited government funds. He agreed and we held a one- day workshop for the Cabinet at a local Hotel to learn more about the nitty-gritties of PPPs. We looked at the types, contracts, strengths, weaknesses and pre-conditions for success.
After the workshop the Cabinet decided to pilot the model by building the Ministry of Health Headquarters using a simple PPP Accommodation model. This was done successfully and Cabinet then turned its attention to the replacement of the referral Queen Elizabeth II Hospital by PPP.
IFC was selected as the Transaction Adviser and a joint team from the Ministries of Finance and Health formed to work with it and report to the Ministers of Finance and of Health, who in turn reported regularly to Cabinet. IFC guided the process and made recommendations to the joint Team of Officials but all project decisions at every stage were taken by the two Ministers of Finance and Health Social Welfare and the Cabinet.
QMMH is a valuable national asset for delivering high quality health services. Government and Basotho in general should be proud of it and cherish it. Basotho should build on its experience to extend services to the under-serviced areas in rural and urban areas instead of trashing it. Regional hospitals to supplement QMMH are needed.
Policy makers in our region are envious of the quality of facilities, the state-of- the-art-equipment, and the professionalism of the staff that they see when the visit the hospital to see and study it. This is not to say that things are perfect at QMMH. But let us fix what is wrong and build on what is good to deliver quality care to all Basotho.
Researchers from Boston Medical Center in the US and from the Global Health Group at the University of California have found that QMMH delivers better clinical services than those delivered in traditional government-run hospitals.
Why, then, do we subject the hospital to this sustained negative publicity? What does the country and its people gain from this negative publicity? What does the world think of us? We built a good big thing but cannot fix small things that are not working well. No outsider will solve the problems QMMH faces. Let us sit down quietly, engage each other in serious deliberative negotiation and avoid myopic posturing and playing to the Galleries.
Netcare is a large international company that may soon be fed up and write off the project to reduce its reputational risk. Do we have a plan B is that happens? I am afraid poor Basotho will be the losers.
It is not too late to retreat from the brink; sit around the table and quietly negotiate seriously to correct and improve the PPIP Contract without blaming anybody. There is enough blame to go around.
Thahane is former Minister of Finance and was involved in the QMMH project as minister. He writes his personal capacity.
Reforms: time to change hearts and minds
A very important milestone is gradually being reached in Lesotho politics. On April 6, 2022, I attended a National Reforms Authority (NRA)’s High-level Forum on the State of the Implementation of the Lesotho National Reforms at ’Manthabiseng Convention Centre.
For the first time, I heard at that meeting politicians acknowledging that Lesotho’s political problems have a lot to do with politicians themselves, and not with written clauses of the Constitution.
This is a point that this country’s intellectuals and academics have made for years. Lesotho politicians have refused to listen both because of their dislike for the country’s academics and because of absence of any communication between the two groups as a result of that dislike.
If politicians could use their newly-acquired wisdom as a basis from which to proceed in attempts to solve Lesotho’s political problems, there is potential for great strides to be made, finally.
Political instability bedevils Lesotho because the hearts and minds of politicians continue to be inclined to break the law, or to look for ‘loopholes’, in pursuit of narrow interests; and continue to change clauses of the Constitution when such clauses do not allow the pursuit and achievement of narrow interests.
We need a change of heart and mind-set among our politicians in order to make headway in building a politically stable society. Politicians’ narrow interests should not be a basis for what needs to happen in Lesotho. The need for constitutional changes and the search for loopholes will persist but they should not be inspired by the pursuit of narrow interests, as has hitherto happened.
Instead, to us the public, it should become necessary to reform the constitution on two conditions only. First, when it is found that the constitution does not adequately address concerns with the socio-economic welfare of Basotho. Second, when it becomes necessary to ensure that Basotho exercise real power on who rules them and on how they are ruled. These conditions are cardinal.
And they should inform all thought and action in Lesotho’s politics.
As has happened many times already, even these costly ongoing reforms of clauses of the Constitution will be all for naught if concern for politicians’ own welfare continues to be a primary motive behind their pursuit for parliamentary seats, and what they do once in parliament.
It may well be that the current and next generation of politicians will be short of men and women with hearts and mind-set fit for service to Basotho’s welfare. But serious attempts need to be made to ensure the generation after the next has a critical mass of such politicians.
This cannot only be wished for. It has to be worked for. One thought is to introduce a curriculum that teaches people the capacity to think of others, and care for others. These are some of the attributes mostly missing among our politicians. Their incapacity to think of others leads to their lack of a sense of public duty that we see and experience every day.
We have neglected the task of socialising and educating empathetic hearts and mind-sets claiming that Africans and Basotho naturally and culturally subscribe to, and live in accordance with, ubuntu (humanity). It is quite obvious that this is not true. People who make this claim loudest are the middle classes who, while claiming to subscribe to ubuntu, live in houses surrounded by six feet high perimeter walls.
There may be other thoughts than socialisation on this. What we have to hope for is that from here onwards, in our search for solutions to Lesotho political problems, we will proceed from the recognition that, primarily, these problems emanate not from inappropriate written texts of the Constitution but from hearts and minds of men and women.
We have lost our moral indignation
I remember when the allegations that Tšeliso Nthane had shot and killed one of his employees first came to the surface. It was in 2019, back when the air was not so poisonous and Basotho still had much of their hope. Well not much because this is generally a hopeless, desolate wasteland but some small pretence of hope still remained. The nation was angry, and rightfully so. The consensus was that men like Nthane, no matter how deep their pockets, should not be allowed to act with impunity. A man was dead and we were baying for justice.
A lot has happened since then. The Covid-19 pandemic, mass retrenchments and job losses, the ever dwindling power of the loti. This and that but all has been more negative than positive in this place so when the time came for Nthane to be handed judgment we had mostly stopped caring as we had to deal with the business of living .
Anyway the man was found not guilty. I will confess I did not read the judgement for fear it will sink me lower into the abyss that is life in Lesotho. However, news of that sort cannot escape one even if they try, more especially if they are on social media. No sooner had judgment been handed down that social media debates began raging.
Suddenly everyone was an expert in punitive versus remedial justices and the pros and cons therein. Many argued that once more the rich had been proven to be above the law. A statement clouded in naivety really because had they been paying attention they would have realised that there is nothing to prove as the rich have always been above the law.
Those who fancy themselves the harbingers of remedial justice argued that Nthane had made certain payments to the family and thus paid his debt. I have no personal knowledge of these payments but I was of course curious to know how much the price of a life is amongst these parts.
They further argued that since Nthane owned many companies that employed many Basotho it would not be in the national interests to send him to prison as jobs would be lost. I am not sure how Basotho think companies work and if they have ever heard that they are a separate legal entity from their owners but no matter. This is certainly an elucidation on the finer points of company law.
I have in the past been guilty of judging my countrymen, perhaps a little too harshly as it is sometimes hard to make sense of their motivations but to hear young people speak so vehemently for letting a man walk free after another has died simply because he is in a position to provide them with a livelihood reminded me once more of the stark hopelessness when it comes to finding a job in this country.
Basotho youths are not uneducated, they are not immoral or unfeeling and they certainly are not pro-murder. At least I hope so. What they are however is hungry and desperate and desperation can reduce even the most pious man to his knees. What good is moral outrage if one is outraged on an empty stomach?
What good will it do for them to be out in the street being activists for social and moral issues when they barely can afford the nine maloti to hop into a taxi and arrive at such a demonstration? To argue that anyone who can offer them jobs should be treated differently as far as the law is concerned is a statement borne out of the worst kind of desperation and instead of making me angry, it made me sad.
Now, I have not enough knowledge of the case against Nthane to say whether I feel the judgment was fair and just. All I know is I certainly want it not to be in favour of him simply because he has jobs and livelihoods to give. It is however easy for me to judge from my privileged position where I have a meal guaranteed every night. It is easy to be morally indignant when one does not have to worry about the indignities of joblessness.
I spoke last week of how easy it is for us to condemn young people who lay their bodies on the human resource table. We laugh at older people who walk for kilometres to attend political rallies and sing for “baetapele” (leaders) and fail to take into account that in a moment of desperation a man who offers you promises of a job you badly need is someone you would follow to a rally.
To see young women in the arms of 70-year-olds who are not even good company. To see young men vehemently justify that murder should be forgiven if the alleged murderer can offer them a livelihood will quickly disabuse one of the notion that there is any progress happening in Lesotho.
So here we are in a country where people are willing to sell their bodies and souls for a chance at a decent life.
Here we are about to enter another election season and the only people who stand to truly benefit are the owners of guest houses. Whether Nthane got a fair verdict or not is immaterial to me, what remains shocking is how we have lost our moral indignation as a country. It appears Tom Thabane, that erstwhile leader was right when he said “sera sa motho ke tlala”. To quote the younger generations of Ma2000: “Because wow”.
Thakane Rethabile Shale
No peace plan, no economic recovery
The world’s struggle to reboot economies viciously disrupted by the Covid-19 pandemic remains real. However, the impact could be more severe to countries that already had dwindling economies and lack a way out, chief amongst them Lesotho. The focus on recovery gets disrupted from time to time by new variants seemingly more infectious than the previous ones; we had the Delta variant and now Omicron.
Several countries seem to be putting their own nationals ahead of everyone else. The squabble between the European Union and the United Kingdom over vaccines was but an example of leaders who put the interests of their own people first. The leaders surely knew that the world would not win the fight over Covid unless the rest of the world is vaccinated as stated by the World Health Organisation.
They however made plans to keep their people safe first, protect their boundaries and then set stringent entry conditions into their countries to further protect their own people. Though this may seem selfish, who in their right mind would not do the same?
As countries draw and implement plans to get their economies back on track, Lesotho has very little to show if anything at all. Businesses shut doors and the few people who had jobs lost their only incomes. Prior to the Covid-19 pandemic, Lesotho was already struggling to engage in much needed capital projects because it simply did not have the money.
Sadly, there is no watertight plan let alone a draft to increase dwindling revenue following the reviewed Southern Africa Custom Union’s approach. There is basically no plan to support entrepreneurs to scale up thereby increasing the tax base. Instead, the Lesotho Revenue Authority (LRA) is expected to milk dry the remaining few dying cows.
With this hopeless state of affairs in Lesotho, one would be misled to think that Lesotho is not capable of making solid plans and sticking to them. The reality is, Lesotho, a country of around 2 million people only is indeed capable of doing more for her few people. She has abundant resources; minerals and human capital.
Sadly, the skills and resources are always misdirected to produce negative energy among Basotho. The only fully funded strategy that Lesotho is committed to at the moment and can be articulated clearly by all parties involved without having to consult is Mothetjoa Metsing’s arrest. Metsing is accused of treason based on a hard-to-understand incident where he was a coalition partner and a Deputy Prime Minister, yet he is said to have been involved in an attempt to unseat the then Prime Minister Thabane.
Thabane of course did leave the country but Metsing never dreamt of taking over the premier’s office. The police, Public Prosecutor and the executive are all on the same page about progress and what the next move against Metsing should be.
There are officers ready to do whatever it takes to bring him down. There is no shortage of resources when it comes to arresting him. Intelligence is on top of its game when it comes to him. The propaganda machinery is fully empowered. When will the government get its priorities right?
The army commander Lt Gen Motšomotšo and senior army officials Col Sechele and Col Hashatsi were shot dead in broad daylight, within the army barracks and there is absolutely nothing and no one who has been held accountable for their killing. This against the background that former army commander Lt Gen Tlali Kamoli and others remain in prison for years pending the case surrounding among others the killing of yet another army commander Maaparankoe Mahao.
Where is the logic here? No investigations, no arrests, absolutely nothing on the killing of the three high profile army officials. Yet the government is persecuting Metsing for allegedly plotting to oust a government which never happened.
Around 80 people died in cold blood in police custody under the All Basotho Convention-led operation – “Tokho”. The then Prime Minister Tom Thabane allowed the police to torture people and the Lesotho Congress for Democracy tried to force the premier to withdraw his instructions to the police. That however drew a blank.
The police chief has not yet been called to account for these deaths. The police are doing what Basotho were complaining about during the reign of the previous regime that the army was acting with impunity. Suddenly, it is ok for the police to brutally torture and kill Basotho.
Suddenly, it is ok for army bosses to be killed with impunity. That’s the only reasonable conclusion that one arrives at based on the hesitation of the government to do anything about the killers on the government’s payroll.
The government of Lesotho needs to focus on revamping this country’s economy, creating jobs, improving health services, building infrastructure, promoting peace and unity and managing the escalating crime rate. Lesotho fails to acknowledge that the country’s peace is a group effort and Basotho must all be in it to work.
Investors are unlikely to risk their money in a country that is not at peace with itself. Until the government get its priorities right, Lesotho will continue to struggle to have peace and a stable economy. This will translate to high unemployment worse compared to where it is currently.
Metsing had a peace plan that was unfortunately not supported by some parties. Those who opposed it could only assume that it would let him go free. They never weighed options nor tabled alternative peace-making efforts. To them the country would rather suffer, rather be divided than accept the fact that the government was never toppled. There are far more pressing issues in Lesotho. Instead of paying loads of money to a foreign prosecutor, and taking much valuable time from our courts of law, we should be focusing our priorities on something positive. We need to heal and move on as a nation, not as individuals.
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