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Lesotho owes SA M86m in Tšepong referrals


Bill said to have accumulated since 2014

Lekhetho Ntsukunyane

Lesotho owes South Africa M86 million for cancer patients referred by Queen ’Mamohato Memorial Hospital (QMMH) to three Bloemfontein hospitals.

The bill has accumulated since 2014, according to Health Minister Dr ’Molotsi Monyamane.

Queen ’Mamohato Memorial Hospital, which was opened in 2011 as the country’s only referral hospital, refers cancer patients to Pelonomi, Univesitus and National hospitals, with government paying the bill.

QMMH is owned by the government but is run by the Tšepong consortium of five companies, namely Netcare Healthcare Group and Afri’nnai of South Africa, as well as Excel Health, Women Investment and D10 Investments from Lesotho.

According to Health Minister Dr Aaron Motsoaledi, the Lesotho government owes South Africa M86 million for services offered at the three Free State hospitals.

Dr Motsoaledi revealed the debt on Friday in Cape Town while appearing before a special committee investigating the cost of private healthcare in the country, according to the South African Broadcasting Corporation (SABC).

The SABC further said Netcare’s Director of Strategy and Health Policy, Melanie Da Costa, explained how the company “is assisting Basotho by providing quality healthcare at lower costs compared to South Africa”.

Netcare is the majority shareholder in the Tšepong consortium.

SABC further quoted Ms Da Costa criticising a report by the Organisation for Economic Co-Operation and Development which concluded that private healthcare in South Africa was among the most expensive and un-affordable in the world.

However, the national broadcaster reported Dr Motsoaledi as saying contrary to what Netcare had presented “the contract with Lesotho has plunged the country into financial distress”.

Dr Motsoaledi, the SABC reported, also said his Lesotho counterpart, Dr Monyamane, was relying on the South African government for assistance to get out of the Tšepong contract.

In December 2007, Tšepong was announced as the preferred bidder for the financing, design construction and operation of a new public referral hospital and the upgrade, refurbishment and operation of the filter clinics on behalf of the Government of Lesotho (GoL). The contract was signed between Tšepong and the GoL on 27 October 2008.  The project was announced as an 18-year contract (including the construction period which was two years) for the provision of clinical and non-clinical services. The project represented a significant shift in role for the government of Lesotho from a service-provider to a regulator. However, the GoL remains the lawful owner of the hospital and filter clinics. The Public Private Partnership (PPP) agreement between the two parties is currently in its sixth year with the contract set to terminate in

March 2026. At the end of this period, the GoL could decide to either renew the contract with the same operator, engage another operator or manage the operations of the facilities.

Asked about the M86 million debt yesterday, Dr Monyamane said he was fully aware of what transpired in Cape Town on Friday.

“I know about Dr Motsoaledi’s appearance before the inquiry on Friday. I know about his submissions and the M86 million debt. What he said before the inquiry is what we discussed some three weeks ago. I will say the same thing if I could be summoned before the same inquiry,” Dr Monyamane said.

The minister told the Sunday Express that the government would soon start paying the money in tranches.

“We are making plans to pay up the debt and also curb the flow of Basotho cancer patients referred to public hospitals in South Africa. A delegation from the Free State provincial government was here three weeks ago. We agreed on a plan to have a team, from our side, which will regulate the flow of cancer patients being transferred from Tšepong to Pelonomi, Univesitus and National Hospital in the Free State. We further agreed on how we are going to pay up our debt. We are committed to paying up the debt in batches until we have settled it in full.”

Dr Monyamane said it was “reckless” that Tšepong was not being regulated regarding the referrals.

“There is no arrangement to the effect that when Tšepong decides to send patients to South Africa, they should consult with the government first. As we speak, the hospital just decides that on its own. This is why now we find ourselves in such a big debt. It seems Tšepong sends patients to South Africa even for minor issues. Our patients are even attended to by junior doctors there in South Africa, yet we have Basotho specialist doctors who can best attend to the problem,” he said.

Dr Monyamane explained the M86 million had been accumulated since 2014 “because you will remember that the Free State government wrote-off another M40 million debt, which we owed in referrals”.

The Minister also indicated that the Government was about to employ as many Basotho medical doctors as possible.

“The reason is simply because they are there even in South Africa. We have highly trained Basotho doctors and specialist medical practitioners who just need us to have the will to engage them. As a ministry, we are going to employ as many of them as possible. Some of the doctors will be deployed at Tšepong premises to curb this problem of referrals.”

He said other Basotho doctors are going to be deployed at Queen Elizabeth II Hospital.

“We are going to rebuild Queen II. It was wrong to close down the hospital (in 2011 and replaced by QMMH) in the first place. I have been instructed by parliament to do all this in the first quarter of the financial year.”

The Ministry of Health was allocated M1.98 billion for the 2016/17 financial year and Dr Monyamane said it was unfair a large chunk of the money would be directed to Tšepong hospital.

“It is very unfair that one-third of the ministry’s budget is directed to Tšepong, yet it is not the only hospital we have in this country. Health issues are so diverse and we cannot only be dealing with Tšepong,” he said.

Dr Monyamane further confirmed he had sought the intervention of several stakeholders, among them the South African health ministry, World Bank, Netcare and Tšepong “to see how best we can revise the contract that the government of Lesotho has with the hospital.”

He added: “We are not saying they (Tšepong) should go. We like the hospital and appreciate its services. After all, this was the initiative of the government of Lesotho.”

The making of QMMH

The government of Lesotho, prior to the establishment of Tšepong around 2006, considered ways to raise the M1.2 billion required to renew the facility and services at the then dilapidated Queen II Hospital.  The annual capital budget of the Ministry of Health at that time was only M80 million, resulting in a significant funding gap for such an ambitious project.

In December 2006, the first draft tender documents were released by the government to registered bidders for a public private partnership (PPP) agreement to establish a modern referral hospital. The deadline for the submission of bid documents was October 2007. The bid evaluation teams in the Ministries of Health and Finance were supported by the World Bank’s IFC which engaged a team of experts for the different fields relevant to the project, such as design and construction, human resources and clinical services to evaluate the submissions.

Only Two bids eventually qualified for evaluation. These were from the Tšepong Consortium including Netcare as capacity partner and a consortium including Life Healthcare as capacity partner. In December 2007, Tšepong was announced as the preferred bidder for the project based on financial competitiveness

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