A new hospital in Maseru is providing improved health care services to Lesotho’s citizens
The hospital and its three filter clinics are part of an innovative public-private partnership
About one-quarter of Lesotho’s population, particularly women and children, stand to benefit
MASERU, October 24, 2011—Lesotho is a small country with huge development challenges. Its people face the triple threat of high food prices, poverty and HIV/AIDS. Despite average GDP growth of four percent before the recent global economic crisis, more than half the country’s population lives below the national poverty line, according to the latest World Development Indicators.
In 2000, the Government of Lesotho determined to narrow the gap between strong economic growth and weakening human development. It set out on a path to increase access to, and provide quality delivery of, essential health services.
“The government had been investing a lot of resources into infrastructure, but seeing few outcomes,” said Ruth Kagia, World Bank Country Director for Lesotho. “They decided the focus should be on performance-based management rather than infrastructure alone.”
On Friday, after more than a decade of health service reforms, infrastructure improvement and human resource capacity building, the government realized part of its goal with the opening of the state-of-the-art, 425-bed, Queen ‘Mamohato Memorial Hospital in Maseru.
Lesotho’s King His Majesty Letsie III inaugurated the new hospital, which is expected to bring improved health services to about one quarter of the country’s population.
The public hospital features eight operating rooms, a maternity wing including 40-bed nursery, a 10-bed adult Intensive Care Unit, an opthomology unit, two Lamina flow theaters for joint replacement surgery and, most importantly, a well-trained, privately-managed cadre of health care professionals.
“There will be a large focus on training at this new facility because of the more modern technology, but also because of the role that this hospital will play in the larger health care infrastructure within Lesotho,” said Karen Prins, Operations Director for the new hospital.
According to Prins, the new hospital and the reforms that have led to its construction, staffing and operations could change the face of health care for Lesotho’s citizens. “This is a really ambitious project and sets the scene for many developing countries to follow suit,” she said.
Partnering for results
The new hospital is part of a wider health care network that has been developed with technical assistance from the World Bank Group, including a $6.25 million grant from the Global Partnership for Output-based Aid and lead transaction advice from the International Finance Corporation (IFC). At its foundation is an 18-year, public private partnership between the government and the Tsepong consortium, led by South African health care investment holding company NETCARE. Under the partnership, the government contracted Tsepong to build, manage and operate the new public hospital without increasing costs to patients.
“In the normal [public private partnership] the private sector brings the resources to build and operate, and in a number of years they will hand over to the government,” said Timothy Thahane, Lesotho’s Minister of Finance and of Development Planning.
But, in this instance, a group of investors came together, lent to the government who then commissioned the private sector to build, manage and operate.
“We will have a referral hospital with the best technology and the best care in the world,” Thahane said. “It will be accessible to every Basotho.”
The project is expected to provide services to 20,000 inpatients and 310,000 outpatients each year.
In addition to the new hospital facility, Lesotho’s improved health network includes three filter clinics distributed across Maseru that provide primary health care services to local residents. The clinics began operating under Tsepong in May 2010 and see between 300 and 500 patients per day. They open from 8 a.m. to 5 p.m. during the week, and on Saturday mornings to cater to patients on compliance drugs. About 47 staff per clinic service patients and each clinic features 24-hour, seven-day maternity services.
“We do on average about 30-50 deliveries per month at each facility,” said Clinic Manager Dr. Prithi Prithivaraj. “Since opening, we’re at 1000 births and no deaths.”
According to Prithivaraj, 75 percent of the clinics’ staff is locally hired, a stipulation of Lesotho’s Employment Equity law, and both doctors and nurses receive regular training in South Africa and in Lesotho.
“I have been a nurse for 19 years. I have worked in government hospitals and clinics for 17 years,” said Sister Nzama, a Registered Nurse and Unit Manager at the Mabote Clinic. “The care that I was rendering there, I was doing all I could, with what I had. I wanted to help every patient, but in most of the cases we would have to refer patients, because of lack of equipment.”
According to Nzama, providing care at the new clinic is different.
“Almost every room has equipment that is needed in that room,” she said. “I don’t shift from one room to another asking for something to use. So really here I do my work quicker. It is really easy to help patients.”
Nzama trains junior staff at the clinic, but also receives training.
“Prevention of mother to child transmission of HIV/AIDS, we go out to get trainings on that,” she said. “We go out to get trainings on HIV/TB co-infection, so that we know how to manage our patients well. In these clinics, nurses are the ones who see TB/HIV patients, so we need to be well trained so that we can take care of them properly.”
Modernizing the health care environment
At the heart of the government’s plan to improve health services are the country’s human resources, its people. Before the new hospital opening, patients received care at the Queen Elizabeth II Hospital, a 325-bed facility built in 1957. Outdated equipment and a crumbling infrastructure regularly forced health care providers to send patients for treatment to Bloemfontein in South Africa.
“I went [to Queen Elizabeth] for my baby’s birth,” said Mataoe Marathabile, a patient who visited the Likotsi clinic, one of the new filter clinics, in July. “The toilets were dirty, there was no hot water for a bath… and the babies were five on one bed, newborn babies together on one bed.”
Marathabile transferred to Likotsi where she and her daughter Rethabile, now nine months old, receive post-natal care.
Relebohile Ntsne lives near the Maseru private hospital but spends four rand to take a taxi to the new Likotsi clinic. “This clinic is free but we get everything we need because the doctors are good, the nurses are good,” she said.
Ntsne tells the story of her sister who visited the Queen Elizabeth II hospital and was placed on a mattress on the floor under another patient’s bed because no other beds were free. Her mother told she and her sister about the new clinic and the family has been coming here ever since.
“The first time I came here, I was treated very nicely,” she said. “It didn’t take me long to get treatment and it’s much better compared to the other clinics.”
The plan is for Likotsi clinic and its counterparts, Qoaling and Mabote, to filter patients to the new Queen ‘Mamohato referral facility.
“The whole vision behind this is a quality health care outcome,” said Dr. Prithivaraj. “It’s a comprehensive approach built on efficiency and effectiveness, procedures and protocols.”