Lesotho Hospital and Filter Clinics - A Public-Private Partnership - Nursing Assignment Help

Assignment Task

Timothy Thahane, Lesotho’s Minister of Finance and Development Planning, understood that by championing a public-private partnership to improve his country’s health program, he was embarking on a risky course. However, he also knew that without private sector involvement, health services would continue to deteriorate. Lesotho had one of the highest rates of HIV/AIDS in the world. The statistics for tuberculosis were not much better. Patients seeking care of the Queen Elizabeth Hospital found the physical plant in poor shape, services unavailable and basic sanitation standards ignored. As the hospital budget increased, its services continued to decline. As one observer pointed out, the hospital was becoming a disease vector.

Thahane had served as Deputy Governor of the South African Reserve Bank and had spent eleven years at the World Bank.1 While serving in these capacities, he had become acquainted with the use of the Public-Private Partnership (PPP) model to improve the quality of public services. When he returned to Lesotho and became its Finance Minister, he argued that the construction of a new police station in Maseru, the nation’s capital, would be an ideal PPP. However, the Ministry of Public Works disagreed. They saw this idea as a challenge to the agency’s traditional role as the designer, constructor, and operator of government buildings. Thahane was unable to overcome this opposition, but when discussions began about constructing a new building for the Ministry of Health, he again argued in favor of involving the private sector. This time he enlisted the Health Minister, Dr. M. Motloheloa Phooko, to help him sell the idea. Together they successfully overcame opposition from the supporters of the old public procurement model, and the new Health Ministry building became Lesotho’s first PPP.

Lesotho’s health network consisted of loosely connected district hospitals and clinics. At the apex of this system was the national referral hospital —the Queen Elizabeth II Hospital in downtown Maseru, the nation’s capital. Since the early 1990s, state health officials had argued that the Queen Elizabeth II Hospital should be replaced. A 2002 report, authored by a consortium of Boston University’s (BU) School of Public Health and a group of doctors and senior officials from Lesotho, reinforced this view.
Further, there was a growing awareness that even if the government could afford to build a new hospital, this project alone would not improve the quality of health care, since it would be providing the same poor services, but in a new building. In other words, Lesotho needed a comprehensive solution that not only included a new referral hospital, but also a network of filter clinics and district hospitals, better doctors and nurses, and an overall health delivery system that met the nation’s changing health needs.

Thahane and the Health Minister Phooko felt that private sector involvement would be critical to realizing this goal. But there were few precedents in Africa of having the private sector involved in both the construction and operation of a new public hospital and the provision of clinical services. Further, to design a PPP for a new hospital, the government would need much better information to establish performance standards required to measure whether the private party was providing quality care. To fill this gap, they reached out to the World Banks’ International Finance Corporation (IFC), which had fledgling experience in using the PPP model in the health sector. To help them, the IFC asked the BU team that authored the 2002 study to work as technical consultants on the hospital PPP and to conduct a series of baseline studies which would inform both the design of the PPP and overhaul of the country’s health system.

To pursue this project, Lesotho had to address several questions: Would the private sector be willing to take on the inherent risk of providing clinical services in an African country? How much more would it cost to run a brand new hospital complex, including three new filter clinics, and could Lesotho afford these additional costs? Performance standards and measures were essential to ensuring that private parties provided the desired level of services. But given that medical technologies and priorities were continually changing, how could these milestones be defined realistically, while remaining sufficiently demanding? How should the private sector’s performance be monitored? Finally, if Lesotho established a high quality referral hospital and several state of the art filter clinics in its capital city, Maseru, would people from throughout the region travel to the hospital, bypassing the other 180 clinics and hospitals scattered throughout the country? In this scenario, demand could skyrocket beyond the new hospital’s capacity and the Health Ministry’s budget to cope with it.

The Queen Elizabeth II Hospital

Every morning at 6 a.m., hundreds of citizens lined up to get medical attention, knowing that the Queen Elizabeth II Hospital allocated medical care on a first-come first-served basis. People arriving late feared that they may not be seen and the fundamentals of care were not being met for a majority of severely ill patients. Many of the buildings dated back over 50 years with the oldest over 100. Morale among doctors and nurses was poor due to the physical conditions and sporadic pay, and the system for processing patients, ordering drugs, and keeping records was extremely inefficient. The annual operating cost of the hospital had increased from approximately 80 million maloti in 2004 to 185 million maloti in 2009, yet services continued to deteriorate.

The Early Stages

By 2002, there was growing consensus that a new referral hospital was needed and that it should be accompanied by several improved filter clinics that would screen patients prior to referring them to the hospital. There was also increasing recognition that private sector involvement would be critical, but no guarantee that a major private company would be willing to take the financial risks of providing both the construction responsibility and clinical health services for what was basically a public hospital.

To help design the PPP, Minister Thahane asked the IFC to serve as the project advisor. This request was fortuitously timed, since IFC officials under the leadership of Catherine O’ Farrell and Carla Faustino had been looking for countries in Africa that might be interested in using the PPP model in the health care sector. Hence, when the request from Minister Thahane arrived, the IFC jumped at the opportunity.

The Center for International Health at Boston University, officials from the Lesotho Ministry of Health, and the team from IFC had completed preliminary baseline studies prior to the IFC’s arrival. These studies were designed to ascertain the condition of the existing health system, and derive the baseline numbers from which the performance targets for the new hospital would be developed. It cost 185 million maloti to operate the old hospital. What did Lesotho get for that sum? How many outpatients were using the hospital every month? What were their health problems, how many needed to be hospitalized, and how many could be treated in an outpatient clinic?

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