MoH seeks return to de-centralisation

The Ministry of Health (MoH) has admitted to the Public Accounts Committee (PAC) that the centralisation of primary healthcare services has brought challenges, which hinder delivery. Appearing before PAC yesterday, MoH deputy Permanent Secretary, Tebogo Banamile pleaded for the devolution of services back to districts as it was before the centralisation process in 2010.

“We believe de-centralisation is the way to go,” said Banamile who was standing in for MoH Permanent Secretary, Dr Shennaz El-Halabi. She said de-centralisation would work very well because services are delivered at district level.

PAC heard that the ministry was grappling with resource shortages owing to the manner in which the transfer of resources from the Ministry of Local Government and Rural Development was carried out.

Up to 1,300 vehicles including ambulances belonging to MoH are currently boarded, according to Banamile. She decried that the transfer of primary health care services from Ministry of Local Government was not properly handled, as some resources were not handed over. For example, houses could not be transferred to MoH as the Botswana Housing Corporation said those were for the Ministry of Local Government. Selebi-Phikwe West legislator, Keorapetse Dithapelo said his interactions with District Health Management Teams (DHMT) indicated that ambulances were centralised, which compromised even emergency services. He said in some cases an ambulance had to be dispatched from 50km away from where it was needed, thereby putting lives at risk.

Dithapelo expressed worry that emergency ambulances doubled as ‘normal’ ambulances in some instances, thereby affecting the functions of emergency service departments.  “Centralisation is causing a bit of a challenge. It means that vehicles are not always readily available as they have to come from some 50km away,” he said. 

When the MP for Tati West, Guma Moyo inquired whether the reported shortage of ambulances was a result of the centralisation, Banamile could not affirm the link. Despite the mountain of hurdles that the exercise had brought to the ministry, she denied that there is a crisis.

Though centralisation appeared appropriate then, Banamile said there was continuous improvement in management hence the plea to go back to de-centralisation as it is more sensible and appropriate.  In addition to plans to purchase 100 vehicles, 50 of which are ambulances, she stated that a fleet audit was undertaken recently to help in reallocation of the vehicles. Banamile said currently, the country faces a 17 percent drug deficit though improvements were registered from the 2012-2013 financial year.

“In 2012-2013 we were at 77 percent essential drug availability, while in 2014-2015 we stand at 83 percent,” she said.

Though a tracking system was said to be in place to augment the supply chain management process, Banamile said that outsourcing of distribution services has led to instances where drugs were available at the Central Medical Stores, but failed to reach their final destinations.

Meanwhile, the PAC heard that due to procurement limitations, delays in projects owing to disagreements with contractors in most cases, has seen MoH utilising only 37 percent of its 2014-2015 development budget. The nine-member committee chaired by Kanye South MP, Abram Kesupile started sitting yesterday till June 18, to examine government accounts for the 2014-2015 financial period.

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