QMMH midterm budget hangs in balance

…as PAC demands governance overhaul before more funding

Mohloai Mpesi

QUEEN ’Mamohato Memorial Hospital (QMMH)’s bid for additional funding through the government’s midterm supplementary budget is hanging in the balance after the Public Accounts Committee (PAC) vowed to block any further allocations until the hospital’s governance and salary structures are overhauled.

The warning came yesterday when officials from QMMH and the Ministry of Health appeared before the committee as part of its ongoing inquiry into the hospital’s governance and financial management.

PAC members subjected both institutions to intense questioning over QMMH’s governance arrangements and salary structure, demanding to know why a government-funded hospital continues to pay significantly higher salaries than those offered to civil servants performing similar duties in other public hospitals.

QMMH, Lesotho’s national referral hospital, opened in October 2011 under an 18-year public-private partnership (PPP) between the government and the Tšepong Consortium, led by South African healthcare group, Netcare.

Initially hailed as a model for healthcare financing in Africa, the arrangement later drew widespread criticism after consuming as much as half of the country’s annual health budget in some years. The government terminated the PPP prematurely in 2021 following a dispute over unpaid fees and a nurses’ strike, assuming direct control of the hospital and its filter clinics in August that year.

Acting Principal Secretary in the Ministry of Health, ‘Matšoanelo Monyobi, told the committee that the government had inherited QMMH’s governance and remuneration systems from the Tšepong Consortium.

“QMMH is a government hospital. It was managed by the Tšepong Consortium before the government took over. By the time the government assumed control, the salary structure used by the consortium had not changed,” Ms Monyobi said.

She said the ministry had already initiated plans to restructure the hospital and had sought technical support from the World Health Organisation (WHO).

“We have taken a step as the Ministry of Health. We are going to restructure QMMH. We have already drawn up terms of reference for that exercise and requested WHO to provide technical assistance.”

PAC member, Dr Tšeliso Moroke, blamed the ministry for failing to properly manage the transition from a privately-run institution to a government hospital.

“I feel like someone did not do their job. No one managed the transition from the partnership arrangement. There is no documentation showing how we moved from a private partnership to a government hospital.

“Are you telling this Committee that ministry officials never took the initiative to standardise the hospital in line with other government hospitals? Am I wrong to blame the ministry’s management for failing to do its due diligence?” Dr Moroke asked.

PAC chairperson, ‘Machabana Lemphane-Letsie, said the Committee would oppose any request for additional funding until the hospital’s governance problems had been addressed.

“We are not going into the next budget with QMMH in this situation, not while I am here. We cannot even approve a midterm allocation.

“Even if QMMH’s budget is insufficient, I will be one of the people standing in its way until this situation changes. We cannot continue allowing public funds to be used like this.

“QMMH will not come here asking for more money during the midterm review while this situation persists. There is no proper structure there. It is used by politicians.”

Ms Lemphane-Letsie said the Committee was still waiting for the hospital’s organisational structure, salary scales and establishment list to determine how employees were recruited and remunerated.

“It is not clear where QMMH’s structure comes from or who authorises it. We expected the hospital’s organogram, salary structure and functions so we can understand how people are employed and how salaries are determined.

“QMMH even used contingency funds to pay salaries. The warrant authorising the release of those funds clearly stated they were meant for medication, oxygen and food for patients, but they ended up paying salaries. That is why we are focusing on the salary structure.

“QMMH is not a private hospital. It cannot operate under a structure different from then government’s when all its salaries and operations are funded by taxpayers.”

She warned that unless the issues were resolved, the hospital should not expect additional public funding.

“QMMH will rather be closed. We are not giving it any more money,” she said.

Senior officials absent

Proceedings continued in the absence of two senior QMMH executives — Managing Director Dr ‘Makhoase Ranyali and Deputy Managing Director for Human Capital, Planning and Contracts Thenjiwe Dlangamandla — who failed to appear before the Committee despite being summoned.

Ms Monyobi said she had instructed both officials to attend, but Dr Ranyali informed her that her lawyer had advised her not to appear because they had lodged an appeal.

The absence marks the latest development in a months-long standoff between the PAC and QMMH’s senior management.

The pair first appeared before the Committee in November last year over allegations of politically influenced appointments, including claims that another deputy managing director had more than doubled her own salary.

After walking out of a Committee sitting in December, they approached the Constitutional Court seeking the removal of Ms Lemphane-Letsie as PAC chairperson, alleging bias and accusing her of prejudging them by publicly describing them as incompetent. They also sought an order halting the PAC’s investigations.

However, in a judgment delivered on 10 June this year, Chief Justice Sakoane Sakoane, sitting with Justices Fumane Khabo and Moneuoa Kopo, dismissed the application, allowing the Committee’s inquiry to continue.

Dr Ranyali and Ms Dlangamandla have since appealed that decision to the Court of Appeal.

“She told me her lawyer advised her not to come because they have filed an appeal,” Ms Monyobi said.

Ms Lemphane-Letsie dismissed the explanation, saying Parliament dealt only through the Attorney General in legal matters.

“Parliament does not work through lawyers’ letters. If there are court matters, Parliament is represented by the Attorney General.

“I am not a lawyer. Lawyers speak to lawyers and their clients. As an arm of government, Parliament is represented by the Attorney General. Unfortunately, this letter was not addressed to him.”

Dr Moroke questioned whether the ministry would discipline the two officials for defying instructions to appear before Parliament.

“What are the repercussions when your subordinate refuses to come after you instructed them to appear before parliament?” he asked.

Ms Monyobi replied that Parliament had its own powers to compel attendance.

“When someone ignores a PAC summons, the Committee has powers to summon that person through its own processes.

“I expect her here. I instructed all of them to come. I even spoke to her this morning.”

Ms Lemphane-Letsie added: “Parliament will deal with them. They can be arrested and summoned to Parliament.”

She further stressed that the Committee would not support additional funding while the hospital’s leadership continued to disregard parliamentary oversight.

“Provident fund contributions for QMMH staff have not been paid for many years.

“With this level of accountability, where a manager ignores Parliament because her lawyer advised her not to attend, we are not going to tolerate it. QMMH will not receive more money while it remains in this condition.”

Audit underway

Ms Monyobi also confirmed that the Ministry of Health had commissioned both a governance review and a financial audit of QMMH.

“Our concept note covers both the restructuring and the audit of QMMH. We have already written to the Auditor-General, who has begun the audit process.

“We expect both the audit and the restructuring exercise to be completed by October.

“The consultant will recommend options for how a tertiary-level hospital like QMMH should operate, and the government will choose the most appropriate model.”

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