As an alphabet soup, UB, SoM, MoH, AG, MFDP, MoESD, HRC is a lumpy offering that gets stuck in the throat each time you try to swallow it. Not yet licensed to practice – or qualified even, medical students tried washing it down with a concoction of petitions, media rants, parental involvement, political intervention and legal threats but that lump seems to have securely wedged itself.
This set of circumstances is certainly not what the University of Botswana anticipated when it presented the development framework of the School of Medicine to the government. By presidential directive, the High Ranking Committee was established. It was initially made up of permanent secretaries from the ministries of Education and Skills Development, Finance and Development Planning, Health and Local Government. The latter’s membership ceased when clinics were transferred to the ministry of health.
One key project milestone was the formation of nine (later 10) work streams which reported to the HRC on a monthly basis. As early as 2007, a time-tabled work plan was developed for the work streams. For example, between June and July, the Oversight Workstream had to establish committee roles, responsibilities and relationships; the Project Management Workstream had to appoint a project team; the Human Resources Workstream had to approve salary structure and scales; the Curriculum Development (Undergraduate) Workstream had to go on a two-day retreat to decide on curriculum model and plan curriculum and policy development; and by December of that year, the Oversight Workstream was to have amended the Public Health Act.
Working alongside UB, the Ministry of Health was to play a key role in the latter assignment. The former was to engage a consultant to research Botswana laws and compile a bibliography of laws pertaining to the practice of medicine. Both parties were to ensure that legislation was enabling and by December 2007, the ministry was supposed to have amended the Public Health Act. This is a process that involves the Attorney General.
The HR Workstream was the responsibility of UB’s HR Director and one of his mandates was to see to the approval of SoM Terms and Conditions of Service; job profiles; guidelines for appointments, promotions and review by the end of 2007. In February of the following year, the founding dean was to be in post and by June of the same year, a UB policy for attraction, development, reward and retention of staff was to be in place. In terms of looks, the package for SoM staff was the most handsome and was approved by both cabinet and the UB Council.
Lecturers were to do more than teach as they were also required to provide service at hospitals. That is why in March last year, UB signed a joint staff agreement with MoH.
When SoM planners gamed out potential downside scenarios to the baseline forecast, the high risk one was of staff leaving. Thus it was necessary that all care be taken to ensure that staff members were, in a literal sense, retained at all costs. Sometime last year, information was leaked to the press that at P1.3 million a year, the SoM dean earned more than the Vice Chancellor. A suggestion has been made that the suspension of a structure meant to bring operational efficiency to UB may have been the reason staff left in droves because they were skeptical of their future with UB. To resolve the current crisis, a source with intimate knowledge of the SoM project says that the priority should be filling vacancies as soon as possible.
Medical students, as indeed their parents, have expressed a great deal of consternation about the possibility of a gap year necessitated by the problems that SoM is undergoing. Little known is the fact that this was a possibility that was identified courtesy of the scenario-planning exercise – which is standard practice in project design. A scenario in which for some reason, the school is unable to provide training was presented and the outcome of brainstorming was recommendation of a gap year during which students would undergo a Master in Public Health programme. Rather than disadvantage the students, the gap year would actually give them an edge over their peers. The growing trend around the world is for doctors to acquire this qualification and after graduating from UB, SoM students would not have to go back to university years later to pursue an MPH.
At a meeting he had with the parents of students, MoESD assistant minister, Keletso Rakhudu is supposed to have stated that UB did not plan SoM properly. Conversely, the source insists that SoM wasn’t a napkin sketch of a plan but one comprehensive in every possible way and adequate to the scale of the project.
Says the source: “Starting programmes is not new to us. We have been doing this for years.”
To an extent, the public’s understanding of the SoM has been limited by poor choice of words – and figures. Construction of the SoM facility itself has been behind schedule and until last month, students had to use a building in the outskirts of the Gaborone bus terminal. Language used to describe this building has not been helpful because it does not reflect the extent of infrastructure upgrade that was undertaken. If not an innocent mistake in word choice, use of the word ‘warehouse’ wilfully strains facts because what has been so described is actually not a factory shell, as the term suggests, but a building that was retrofitted with offices, laboratories and lecture rooms. UB’s Director of Public Affairs, Reetsang Mhitshane, says MoH spent P2.5 million on this facelift. The school’s staffing levels are not where they should be but figures being bandied about to describe SoM’s staffing levels reveal only enough truth to be misleading.
Conventional wisdom is that when the school should have 87 members of staff it only has around half of that number. The important thing here is to put the stated figure in context: when fully operational, SoM will have 87 staff members and on a progression rate, what it has now is not wide of the mark.
SoM’s story also raises the question of how integrated Botswana’s national planning is. The students do their practicals at nearby Princess Marina Hospital but this is a facility that was never built to be a teaching hospital. The only one such in the whole country is some 200 kilometres away – Mahalapye Primary Hospital. Lots of money had to be spent to bring Marina up to the required standard.
The source insists that SoM is not a ‘Mickey Mouse’ operation and buttresses that point by pointing to the number of credible international institutions that have partnered with it. The list includes two Ivy League institutions (Harvard University and the University of Pennsylvania), Cambridge University, Mensah and the University of Pretoria.
Mhitshane says that notwithstanding the problems SoM has been facing, it still maintains close developmental ties with Harvard University, and University of Pennsylvania.
“In January 2012, the University of Botswana signed new Mosu with both the Harvard University and University of Pennsylvania. In both memoranda, emphasis has been given to enhance the relationship between the Faculty of Health Sciences (where School of Medicine is located) and the Universities. In 2012, UB received a grant of up to P68 million over a five-year period from the United States government as part of the Medical Education Partnership Initiative (MEPI), to strengthen medical education in Botswana. The School of Medicine, University of Pennsylvania and Harvard are partners in the programme,” she says.
Former health minister, Professor Sheila Tlou, played a key role in the establishment of SoM but left parliament before the project was completed. She oversaw the process to amend the Public Health Act in readiness for the school but when she left the ministry in April 2008, that had yet to happen.
Tlou suggests that change of personnel might be the reason not enough progress has been made.
“Remember it was not just ministers changing but a lot of officers at the Ministry of Health resigned. That lack of continuity also caused problems,” she says.
Faces around SoM have indeed changed a lot. President Ian Khama’s administration inherited the project from Festus Mogae’s. Tlou’s predecessor was Lesego Motsumi who was later replaced by Dr. John Seakgosing. Plans for the school started when the late George Kgoroba was minister of education. He was replaced by Jacob Nkate, who was replaced by Pelonomi Venson-Moitoi. The permanent secretary was Phillimon Ramatsui who was replaced by Festinah Bakwena who was succeeded by Baduetse Hubona who was succeeded by Ruth Maphorisa who was succeeded by Grace Muzila. From Mathias Chakalisa to Batatu Tafa to Newman Kahiya to Dr. Kolaatamo Malefho, the Ministry of Health has had different stewards. At SoM itself, the project started under Professor Bojosi Otlhogile who has now been replaced by Professor Thabo Fako. After his resignation, the school’s founding dean, Professor Thomas Massaro, was replaced by Professor Yohanna Mashalla.
If, as Tlou suggests, change of stewards has anything to do with SoM coming to chaotic default, somebody’s fear about what too many cooks are likely to do to a pot of broth may have tragically become real.
