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a) “Just see how the government hospitals are managed. How the services are in the government hospital. So if the hospital is given back to the same management, all of this [at QMMH] will fall. That is my personal opinion.” – QMMH higher management, clinical role
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b) “I don’t think this infection control office, quality office and all of that will be functional. I think as soon as government takes over, things are going to deteriorate. Because if they were copying what QMMH is doing now, and trying to implement it at the district hospital, I would think they will be able to manage the hospital by then. But seeing that they have not even started [trying to learn what QMMH is doing], I am not convinced they will run this hospital to a level that it is at now.” – QMMH staff, clinical role
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c) “[There was a] pilot of the COHSASA standards [at] three institutions, [including] Christian Health Association of Lesotho institutions and government. The assessors of COHSASA said: [for] government institutions – this is an impossible task. [The institutions said] we will not be bothered; we don’t want this thing of yours. You can go away with your standards (…) You see, they [the government-run hospitals] are untouchable.” – QMMH staff, non-clinical role
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d) “Keep on doing the good things that you are doing. Learn about the new things that are coming up, and make sure that you improve and adhere to the new research and evidence-based practice.” – QMMH higher management, clinical role e) “In regard [to the] availability of medications. We already [have] the strategies of how we make sure things are available (…) which should be maintained (…) Maintaining the camera-surveillance system will also save the budget of this country. I am even suggesting it can go to other areas [other hospitals] (…) I am able to see what our filter clinics have while I am sitting here. This can be an improvement for the country to have a centralized area with computers that is it able to locate where everything is.” – QMMH higher management, clinical role f) “Botle, they’re a private [maintenance] company. If I were [the government], I would keep them (…) because they know everything. They have the floor plans, everything. So if you have somebody else they are going to [have to use] the first year try to figure out [what to do].” – QMMH staff, non-clinical position
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g) “The government must start by preparing management [staff] that will take care of this hospital (…) So let’s train people so that when take over here they know what to do.” – QMMH higher management, clinical role h) “Make sure that you have at least a specialist in every department. Two in the big departments; have two surgeons, two physicians, two obstetricians, two pediatricians, two ophthalmology, maybe one ENT, dental one. If you have spread out the skills like that, you develop in every area. If that training program was there (…) by the time the government takes over, you have people who can head those departments.” – QMMH higher management, clinical role i) “Other clinics around us are referring patients to us and then the staff start feeling that they are underpaid. And yet they have to do more work than their colleagues who are working in smaller health centres, but they are making more money than they are. It’s an issue of creating better job satisfaction [through better pay].” – Clinic staff, clinical role
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j) “You’re handing this over a few years from now. There are contractual obligations that when you hand over equipment should be within its usable lifespan…I say start offering more trainings to people (…) The building, structural equipment should be intact when handed over. What about staff? Are they going to be here?” – QMMH staff, non-clinical role k) “Do projects that are geared towards employees’ empowerment. We have people who need to go to school; (…) sponsor them to do part-time studies. That would help all other things, because if our human resources are not doing well then (…) dissatisfaction will arise. But if projects are geared towards their [staff] improvement and wellbeing, that would motivate staff. If you have motivated staff, then the output is good.” – QMMH staff, non-clinical role
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l) “Doctors come from all over the world to Lesotho (…) Before they get dispersed into the other districts, they would sit at Queen Elizabeth II for six months for training. Which was excellent, because you know what they know, you know what they do not know, you put emphasis on developing them. (…) you have self-sufficient hospitals because you have appropriate doctors for that facility, but now we don’t have that. I don’t know [if] QMMH can help the country with that.” – QMMH higher management, clinical role
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m) “[We need] a functioning health system and a good referral system so that people are referred [only] if they qualify (…) As it is now, people who come [to QMMH] are people with basic things that need to be attended to at the district health hospitals.” – QMMH higher management, clinical role n) “I think as a country as a whole, we need to try to have a network like [QMMH-IN] Where, there are levels of care: primary, secondary, tertiary level of care. We don’t want patients coming straight to casualty with cough and diarrhea whilst they could have been attended to at the clinic level.” – QMMH higher management, clinical role
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