MINISTRY OF HEALTH AND QUALITY OF
LIFE
13.1 Pharmacy
The Commission for Health at Rodrigues places orders of drugs with the Central Supplies
Division of the Ministry of Health and Quality of Life. These drugs are to be used for the
next three months and thus issues should be effected with appropriate shelf life.
In my previous audit reports, I commented on the presence of expired drugs or drugs nearing
expiry on shelves. These items had to be either returned to Mauritius or disposed of.
Observation
Drugs nearing expiry dates and with even less than one month shelf life were being sent to
Rodrigues.
Implication
Rodrigues has limited care centres and in the event of receipt of drugs nearing expiry they
have no other alternatives than to dispose of them or send them back to Mauritius.
This eventually involves additional administrative work as well as cost.
Recommendation
Taking into consideration the specificity and remoteness of Rodrigues Island, the CSD should
supply drugs with reasonable shelf life or with a minimum of a specific shelf life. In the event
that they are not available, the Pharmacy Unit of the Queen Elizabeth Hospital should be
informed of the expiry dates and clearance be obtained before sending them to Rodrigues.
13.2 Lithotripsy Machine at Victoria Hospital
In 2000, the Ministry purchased one lithotripsy machine (Model Econolith 2000) for
Rs 6,650,000. The machine was installed and commissioned on 13 January 2000, by the
supplier. Since its acquisition, problems have been encountered with the machine.

As per logbook, the machine was out of order frequently as shown in Table 49.
Table 49 Frequent Machine Breakdown
Year
2000
No. of days machine
breakdown
43
2001
74
2002
96
2003
105
 No maintenance agreement was entered with the supplier after the end of the warranty
period.
 Repairs have been effected on the machine. However, the Biomedical Unit did not
exercise proper control over the use of the equipment.
 In April 2004, the Consultant reported that he has been using the machine for the past 18
months and the result obtained from the machine was not satisfactory, that is no
ureteric/kidney stones could be broken. Same was confirmed by a medical officer who
has used the machine.
 In several cases patients had to come to hospital at least four times for stone breaking
without success.
 Patients are no longer given appointment for stone breaking. In April 2004, 24 patients
were on the waiting list for stone breaking, some dated as far as back as February 2003. I
have been informed that these patients are being sent to J.Nehru Hospital.
To the National Audit Office the frequency of breakdown of the machine appears to be
abnormal. The Ministry should investigate into the causes.
13.3 Infrastructural Problems at Hospitals
13.3.1 Dr A.G.Jeetoo Hospital
In line with the National Health Plan (NHP) designed to improve and sustain the quality of
life in Mauritius through strengthened health care delivery system, Government initiated a
project to upgrade Dr. A.G Jeetoo Hospital.
This project originated with the visit of a representative of African Development Bank
(ADB) in April 1991. The Project was approved by ADB in 1993. However, the loan
agreement was cancelled as Government took the decision to construct a new regional
hospital on a different site. In 2000, Government approached ADB for the financing of the
construction cost. The loan agreement was signed in August 2002. The ADB will finance
around 83 percent of the project value (Rs 660 million) and the remaining balance will be
funded by Government.
More than thirteen years since its inception, the project is still at the embryonic stage. The
Central Tender Board’s approval has just been obtained for consultancy services. Further, the
Ministry decided in June 1998 that no renovation work would be effected as there was a
project in the pipeline for the construction of a new hospital.
On one hand the project for the construction of the new hospital is not being implemented,
while on the other hand, major repairs are not being carried out to existing infrastructure.
Meanwhile the infrastructural conditions at Dr Jeetoo Hospital are deteriorating.
Observations
Infrastructural problems are adversely affecting the level of health care delivery. In several
units, the lack of space is causing much inconvenience to both patients and staff. Further,
difficulties are being encountered for the installation of bio-medical equipment.
Accident and Emergency Department & Out-Patient Department(OPD)
Accident and emergency cases as well as out-patients are being attended to in the same area.
Some 800 – 1,000 patients attend the hospital daily. The following clinics are held daily at
the OPD:
 Paediatrics
 Medical
 Gynaecology
 Antenatal
 Cardiac
 Physical medicine
All the above-mentioned clinics are held in the same area, with one to two consultation rooms
for each clinic. This area is overcrowded nearly at all times. At times it is so crowded that it
is hardly possible for patients to move freely. It is even more difficult for patients in
wheelchair and on trolleys to move.
Medical records staff are accommodated in a small corridor. Sometimes three to five staff
work with two office desks, in a single office. Other office equipment, computers and
patients’ cards render these small offices cumbersome and thus difficult for officers to
operate more freely.
Ministry’s Reply
At present, the Ministry has to manage with what it has at this old infrastructural set-up. With
the coming of the New Jeetoo Hospital, more space would be made available.
Wards
Most of the wards are in a bad state. Although a huge sum of money is being spent under the
item ‘Repairs & Maintenance of Buildings’, still much need to be done because of the state of
the building. The wards and other areas continue to leak. Some need major repairs, namely
Wards 3 and 10 have been condemned for the time being.
Repairs and maintenance for the previous four financial years are shown in Table 50
Table 50 Repairs and Maintenance of Buildings
Year
2000-01
2001-02
2002-03
2003-04
Budgeted Amount
(Rs)
3,720,000
3,950,000
4,000,000
3,600,000
15,270,000
Actual Amount
(Rs)
3,642,237
3,933,902
3,996,624
6,034,760
17,607,523
For the previous four years, some Rs 18 million have been spent. Expenditure under this item
is increasing year by year, and will continue to increase due to the state of the hospital.
Ministry’s Reply
The Ministry is contracting out major works such as leakages and upgrading of wards.
Operations Theatres
The physical conditions of the operating theatres are worsening. Though repairs had been
carried out on the roof of the building in the past, yet it continued to leak during periods of
heavy rain. Sometimes operations had to be postponed in the Ortho theatre due to risk of
electrical failure.
There was inadequate space to move in the offices, which accommodate staff of the theatre.
The offices are crammed, accommodating staff, furniture, surgical items, solutions and drugs.
Ministry’s Reply
The Ministry has already reported the problem to the Ministry of Public Infrastructure (MPI).
MPI is currently finalizing a survey.
Installation of bio-medical equipment - C-Arm Image Intensifier
The request for the purchase of a C-Arm Image Intensifier for the implementation of
pacemakers was made since February 1999. The quotation was finalised in April 2001. The
order for the equipment worth some Rs 10 million was placed on 28 January 2004.
As at September 2004, the equipment has not yet been delivered due to non-finalisation of
infrastructural works, with the consequence that treatment for cardiac patients are being
delayed.
Recommendations
The project for the construction of the new Dr. Jeetoo Hospital be given due consideration.
The implementation of the project may also have the following benefits:

The high cost of repairs and maintenance could be reduced, if not eliminated.

A better and enhanced working environment could be provided to medical, paramedical
and other staff of the hospital.

The new hospital can house new high tech and up to date equipment that are being
deprived for the time being because of space problem.

The early implementation of the project is desirable, as construction cost tends to
increase with time.
13.3.2 ENT Hospital
Tests performed by the Environment Health Unit, in January 2000 and September 2003, have
revealed the contamination of the water supply. Biological growth from internal corrosion
deposits and encrustation in water pipes had resulted in bacteriological water quality
deterioration and this represented a public health risk. The metal water tanks have been
replaced but still water pipes of the whole system have not yet been replaced.
The MPI has appointed a private consultant for upgrading of water reticulations, but no
survey was carried out yet to establish the scope of works involved.
Leakage of Water in Wards
In the three wards of the Hospital, water leakages have been noted during periods of heavy
rain. During visits effected in the wards, it was observed that rain water drops directly onto
beds in the Paediatrics Ward, whereas in the Female Ward, one patient even complained that
rain water splashed onto her.
Acute space problem in Medical Records Department
The Medical Records Department is facing acute space problem for more than five years. The
Officer in Charge has in each monthly report submitted at Management Meetings informed
the Ministry of the problem. Temporary measures have been taken but the problem was still
as acutely felt as before.
Evoked Response Audiometer
The Evoke Response Audiometer is an essential instrument enabling the diagnosis of hearing
loss among children under three years old. The equipment was purchased in 1997-98 at a
cost of Rs 605,958. The equipment, which was ready for delivery has been dormant in the
stores of the supplier for two years and could not be installed since the audiology room was
not ready to house it.
The equipment was finally delivered on 13 March 2000 and the acceptance test certificate
signed on 18 May 2001 with the remarks that two weeks training was not provided to the user
and that the ECOG and CERA functions were not tested due to lack of training. As at
September 2004, after four years, no training has yet been provided. Thus, only one test,
instead of three available on the equipment, could be effected.
13.3.3 Brown Sequard Mental Health Care Centre
The completion date for the new psychiatric hospital, which was scheduled for 26 January
2004 has been revised to 26 May 2004. A further request has been made for an extension of
220 days, thus delaying the construction works by another year.
Meanwhile patients continue to be accommodated in the existing buildings at the Centre.
Several wards were in a deplorable state. Roof leakage was noted in four wards in the Outpatient Department and in the newly relocated Occupational Therapy Unit. The roof was
covered with tarpaulin in one ward. During rainy periods, electrical installation is subject to
power cut. There was also no emergency exit in two wards on the first floor. This is against
the recommendation of the Fire Services.
Ministry’s Reply
The new psychiatric hospital is scheduled for completion in December 2004.
Effects on the level of service
The above situation has resulted in several wards being overcrowded. A survey carried out by
my officers revealed that almost all wards were accommodating patients over and above their
bed capacity. No official record was available for the bed capacity, of wards of different
sizes. I was informed that in general, an average of 25 patients per ward was acceptable.
Actually in some 12 wards, it was noted that the number of patients was around 40. Hence,
beds were even placed in the middle of the corridor, or wherever space was available. There
was only a half-metre distance between beds in some wards resulting in limited available
space.
It is to be noted that in general, these patients are not bed-ridden, whereby the need to move
about freely in wards.
Ministry’s Reply
Adequate space is available in the yard for patients to move around freely. With the
foreseeable completion of the New Psychiatric Hospital, patients would receive health care in
a state-of-the-act environment.
13.4 Dental Services
In Mauritius, dental services are being provided by both the public (free service) and private
sector. It is characterised by a predominance of 104 private practitioners compared to 54
dentists in the public sector, (ratio 2:1). Still, the Public Dental Services are fast expanding.
In fact, the number of dental clinics is almost two fold compared to some 15 years back. In
addition, Government provides specialised services such as Orthodontics and Oral Surgery.
Below are the various problems identified in respect of the services provided.
Physical Working Environment
Visits were effected at 16 clinics.
Observation
The physical infrastructure and facilities were satisfactory in most of the clinics, except in
some cases where space was too limited, namely Eastern Suburb, Oral Surgery Unit at JNH,
VH clinic and the Public Health Dentistry Unit. It was difficult for both staff and patient to
move around.
Equipment
(i) Records
Fixed assets records were not available at the Ministry in respect of dental equipment. Such
records not only serve as a tool to exercise proper control over equipment but also help
management to derive valuable information for acquisition planning.
In the absence of the above records, it was therefore not possible for my officers to ascertain
the completeness of dental equipment.
Recommendations
The Ministry should carry out a survey of dental equipment in all clinics and compile a
master record. Relevant information such as date received, serial number, make, cost of
equipment together with list of accessories and tools inserted for each clinic within the
inventory records.
Ministry’s Reply
A master record is being compiled for dental equipment.
(ii) State of Dental Equipment
Several dental equipment are quite old and are subject to breakdowns. This hampers the
smooth running of the service.
Dental Consumables
Expenditure incurred under item Dental Materials, Equipment & Stores, amounted to Rs 4.1
million as at 31 May 2004.
Observations
 Some items are recommended for purchase on the basis of samples. However, these
samples were not sent to Central Supplies Division (CSD) for delivery purposes.
 Storage conditions were not satisfactory. Dental materials were stored in different
locations. Further, due to lack of space, dental consumables were seen kept together with
other surgical items.
 Some items have been purchased in spite of adequate stocks. Based on the trend of
issues, it appears that available stock represents several years’ consumption.
 Braided suture worth some Rs 900,000 was lying dormant.
Human Resources
The Dental Services have been fast expanding, with a total of 35 dental clinics, and three new
clinics are to be set up. However, there are eight dental clinics, which operate on a part-time
basis due to a shortage of staff.
Dental Surgeon
Despite the recruitment of four dental surgeons in April 2004, there is still a shortage of staff
for the time being, as two dental surgeons are on study leave and staff are needed for
replacement during leave period.
Dental Assistants
There are actually 45 dental assistants in post against 53 established posts. However, after
three years, vacancies have not yet been filled in due to the inordinate length of time to
amend the scheme of service.
Post of Dental Technician
The post of dental technician has been created since financial year 1999-00. But it was not
until October 2003 that the Ministry worked out a proposed scheme of service for submission
to the Ministry of Civil Service Affairs. After three years, this scheme of service has not yet
been finalised.
Delivery of Service
Dental Clinics
The MOH provides curative services to the public in 45 dental clinics and one mobile dental
clinic. 37 dental clinics operate on a full week basis and eight clinics work on a part-time
basis. Morning sessions are reserved for out-patients and afternoon sessions for
appointments. Emergency cases are also attended to in the afternoon. Visits at the dental
clinics revealed the following problems:
Heavy Workload for Morning Sessions
In general, the morning sessions were quite heavy. In fact, in regional hospitals such as
Victoria Hospital, JNH and Flacq Hospital, where there is only one dental clinic, the working
sessions were much heavier compared to those at Jeetoo Hospital and SSRNH, where two
clinics are in operation.
At five clinics, namely Curepipe, Victoria Hospital, Mahebourg, E.Suburb and Flacq, the
number of outpatients was very high.
Afternoon Sessions
The following unsatisfactory features have been identified:
 At Petite Rivière and Flacq Clinics the number of appointments was less than 10 and
appointment was given after longer intervals.
 There is a high percentage of patients who did not turn up on appointment – up to 58 per
cent. This might be attributed to the fact that appointments were given after long intervals
(ranging from two to four months), The National Oral Health Survey carried out by WHO
in 2001-02 indicate that less than 50 per cent of the public were satisfied with the public
dental services.
 A scrutiny of the patients register revealed that appointments for specific treatment such
as filling and scaling, were given after lengthy periods – three to seven months. It is
understood that a reasonable delay is six weeks for filling treatment. Striking examples
for unreasonable appointment schedule were evidenced at Curepipe and Eastern Suburb.
I was informed that due to the inordinate length of time for an appointment, instructions were
even given not to give appointment to patients and to advise them to come as an out patient
again.
Preventive Unit
Awareness of dental services
The Public Health Dentistry Unit, which was set up in year 2000, is responsible for the
management of oral disease prevention and oral health promotion programmes in the
community and schools. The dental clinics provide a wide range of services to the public
namely extraction, filling, scaling and orthodontics treatment among others.
The public at large is not fully aware of all the facilities provided by the public dental
services. There is this general impression that only extraction and filling services are
provided. The public should be well informed about the various dental services provided,
through brochures and TV advertisement.
Fissure Sealants
The application of fissure sealants on erupting molars (six years old) prevents caries from
developing or progressing. This programme was first introduced in some clinics around 1992,
as preventive measures. However, such application is on the decline – 3,358 applications in
1997 compared to 1,257 applications in 2002, i.e. a decrease of 63 per cent over a six-year
period. It is to be noted that there is actually a stock of fissure sealants at the CSD, which is
not being used.