The Commission for Gender Equality (CGE) says there are interdependent challenges in public hospitals in the Eastern Cape’s maternity wards that worsen overflowing, infections and maternal mortality.
The commission released a report on Thursday, The state of maternity and Neonatal Healthcare in the Eastern Cape Province (2023/2024), which focused on six hospitals: Cecilia Makiwane, Dora Nginza, Bhisho, Frere, Livingstone and St Elizabeth.
The report’s findings revealed that the main problems pertained to infrastructure maintenance and a deficiency in psychosocial support for patients and staff.
“Delays in equipment procurement were observed, potentially contributing to the elevated rates of neonatal and maternal mortality in the province. Furthermore, the process of decompleting both Dora Nginza Hospital and Livingstone Hospital appears to present its own set of challenges,” reads the report.
It found that out of 776 facilities, only 143 were compliant with health standards for accommodating patients with disabilities.
Another issue was their failure to meet the reports and ground-level recommendations outlined in the Saving Mothers Annual Report which underscores the urgent need for corrective action.
“There is a pressing need to bolster training for new assessors and quality assurance at the provincial level to promote consistency in coding the primary causes of maternal death,” read the report.
It found discrepancies in performance among the facilities. One hospital would offer a termination at a limited capacity. Also, the provision of C-sections is not consistent. Some hospitals have more clinical personnel and others fewer.
The report found a leadership vacuum was a concerning factor affecting hospital performance and the filling of critical clinical vacancies.
Patient transport was identified as a (negative) factor as most women in the province come from rural areas where public transport is a challenge. This results in mothers having to share a bed, which exposes them to infections and attracts other risks.
Cecilia Makiwane Hospital (CMH) — a regional teaching hospital in Mdantsane township — cited challenges related to overflow in maternity services.
It reported serving 100 patients for each census in its outpatient department headcount. However, no explanation was provided for this response. Consequently, the commission was unable to conclude in this regard.
“According to its report submitted to the commission in the fiscal year 2020/21, CMH recorded 17 maternal deaths per perennial problem identification problem (PPIP) and 15 per District Health Information System (DHIS).
“Notably, the maternal mortality ratio was reported as 249.6 per PPIP and 344 per DHIS. In the subsequent fiscal year 2021/2022, CMH reported 11 maternal deaths per PPIP (including one home death) and eight per DHIS, corresponding to maternal mortality ratios of 249.6 per PPIP and 186.2 per DHIS,” read the report.
From April 2020 to March 2021, a mortality rate of 14.3% was recorded. Between April 2021 and March 2022, the rate was 11%, and from April 2022 to March 2023, it stood at 13.9%.
These deaths were attributed to various causes, including maternal hypertension, spontaneous preterm births, infections and overcrowding in neonatal units.
“However, CMH did not provide a report to the commission indicating or illustrating any interventions taken to prevent potential future occurrences, nor did it indicate any interventions taken within the reported years,” said the report.
The commission’s investigation into Dora Nginza Hospital unveiled significant concerns regarding inadequate bed capacity and the resulting strain on nursing staff.
“Nurses’ strike actions have underscored the need for increased provision of beds and staffing, highlighting dissatisfaction with prior engagements with the department of health. Further scrutiny has validated the challenging conditions within the maternity wards, revealing instances of post-partum patients being displaced due to bed shortages and some patients resorting to makeshift sleeping arrangements on floors or benches.
“While the hospital has addressed concerns regarding the backlog of C-section services, the absence of a current waiting list poses challenges in assessing backlog reduction efforts,” reads the report.
Women’s experiences of state service delivery about their sexual and reproductive health reveal a discernible “politics of women’s health”.
“There are two reasons for this. First, South Africa is experiencing an AIDS epidemic that has become entrenched and disproportionately affects women. Second, women in this country are not able to routinely implement their sexual and reproductive decisions safely and securely, regardless of whether they attend state-run hospitals.
“There were instances where the data provided to the commission by Bhisho Hospital did not provide a clear picture regarding this, preventing the commission from conducting a measurable assessment of the rise or decline in the variables to be analysed and concluded. This was mainly premised on the notable scoring criteria used for various financial years, which often differed from one another.
“The commission has concluded that Bhisho Hospital exhibits deficiencies in its quality information systems, leading to discrepancies in reporting accuracy and evident lacunae in routine reporting practices, thereby impeding effective performance monitoring at the hospital,” read the report.
Regarding reach in relation to the catchment population, Bhisho Hospital stated a reach of 65%, albeit without providing a numerical figure, rendering it impossible for the commission to quantify the extent of its reach numerically.
“Regarding this, Bhisho Hospital submitted a Quality Improvement Plan (QIP) focusing on areas where the hospital scored poorly. The plan addressed laundry services, human resources, infection control and waste management, all pivotal in ensuring the delivery of quality service delivery associated with women’s health and maternal services within the facility,” reads the report.
TimesLIVE
Kgaugelo Masweneng
www.timeslive.co.za
