More than 80,000 newborn babies died within just two years as a result of negligence and the poor quality of healthcare in public hospitals, according the Saving Babies report of the SA Medical Research Council. And MPs have grilled the Public Service Commission on its findings about the state of public health services in four provinces, suggesting that patients faced a far bleaker picture than that painted by the institution
MPs have grilled the Public Service Commission (PSC) on its findings about the state of public health services in four provinces, and suggested patients faced a far bleaker picture than that painted by the institution, reports Business Day.
The PSC is an institution established under the Constitution, responsible for ensuring South Africans have access to an effective public service. Its staff visited selected clinics and hospitals in the Free State, Western Cape, North West and Limpopo two years ago to gauge medicine supplies and medical equipment. The report says though the PSC's reports on these visits highlighted a wide range of serious shortcomings, commissioner Henk Boshoff delivered a sanitised presentation to MPs that skated over the issues and emphasised the willingness of provincial health departments to act on the institution’s recommendations for improving service delivery.
When MPs fired off their questions, Boshoff conceded that patients were often failed by the public health service. PSC chief director for service delivery and compliance evaluation Irene Mathenjwa said the institution had conducted public hearings on the problems facing service providers at various government departments in 2012, many of whom complained they were not paid on time. Some health companies had consequently withdrawn their services, she said.
The PSC made a presentation to the Committee on the availability of medicines and medical equipment in three provinces – the Free State, North West and Western Cape — outlining the problems and successes faced by the provincial departments and the districts in the delivery of services. What emerged was that there were some pockets of excellence, but the problems of medicine availability, waiting time for consultation and the quality of medical equipment, were serious challenges which the PSC had observed through inspection. Human and financial resource management had been revealed as a major problem. There was a shortage of health professionals and there were serious budgetary constraints affecting proper hospital governance. The recommendations made in 2009 by the PSC had been adhered to, with exception of North West, but the recommendations of 2012/2013 had not been adhered to in the same way.
The inspections had revealed deep institutional issues, such as the unavailability of ambulances and the attitude of some staff members at the sites visited. The PSC drew attention to the Mmabatho clinic and the Pelonomi Hospital in the Free State. The Mmabatho clinic was experiencing hygiene, infrastructure and service provider problems, while Pelonomi was experiencing financial management, human resource shortages and infrastructure maintenance issues. The PSC said it that would be working closely with Pelonomi to address the issues, but the challenges at Mmabatho clinic were still to be addressed.
Members said they had hoped that the presentation would have been more detailed in terms of which districts the PSC had visited and what criteria had been used to select the health facilities and provinces. The PSC responded that the facilities and provinces were selected for the 2009 inspections, and this was just a continuation.
A Member commented about the inspections and how they had failed to look at the four areas which the Minister of Health had identified as major problems in the health system. The PSC responded that the inspections had also revealed that the PSC itself had capacity constraints in terms human resources, but it would attempt to meet the request for more detailed presentations. Overall the Committee welcomed the findings of the PSC and invited them to make another presentation in order to provide more detail.
Ms Irene Mathenjwa, Chief Director: PSC, said that the issue of service providers applied across all levels of government, not only in the health sector. Public hearings had been held by the PSC with service providers, to investigate the challenge of the 30-day payment period, and non-payment of service providers. The problem which had become evident was the dishonesty within government — people who were required to pay bribes before being paid for their services. The service providers were unaware of the invoice requirement by Treasury, the process of payment and the general requirement before becoming a viable service provider. Management of the budget, especially at the beginning and the end of the financial year, was problematic. Due to the need by government agencies and departments to have clean audits, or to the general problem of exhausted funds, the payment of service providers was delayed. The health district strategic plans were created under the guidelines of the National Health Act, and there had been problems with some of them, but overall they had been good. There was a new public hearing session for service providers which would take place in collaboration with the Department of Public Service and Administration, to address the payment challenges. There had been a collaborative agency formed by the Department of Planning, Monitoring and Evaluation and the Treasury to hold provincial and national accounting officers responsible for departmental expenditure.
The issue of staff attitude was problematic. There was problem with management styles in the hospitals and clinics. One had to look at human resource management and the grievances surrounding performance management, and how that impacted service delivery and staff attitudes. The announced inspections had been very open to management and staff, but most of the problems had been discovered during the unannounced inspections.
The issue of the DDV was that the hospital paid for the medication itself through its supply chain management department. The health district would determine beforehand exactly what the prevalent diseases were, and the medications for those were the only medicines allowed to be purchased on DDV with the district’s approval.
Meanwhile, another report, the Saving Babies report, has found that more than 80,000 newborn babies died within just two years as a result of negligence and the poor quality of healthcare in public hospitals, reports City Press. Many of the deaths could have been avoided had healthcare workers in public hospitals followed simple guidelines, such as monitoring the heart rate of the foetus and looking after the overall health of the mother.
The report, compiled by the Medical Research Council, traced the number of live births, neonatal deaths and causes of deaths of newborn babies at South Africa's 588 health facilities between January 2012 and December 2013. Out of the 82 453 deaths recorded in the report, about 44% occurred at district hospitals and the ¬majority of them were stillbirths. Researchers found that unexplained stillbirths, spontaneous preterm labour – when a woman goes into labour before her planned delivery date – and intrapartum asphyxia (oxygen deprivation) were the most common causes of deaths in district hospitals and community healthcare centres.
Professor Robert Pattinson, co-author of the report and director of maternal and infant healthcare strategies unit at the Medical Research Council, is quoted in the report as saying: "Most of the deaths due to intrapartum asphyxia could have been avoided if the quality of intrapartum care was improved." He explained: "Improving the quality of intrapartum care has to do with improving the knowledge and skills of healthcare providers; ensuring that facilities have the appropriate equipment and human resources; and that there is an efficient, reliable emergency transport system."
A number of initiatives aimed at improving newborn infant, child and maternal healthcare at district level have been introduced by the national department of health in the past five years, including the introduction of district clinical specialist teams – obstetricians and gynaecologists, paediatricians, family physicians, anaesthetists, midwives and paediatric nurses.
The highly specialised teams that mostly began work in 2012 were tasked with reducing the maternal, infant and child death rates in all of South Africa's 52 districts as soon as possible. However, their impact, based on the latest official statistics of newborn deaths, has not been that great.
Department of Health spokesperson Joe Maila said in the report that some efforts had been made to reduce early neonatal mortalities in South Africa. At the district level, he said, government has implemented Essential Steps to Manage Obstetric Emergencies training.
Pattinson agreed with Maila, adding that, at face value, it may seem like nothing has changed, but there have been some improvements at different levels of healthcare. However, he stressed that a lot of work still needs to be done, not just at district level, but at academic hospitals as well.
Lekan Ayo-Yusuf, interim executive dean at Sefako Makgatho Health Services University writes in a Business Day reports that millions of South Africans are missing out on basic healthcare because of a skewed system that fails to make use of all the country’s skilled health professionals.
It is public knowledge that there are not enough doctors in the public health system. For every 1,000 people, South Africa has less than one doctor available. Brazil, with a gross national product per capita similar to South Africa, has nearly two doctors for every 1,000 people. He says what is less well known is that if SA's total health workforce is tallied, a critical shortage of human resources is not evident. The combined national average is 2.9 doctors, nurses and midwives for every 1,000 people. This is similar to Thailand, which has a comparable economic environment and counts 2.7 doctors and nurses for the same number of people. Both figures are well above the World Health Organisation's suggested 2.28 doctors and nurses for every 1,000 people as the critical shortage threshold.
He says in the report that the challenge with the health workforce in South Africa is twofold: a skewed distribution of skilled staff and an imbalance of skills. Doctors are mostly in private practices located in urban areas and the skills imbalance means there is limited use of the mid-level health workforce.
Distribution needs urgent intervention. He points out that even if the number of healthcare workers increases, the urban-rural imbalance may be worsened, particularly with doctors.
[link url="http://www.bdlive.co.za/national/health/2015/05/21/mps-grill-commission-on-sanitised-health-services-report"]Full Business Day report[/link]
[link url="http://www.news24.com/SouthAfrica/News/Infants-die-in-droves-due-to-negligence-poor-healthcare-facilities-20150524"]Full City Press report[/link]
[link url="http://www.ppip.co.za/saving-babies/"]Medical Research Council report[/link]
[link url="http://www.bdlive.co.za/opinion/2015/05/21/we-have-enough-medics-but-theyre-in-the-cities"]Full Business Day report[/link]