The South African Society of Obstetricians and Gynaecologists (SASOG) has hit out at Netcare’s decision to shut maternity facilities at its Ballito facility on the KZN North Coast, accusing the hospital group of having an “apparent lack of regard” for the community.
SASOG said with Ballito being one of the fastest-growing towns in South Africa, the demand for maternity services at Alberlito Hospital was likely to increase in the future and the closure of this resource was unwarranted.
Netcare recently announced the “resource-intensive overnight paediatric and neonatal intensive care unit as well as obstetric facilities” at the facility would be closed because of dwindling demand, sparking an outcry in the upmarket KwaZulu-Natal town.
TimesLIVE reports that it intends to replace the maternity, neonatal and paediatric units with an 80-bed mental health service for adolescents and adults, saying such a facility is in short supply. Specialist doctors affected have been offered practising privileges at other Netcare facilities.
“The five ObGyn specialists and four paediatricians with practices at Alberlito Hospital have been informed that their leases will not be renewed in January 2023 and that they must vacate their consulting rooms by the end of April 2023,” said SASOG president Dr Haynes van der Merwe, who added that SASOG was also disputing a statement on the issue, which was released by Netcare on 24 October and contained “factual inaccuracies and is misleading to the public”.
“In its statement, Netcare states that only 15 deliveries per month have been recorded over the past 15 years with an average of just 13 deliveries per month during 2022. Netcare also said that in the past six years 99.5% of deliveries were by Caesarean section.
“According to the five specialists at Alberlito, 327 births occurred over the past year alone, 62 of which were vaginal deliveries and 265 Caesarean section births. We find the publication of incorrect figures by Netcare dishonest and a deliberate attempt to discredit the group of specialists,” Van der Merwe said.
SASOG also refuted Netcare’s viewpoint that patient demand and growing community needs are better served through this shift in focus by Netcare.
“While SA’s birth rate has declined slightly over the past eight years, according to the recently published Africa Wealth Report, Durban and Umhlanga are in the top five wealthiest cities in Africa and Umhlanga and Ballito are two of the fastest growing towns in South Africa. The demand for maternity services could therefore be expected to increase in the years to come in this particular area,” said Van der Merwe.
“These five ObGyn specialists are dedicated to this community and are seeking ways to maintain services. We believe that children and pregnant women should always have access to community-based healthcare. This decision will affect the children and pregnant women who live in Ballito and will have a negative impact on the livelihood of most of these clinicians and their staff.”
SASOG has also refuted Netcare’s reference to “patient safety” as a feasible consideration in arriving at the decision to re-allocate capacity.
“The society believes that the studies cited by Netcare in its statement and its comment that ‘mothers and their babies are at higher risk of complications when they have their deliveries at hospitals with an extremely low number of births’, are misleading and are being referenced out of context.”
Van der Merwe said the Alberlito maternity unit was a specialist driven unit that was vastly different from the obstetric units included in the referenced studies, which may be junior non-specialist doctor or even midwife driven.
He said the studies “are quite old and Netcare’s statement conveniently ignores the fact that some adverse outcomes are increased in higher volume centres”.
“It would be much more appropriate to compare the outcomes of deliveries in Alberlito to other hospitals in the Netcare group to see whether there are any differences in the maternal or neonatal outcomes”, he said.
According to the Netcare statement, a concession will be made whereby 15 of the 37 beds will be made available to paediatric patients.
SASOG questioned why, if Netcare is prepared to make a concession for paediatric patients, it could not make a similar concession to have maternity beds available.
Furthermore, while it is true that maternity units require the services of midwives, “these midwives could be utilised in other service areas when not required in the maternity wards, if a concession were to be made to accommodate obstetric services”, observed SASOG.
Van der Merwe said the assurances made in the Netcare statement regarding the continued availability and resourcing of maternal and paediatric healthcare were misleading. “A facility cannot be considered ‘fully resourced for all paediatric and maternity emergencies’ without the support of available specialised paediatricians and obstetricians,” he pointed out.
As reported in Medical Brief, Ballito residents staged a protest outside the hospital last month and started a petition campaign to fight the closure.
After a recent meeting with the affected doctors, Netcare said a dedicated paediatric ward, with fewer beds, would remain in place. It said neonatal and birthing facilities would be available until June 2023. From 1 July, the service would be terminated.
“Netcare has indicated it would be willing to transfer the required licence to a separate, independent facility, subject to approval from the Department of Health,” it said, adding that patients with obstetric emergencies would be stabilised and transferred to hospitals with suitable obstetric units.
See more from MedicalBrief archives:
Petition over Netcare’s closure of Ballito maternity, paediatric units
SA’s obs-gynae crisis: Innovative risk solutions needed
National Health report details grim state of KZN public hospitals