The backlog of pregnant women awaiting elective Caesareans at Tygerberg Hospital’s maternity ward has increased, according to staff, who say that while the waiting list is not new, it has, in fact, worsened.
An insider told Daily Maverick that not only had patient numbers increased, “but there are also fewer consultants and doctors because of the budget cuts”.
“And theatre times – even though there are enough theatres, there are just no people. A lot of nurses resigned from theatre because of the constant pressure.”
Aside from budget cuts and staff reductions, another factor was a higher patient load. The source claimed some patients were travelling to the Western Cape from other regions to seek more reliable medical care.
“It’s been for a while now, say a year or two, but it’s unbearable,” they said.
Long-standing issue
Professor Stefan Gebhardt, head of the Department of General Specialist Services (Obstetrics and Gynaecology) at Tygerberg Hospital, confirmed the facility had seen a “challenging backlog” of patients for elective C-sections over the past few weeks, with up to 30 women awaiting procedures.
But this had been a “long-standing issue since 2009”, he said, despite their best efforts and improvements over the years.
“While these procedures are important for ensuring maternal and foetal health, they are scheduled around more urgent, emergency and high-risk cases, which are prioritised due to limited resources and theatre time. As a result, elective C-sections may experience delays, particularly when the demand for emergency or complex cases is high,” he added.
The hospital source said there had been instances where patients – whose elective C-sections were delayed – suffered adverse health outcomes, including two cases this year where the women allegedly went into labour and suffered uterine ruptures, and one in which a woman died due to pre-eclampsia.
Gebhardt said there had been no increase in the hospital’s maternal death rate.
“The average has consistently ranged between 14 and 20 per year, and this has remained the case in 2024. The only exception was during the pandemic, where we, like many others, faced a significant increase because of the disease.”
Complexities and delays
Gebhardt said while the number of pregnant women being referred to the Obstetrics and Gynaecology Department has not increased, the complexity of the cases has risen.
“Many of these women require specialised and urgent care that Tygerberg, as the only level 2/3 hospital in the eastern half of Cape Town, is equipped to provide.
“We have one theatre running 24/7 and additional weekday lists, but any unforeseen circumstances, like complex cases taking more time than expected, can mean delays,” he said.
All doctor positions in the Obstetrics and Gynaecology Department had remained filled this year, but Gebhardt described specialised nursing and anaesthetic support as “a precious and limited resource”.
“In O&G, there has been a reduction in theatre time over the years, specifically affecting gynaecological surgeries rather than obstetrics. We acknowledge the extended waiting times, like more than a year for fertility surgeries or more than six months for hysterectomies, and we understand how challenging this is for patients.
“Cancer surgeries are also under pressure…this is a challenge faced by other hospitals as well, but we remain dedicated to minimising any impact on patient outcomes.”
Health funding crisis
The reports of the backlogs at Tygerberg have emerged against the backdrop of a broader health funding crisis in the Western Cape and the country, generally.
Head of the Western Cape Health Department Dr Keith Cloete told Daily Maverick there was a “significant shock” to public healthcare financing in the country during the 2023/24 financial year.
A major factor was the government’s commitment to a higher-than-expected wage increase for public servants, which ended up being only 78% funded.
The Western Cape also had a reduction in the Provincial Equitable Share, which is the funding from the nationally collected tax revenue, allocated by the Treasury for the provision of healthcare, education and social development services, among other needs.
“Those two things – and the fact that the actual annual increase for public health spending has been stagnant for many years, and it was not keeping up with the annual inflationary pressure – all came together in 2023/24,” he said.
The resultant shortfall of almost R1bn in the province’s health funding meant the Western Cape Department of Health & Wellness was unable to fill all vacant posts towards the end of last year.
Cloete said the budget cuts have resulted in growing backlogs on all elective surgeries.
“Post-Covid, we had almost eliminated all of our backlog, but it has escalated again, nearly to the same levels… All the gains we’ve made have almost been undone because of this financial situation.”
He added that with the “acute assault” on the health budget, any strategies to address the impacts could take about three to five years to get the system to a point of recovery.
“We’ve almost hit the bottom of this and we need to start building up, but it will take several years to recover from that.
“We cannot sustain where we are now… We have to start… employing more staff, getting the right people into the system and slowly start to make gains, which we are beginning to do because we are in a position where we can start filling posts again.”
Daily Maverick article – Tygerberg hospital faces Caesarean section backlog crisis (Open access)
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