A task force report containing damning findings on the operations at Pumwani Maternity Hospital and which is likely to shed light on the causes of the high maternal and child mortality at the facility has been handed over to appropriate government authorities for action.
Corruption, financial crisis, lack of critical supplies required by mothers and babies, mistreatment of mothers, moral and ethical decadence, and absenteeism among doctors, are highlighted as some of the factors that have compromised the quality of services delivered by the hospital.
For the first time, the report attempts to pinpoint on areas that seem to have brought the hospital, the third largest and busiest provider of maternal services in Africa, to its knees. Established in 1926 by Lady Griggs Welfare League as Lady Griggs Maternity, the hospital caters for the poorest from all corners of Nairobi.
The report brings to light the sorry situation at the hospital where poor expectant mothers go through major difficulties before and after delivery. Only one theatre works full-time resulting in up to 13 mothers who need immediate obstetric attention queuing for up to 24 hours to get emergency C-section. Death for them becomes inevitable.
There is shortage of necessary supplies required during and after delivery; and mothers bathe in cold water after the boiler became non-usable, says the report, Services at Pumwani Maternity Hospital under the Nairobi City Council, 2011.
Only one out of the four autoclaves – equipment used to sterilise linen and theatre instruments so as to prevent infections-is in working condition. Sometimes the hospital is forced to sterilize the tools at Kenyatta National Hospital to cope with theatre demand or when this machine breaks down.
Only a sixth of the required number of incubators for immature babies is available, hampering efforts to increase child survival rates.
Workload is more than the workforce of 14 doctors and 194 nurses, affecting the quality of services offered as staff struggle to attend to as many mothers and babies as possible. The hospital delivers between 50 and 100 normal deliveries and 8 to 15 caesarean sections every day. In the financial year 2010/2011, more than 18,000 women delivered at the hospital.
Of these, 13 died, 253 developed complications, and 4, 185 underwent C-section. During that period, a total of 1,111 baby deaths were recorded at the hospital. Among these, 545 babies died immediately or few days after birth and 566 were still births- a baby who is born without any signs of life at or after 20 weeks pregnancy. This baby may have died during pregnancy, labour or birth.
Staff complained of burnout from the workload, which had a negative impact on the quality of services delivered and the handling of women who deliver at the facility.
Corruption is also rife at the hospital, with the funds meant for the wellbeing of mothers and babies being misappropriated. Revenue collected from the hospital under the cost sharing arrangement, for instance, is taken to City Hall for banking. The report says this creates a loophole for under-banking.
This procedure has affected the delivery and smooth running of services at the hospital, with those who manage it finding it difficult to run the institution without sufficient resources. Two officers at the hospital who spoke to the Sunday Nation said the situation was so bad late 2010 that the institution was forced to sustain patients using daily collections.
These findings are contained in a report of a 10-member taskforce which was formed after the Prime Minister Raila Odinga visited the hospital in July and directed that a clinical audit of the hospital’s operation be done following negative reports in the media. They are also based on interviews Sunday Nation conducted with numerous staff at the hospital.
The task force was mandated, to, among other things, recommend ways of reducing maternal and child mortality and improvement of the hospital’s battered image.
Dated August 19th, 2011, the task force report has very disturbing findings, which confirms Pumwani is hospital in a crisis that needs urgent attention and action from the government and support from donors and well-wishers.
It also comes on the heels of admission by the government through a ministerial statement in parliament early this month that 342 babies had died at the hospital between January and July, 2011, raising questions as to what is exactly going on at the hospital.
Attempts to sort-out the issues ailing the hospital remain a pipe dream due serious financial problems. In the financial year 2011/2012, the hospitals creditors are said to be owed over Sh 60 million, with debts standing at over Sh 5 million.
Sources within the hospital indicated that the City Council of Nairobi worsened the situation by failing to remit Sh 2 million every month towards improving quality of services at the facility. They claimed that the hospital has been turned into a cash-cow by some individuals at the council.
A fraction of the money collected from the hospital is ending up in individual pockets than benefiting the women and babies who need it most. Some of these officials, said the sources, insist on controlling the hospital imprest and have resisted computerisation of the billing system. Those who have tried to question the dealings have been sacked or transferred.
Another financial headache is presented by the National Health Insurance Fund whose refunds are infrequent and come in piece-meal, making it difficult for the hospital to buy important consumables used during and after birth of the babies. Senior managers at the hospital say from early this year, NHIF was supposed to refund the institution Sh 13 million, money accumulated since late last year.
“NHIF refunds us in small instalments sometimes of a half million, which makes it difficult to pay suppliers of the key consumables needed by the hospital,” says a source at the hospital who requested anonymity because of the sensitivity of the matter.
The hospital is heavily polluted by dust from its surroundings and smoke emitted from vehicles plying on almost sides of the hospital, affecting the performance of the staff and increasing the chances of infection in babies and mothers.
Besides the financial and environment concerns, the staff complained of a demoralising working environment-salary delays, inequitable remuneration allowance, non-payment of risk allowance for the past two years, lack of welfare benefits, lack of scheme of service, and use of abusive language by their seniors at City Hall. All these things impacted on the quality of the services they offered.
The nurses blamed medical officers for failing to undertake adequate consultations, and to communicate appropriately their decisions, says the report.
This situation is made worse because there is poor or no external supervision or monitoring of the health workers and their performance. “Nobody is held accountable for the deaths of babies and mothers,” said a source at the hospital. One of the problems, the report and interviews with staff revealed, is the hospitals poor management system.
There are parallel management systems with hospital workers reporting directly to different offices: some report to officers at City Hall, others to the hospitals superintend, while doctors to the Ministry of Health.
The hospital’s board is just a toothless organ. It does not “determine the staffing requirements for optimal operation of the hospital, and neither does it determine their terms and conditions of service,” the report notes.
Of concern also is the serious political interference especially when it comes to collection of fees and procurement. Politicians, the report notes, influence significantly the hospital waiver system, sometime making it lose a lot of money. Senior officers at the council claimed that the waiver is also being used to siphon the meagre resources from the hospital.
The politicians have also played a role in the grabbing of prime land belonging to the hospital which was to be used for expansion and improvement of services. According to the report, Doctors Flats on parcel L.R. 36/VII/253 and vehicle access on parcel L.R 36/VII/254 are some of the parcels grabbed with officers at the City Hall facilitating the process.
The poor security and the porous fence at the hospital is another issue that denies the hospital some resources as patients sneak from the wards without paying hospital bills.
In view this sorry state, the Task Force has made a raft of recommendations. It says four theatres need to be fully operational and a minimum of 16 medical officers, four gynaecologist, two paediatricians, three more anaesthetist, and additional 20 nurses employed to enable the theatres operate optimally. Provision of warm water should be made available for mothers.
To improve efficiency and standards, the report recommends the hospital be delinked from City Hall in personnel management, financial and procurement systems.
The report recommends that the Pumwani Maternity Hospital Management Board be the one to decide on the staffing in the hospital in line with the Local Government Act (Cap 265) in Legal Notice No. 98 of 2000. External supervision of the hospital and provision of continuing medical education for hospital staff will have to be done.
Sourcing of blood from Avenue Healthcare Limited should be immediately stopped and instead blood sourced from the National Blood Transfusion Services, the report adds.
Other proposals by the report authors are: A plan be put in place to improve the image of the hospital; building a perimeter wall around the facility; and construction of a small mortuary to cater for deaths happening in the hospital.
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