22 July 2007
I must first express my happiness about what we noticed last night when
there was an electricity outage in almost the whole of East London, Frere
Hospital continued to function using the electricity back-up system available
at this hospital. It was actually the only lit building as you drive up the
Oxford Street.
The Department of Health and Eastern Cape Government are concerned about the
serious allegations made with regard to healthcare delivery at Frere Hospital.
We are determined to act with the necessary urgency to ensure that the issues
undermining the integrity of the public health system are investigated and
swiftly addressed.
As a result of this concern, a team comprising of the special adviser to the
Minister of Health, Prof Ronnie Green-Thompson, Chief Director for Hospital
Services Dr Thabo Sibeko and Dr Nat Khaole, Director for Women's Health were
sent to the Eastern Cape to investigate these allegations. In addition to
making their own observations during pre-planned and unannounced visits to the
hospital, the team met with the Provincial Executive Council and a number of
other parties including clinical staff, representatives of organised labour and
hospital management over the three days.
Their report contains several findings and recommendations. The
recommendations will be implemented to improve efficiency and quality of
healthcare services delivery at Frere Hospital. To the extent relevant, these
recommendations may also be implemented in other hospitals such as Cecilia
Makhiwane Hospital which was visited by the team.
Findings and recommendations
The team has raised concerns about maintenance of the hospital and
recommended an increase of the maintenance budget. Presently is 0,5% (R3,5
million) of the total hospital budget and ideally it should around five percent
(which would be about R35 million). The non-functioning electronic
nurse-calling system needs to be replaced. Converting the room currently used
as a storeroom into another labour ward should create extra space.
Basic equipment was available and interviews with the clinical staff and
hospital management indicated that no baby has died as a result of the
non-availability of equipment. Therefore, the statement that health workers
"play God" and decide which patient lives or dies because of acute shortages of
equipment was not found to be true.
The team recommended the replacement of six of the eighteen incubators that
required frequent repair. Additional neonatal ventilators should be purchased
to supplement the ones available instead of moving neonates requiring
ventilation to the main hospital Intensive Care Unit (ICU).
There were some issues relating to infection control and hygiene that were
raised in the report requiring installation of elbow operated taps, additional
hand-washing basins and the adherence to infection control procedures. These
will be attended to as a matter of urgency.
Although there is largely a commitment to service delivery amongst staff,
the current levels of staff complement was the main area of concern. There is
an urgent need to increase the number of porters, messengers, general
assistants and clerical staff and ensure that these categories of health
workers are available at all times so that clinical staff can focus on what
they have been trained to do.
The current nursing staff allocated to the Maternity Unit, Neonatal Unit and
Neonatal ICU is not adequate. During one unannounced night visit by the team,
there was one professional nurse and one nursing assistant allocated to a 32
bed ward. The provincial Health Department and Frere Hospital must utilise all
the opportunities that are available for recruitment and retention of staff.
The rotation of staff between different departments to the extent that skills
are lost should be done away with.
The general complement of doctors is reasonable but can be increased.
Medical officers in the Maternity Unit must be available on site to ensure
optimum supervision of interns and clinical care of patients. Consultants
(specialists) must conduct scheduled night rounds and use them for teaching
purposes.
Clinicians were requested by the team to provide detailed statistics of all
fresh and macerated stillbirths and all neonatal deaths above 1 000 grams. The
1 000 grams cut off was used as it is an internationally used benchmark for
reviewing perinatal outcomes.
The Saving Babies Report (which aggregates the figures for 164 sites and
considers 20% of the births in South Africa) provides the perinatal mortality
rate of 27,9/1 000 live births. Frere Hospital's rate was 29,2 for 2005, 34,5
for 2006 and 32,9 for 2007 thus far. These figures are for the deliveries at
the hospital using the denominator of all live births at the hospital. They do
not include all the live births within the catchments area of Frere Hospital
and therefore need to be adjusted by using as the denominator all the
deliveries in the referral area of Frere Hospital.
The neonatal mortality rates per 1 000 live births for 2005, 2006 and
2007 (to-date) were 5,5, 12,9 and 9,5 respectively. The Saving Babies report
figure is 8,5/1000 live births. Adjustment also needs to be done here also.
Further review of data relating to Frere Hospital catchments area is necessary
since Frere Hospital is a referral facility that receives complicated
pregnancies from various lower level facilities. The national Department of
Health will also be initiating a national review of peri-and neonatal mortality
rate in a similar approach as confidential inquiry into maternal death.
The clinical audits meetings held every week at the hospital must be
formally recorded. Issues arising from the audits should be addressed by the
clinical staff and the hospital management. The District Health System must be
strengthened to reduce the number of unnecessary referrals and enable the
hospital to concentrate on the high-risk patients and thereby improve the
peri-natal outcomes.
The current East London complex system must be reviewed in line with a
national policy of delegating powers to the hospital Chief Executive Officers.
The management at facility level at Frere and Cecilia Makhiwane Hospitals
should be delegated the necessary authority and responsibility to manage these
institutions including control over budgets, staff establishments and services
rendered. The provincial Department of Health must provide the support and
oversight necessary to ensure that these facilities run efficiently and provide
good quality of care.
Conclusion
Reduction of maternal and infant mortality rates are among the main
priorities of the Department of Health and are important indicators of the
functioning of our health system. There should be deliberate efforts made to
encourage mothers to attend antenatal clinics early and regularly to enable
early detection of any complications.
However, it is true that both these indicators are also affected by the
environment in which people live in. Government will continue to address social
factors such as poverty and poor nutrition that have direct effects on
birth-weight and general health condition of infants.
There have been individual cases of inappropriate care that have been
reported and the provincial Department of Health is committed to investigate
these cases. We encourage everyone who may be aggrieved about the conduct of a
nurse or doctor to lodge a complaint with the Department of Health management,
the Health Professions Council of SA or the SA Nursing Council. We will be able
to assist in this regard and the toll free number 08000 32364.
While we accept the findings of the team, we call upon anyone, including the
media, who may have other information that may be helpful in strengthening the
quality of care at this hospital to make such information available to the
Department of Health.
Enquiries:
Sibani Mngadi
Cell: 082 772 0161
Issued by: Department of Health
22 July 2007
