Elusive joy for mothers and babies as cartels run maternity down

More than 1,000 children died at the crisis-ridden Pumwani Maternity Hospital in the past year as the City Council facility continued to sag under the weight of mismanagement, low staffing levels, corruption and the absence of equipment, a task force has found.

In the period from July last year to July this year, 13 mothers died in childbirth, while some 253 developed complications and 4,185 gave birth through by Caesarean section. Another 13,000 mothers gave birth normally and were discharged without complication, the report shows.

The task force’s 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 government authorities for action.

Under-secretary in the ministry of Medical Services, Mr Adan Adan, chaired the task force. Members included Dr Simon Mueke, Dr Izaq Odongo, Mrs Susan Otieno, Mr Manasseh Bocha, Dr Rachel Nyamai, Mrs Anne Njeru, Dr Robert Ayisi, Mr Sylverio Wanjira and Mr Karisa Iha.

Corruption, financial crisis, lack of critical supplies for 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 at the hospital.

For the first time, the report attempts to pinpoint 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 the Lady Griggs Welfare League as Lady Griggs Maternity, the hospital caters especially for the poor in 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-sections. Delay often leads to death.

City council

There is a shortage of necessary supplies required during and after delivery, and mothers bathe in cold water after the boiler became non-usable, according to the Services at Pumwani Maternity Hospital under the Nairobi City Council, 2011 report.

Only one of the four autoclaves — equipment used to sterilise linen and theatre instruments to prevent infection — is in working condition.

Sometimes the hospital is forced to sterilise the tools at Kenyatta National Hospital to cope with theatre demands or when this machine breaks down.

Only a sixth of the required number of incubators for preterm babies is available, hampering efforts to increase child survival rates.

Workload is more than the 14 doctors and 194 nurses can handle, affecting the quality of services offered as staff struggle to attend to as many mothers and babies as possible. The hospital records between 50 and 100 normal deliveries and eight to 15 Caesarean sections every day.

Staff complained of burnout from the workload, which has 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 an opportunity 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 last year that the institution was forced to sustain patients using daily collections.

These findings are contained in the report by a 10-member task force formed after Prime Minister Raila Odinga visited the hospital in July and directed that an audit of the hospital’s operations be done following negative reports in the media. The Sunday Nation interviewed numerous staff at the hospital who corroborated the findings.

Battered image

The task force was mandated to, among other things, recommend ways of reducing maternal and child mortality and improving the hospital’s battered image.

Dated August 19, 2011, the report has disturbing findings that confirm Pumwani faces a crisis that needs urgent attention and action from the government and support from donors and well-wishers.

The report comes on the heels of admission by the government through a ministerial statement in Parliament early this month that 342 babies had died between January and July, raising questions as to what exactly is going on at the hospital.

Attempts to sort out the issues ailing the hospital remain a pipe dream due to serious financial problems. In the financial year 2011/2012, the hospital’s creditors are said to be owed over Sh60 million, with debts standing at over Sh5 million.

Sources within the hospital indicated that the City Council of Nairobi exacerbated the situation by failing to remit Sh2 million every month towards improving quality of services at the facility. They claimed the hospital has been turned into a cash cow by some individuals at the council.

Some of the money collected from the hospital ends up in individual pockets rather than being used to benefit 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 (NHIF) whose refunds are infrequent and piece meal, making it difficult for the hospital to buy important consumables used during and after delivery.

Senior managers at the hospital say from early this year, NHIF was supposed to refund the institution Sh13 million, money accumulated since late last year.

“NHIF refunds come in small instalments, sometimes of half a million, which makes it difficult to pay suppliers,” said a source at the hospital who requested anonymity because of the sensitivity of the matter.

Affecting performance

The hospital is heavily polluted by dust from its surroundings and smoke emitted from vehicles plying on almost all sides of the hospital, affecting the performance of the staff and increasing the chances of infection of babies and mothers.

Besides the financial and environment concerns, the staff complained of a demoralising working environment — salary delays, inequitable remuneration allowances, 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 factors 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 hospital’s poor management system.

There are parallel management systems with hospital workers reporting to different offices: some report to City Hall, others to the hospital’s superintendent, while doctors report to the Ministry of Health.

The hospital’s board is toothless. 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, significantly influence the hospital waiver system, sometimes 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.

Poor security and the porous hospital fence is another issue that denies the hospital resources as patients sneak from the wards without paying hospital bills. The task force has recommended additional staff and that the four theatres be fully operationalised.