Batswana women who cannot afford medical aid and have to be attended at government hospitals are more likely to die from complications surrounding pregnancy and childbirth than their counterparts who are treated at private hospitals – an explosive audit report has revealed.
For many Batswana the Auditor General’s performance audit report into the country’s public health system only confirmed what they already knew – being poor and pregnant carries more risk.
The audit revealed that scores of Batswana women suffer life altering injuries or die during childbirth because government hospitals and medical workers skip safety practices known to head off disaster.
“There was inadequate monitoring of mothers in the third and fourth stages of labour in facilities, particularly in hospitals. As a result of inadequacies in the monitoring of patients in labour, there was an increase in the occurrence of complicated cases, some of which resulted in maternal deaths”, states the audit report.
“Domiciliary Care Health facilities did not adequately carry out domiciliary visits as most of them either did not conduct them at all or conducted a smaller number of domiciliary visits as compared to the number of deliveries per year.
It further emerged that, “there was no effective management of obstetric emergencies, as hospitals were not adequately monitoring and preventing complications. Out of a total of nineteen cases reviewed from the Maternal Death Audit Reports for the period 2014 to 2016, 40% were caused by poor monitoring of patients and prevention of complications while 30% were caused by poor intervention and the other 30% caused by poor diagnosis.”
The audit confirms earlier findings by the United Nations that Botswana’s maternal and child mortality rates were a major stumbling block to the country achieving Millenium Development Goals (MDGs).
The former UN resident Coordinator Anders Pedersen revealed a few years ago that current maternal and child mortality rates were not encouraging and, therefore, much effort is needed to reduce them drastically in order to achieve the desired target .
The Auditor General’s report also turned up congestion in hospital wards. “Some health facilities had patient numbers and beds beyond their prescribed carrying capacity, which was an indication of congestion of patients. In one instance, there were 48 beds in an ante-natal ward designed for a 30-bed capacity. The post-natal ward on the other hand had a bed capacity of 52 beds but had an extra 22 beds and 18 patients sleeping on the floor. This compromised patients’ privacy as well as quality of health care services.”
The audit team found that, “the Ministry of Health and Wellness did not put mechanisms in place to ensure that all services were provided in an efficient and cost-effective manner. Substantial investments were made in construction of health facilities, which remained of no benefit to local communities because they remained unutilized for a considerable period of time after their completion for a variety of reasons.
“During the audit, three facilities, which had been constructed and remained unutilized for a considerable period of time, were identified. These were Matshwane Clinic in Maun, where a maternity ward was completed and fully equipped in 2014, but never utilised; a similar clinic in Donga, Francistown was also completed and commissioned in 2011, but never utilised. The third was Letsholathebe II Memorial Hospital Intensive Care Unit in Maun, which was constructed and completed in 2010 with some defects that remained unrectified and as a result the ICU facility had never been utilised In response management stated that Donga Clinic, which was undergoing maintenance to add structures such as sluice facilities, was expected to be completed in financial year 2018/19. Matshwane Clinic Maternity Ward was not yet operational due to shortage of midwives while the Ministry was working on rationalization and recruitment of midwives.
Hospital management acknowledged the findings and promised to make significant changes. “In response management stated that they planned to procure equipment that would facilitate continuous and timely monitoring of women in labour and they were to further devise guidelines that would manage skills utilization within and across the institutions. They were also to consider incorporating midwifery to the General Nursing programme so that when one finished training they would have attained both skills. This would help address the shortage and maximize service provision. Management was also in the process of developing Human Resource (HR) policy, which would advise the staffing norms.”