Doctor says, "it wasn't me" as woman dies after delivery

Minister of Health Dr. Christine Ondoa: will she make the call on quality?

 A woman in Kiryandongo District has died after giving birth and failing to expel the placenta for several hours. Alice Nyandira, 39, according to eye witnesses, called for the help of the nurses on duty but got no attention.

In an interview, Dr Fred Mutabazi, the doctor on duty at the hospital, said after the call, he rushed to the hospital to save the situation but it was already late.
“When I came, it was already too late to save her life,” said Dr Mutabazi.
He, however, denied the claim that the woman died out of negligence because a hospital staff helped her deliver.
But the Kiryandogo District Chairman, Mr Ben Moru, said serious action must be taken against the implicated health workers to serve as a warning.
He said negligence in hospitals is forcing mothers to visit traditional birth attendants.

Stop press! The maternal mortality rate in Jinja Regional Referral Hospital is 1000 per 100,000 live births

According to press reports in the month of May 201, 508 deliveries took place in Jinja Regional Referral Hospital. Out of these 8 newborns died and 5 mothers lost their lives.

The calculation

Maternal mortality rate (not ratio!) is given by

Number of deaths due to pregnancy and childbirth

up to 42 days after delivery                                                                                -----------------------------------------------------------------   x 100,000 

Total number of deliveries during that period

After the dust has settled down we have:

5 deaths/508 deliveries x100, 000= 984.25 deaths per 100,000 births for the month of May 2011 in Jinja Regional Referral Hospital

This is a regional referral hospital which should be a standard for quality for the lower level health units under its jurisdiction.

Imagine what is happening in health facilities with even worse staffing levels?

HARMING NOT HEALING: THE CRISIS IN THE UGANDA HEALTH SYSTEM

It's the economy, stupid!

"It's the economy, stupid" was a phrase in American politics widely used during Bill Clinton's successful 1992 presidential campaign against George H. W. Bush. At that time, Bush was considered unbeatable because of foreign policy developments such as the end of the Cold War and the Gulf War.

The Uganda health system is in a crisis; and, as a public health professional, I say, it is quality of care, stupid! This is because the stories emanating from the health facilities around the country point to only one thing: a gross failure in quality of care. 

Litany of tragedy

• Museveni pays medical bills of riot victim and her baby
• Two die in labour as blood crisis hits Lira Hospital
• Hoima hospital in staff crisis
• Foetus found in Fort Portal hospital toilet
• Mob lynches child killer released by police
• Arua referral turns into death trap
• Distraught couple sues hospital after loss of baby
• Newborn bleeds to death in hospital

What is quality of care?

Quality of Care is “the degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Institute of Medicine, 2001). While the WHO considers Quality of Care as, the “proper performance (according to standards) of interventions that are known to be safe, that are affordable to the society in question, and that have the ability to produce an impact on mortality, morbidity, disability, and malnutrition” (Roemer and Aguilar, WHO, 1988).

Uganda’s MOH flunks the test of quality

From the indicators of quality of care above, the Uganda health system does not “increase the likelihood of (of achieving) desired health outcomes” for the vast majority of its users.

When one assesses the Uganda health system’s performance on the six dimension of quality: patient safety, effectiveness; patient centeredness; efficiency; timeliness; and equity; you find that it woefully fall short in all these dimensions.

Paying lip service

In many Ministry of Health documents, mention is made of quality of care; however, the quality of care has remained low in Uganda as evidenced by poor health indicators, especially maternal mortality and infant mortality. Yet, improving the quality of care can significantly contribute to the attainment of health-related Millennium Development Goals, especially the reductions in maternal and child mortality.

Where did the maternal mortality ratio of 350 come from?

A lie told often enough becomes the truth

Recently, government officials from the Ministry of health and the population secretariat have started a remour that the maternal mortality ratio of Uganda has reduced from 435 per 100,000 live births to 350 per 100,000 live births. However, the study or survey that informs this conclusion is never cited for scholars and other stakeholders to appraise themselves with. The only conclusion that can be drawn from this remour is that the Ministry of Health is involved in wishful thinking and hoping that once they repeat this lie long enough it will become the new truth.

THE UN casts doubt

Even right now, questions are still being asked how the ministry of health arrived at the current maternal morality ratio of 435 per 100,000 live births. The 2010 MDG report for Uganda says explicitly that this figure is an underestimation. According to the MDG report of 2010, “the methodology used and the sample sizes implemented in the three surveys do not allow for precise estimates of maternal mortality. The errors that follow from the representative sample around each of the estimates are large and, consequently, the changes are not statistically significant. It is therefore not possible to say confidently that maternal mortality has declined”.

WOLOKOSO!!

The challenge of maternal health is not helped by the poor birth and death registration system in Uganda. This is aggravated by the fact that only 30% of Ugandan women deliver in health facility.

Unless we hear a clarification from the Uganda Bureau of Statistic (UBOS), we shall take the new alleged maternal mortality ratio of Uganda of 350 per 100,000 live births for what it is: WOLOKOSO!!

Health Experts Unhappy With Government Priorities

Reproductive Health
This year, finance minister Maria Kiwanuka announced that sh24b has been earmarked to improve maternal and reproductive care in addition to rehabilitation of Mulago Hospital and building of a maternal and child health centre.
This will supplement $130m (sh312b) committed in last year’s budget to improve maternal and reproductive health over five years and construct health infrastructure. Besides, she said, “Government is committed to building hospitals in the five divisions of Kampala.” This will reduce congestion at Mulago National Referral Hospital, especially in the labour wards. Construction of a hospital by Chinese in Naguru, Nakawa Division is ongoing.
Malaria
Last financial year, the health ministry received an additional sh7b targeted towards the purchase of essential drugs and the control of malaria. Malaria is endemic in 95% of Uganda and it is the leading cause of maternal mortality in the country. It also accounts for 70,000-110,000 child deaths annually in Uganda, some of whom get infected from their mothers. So by increasing the health budget, especially to cater for maternal health, women and children’s lives will be saved further.
Education
In the education sector, an additional funding of sh115.9b has been allocated this financial year. This is aimed at increasing the number of children, especially girls, who enroll in and complete primary. In the 2010/2011 budget, funds to the education sector increased to sh1.13trillion from sh1 trillion in 2009. This year, another sh20.3b has been allocated for the capitation grant to scale up USE.
Education as a Contraceptive

Uneducated girls face greater risks of HIV, sexual exploitation and child trafficking, according to Ms. Martha Songa of Reproductive Health Uganda (RHU). Uneducated girls are also less likely to have healthy children and to send their children to school.
Criticisms: Square Peg In A Round Hole

But not all stakeholders in the health sector are happy with the government's priorities. The president of the Uganda Medical Association, Dr Margaret Mungherera, said she is disappointed that a key demand for better pay has not been addressed for the past five years despite consistent promises by President Museveni to increase health workers' pay.

"If you concentrate on drugs, ambulances, infrastructure without looking at the people who are offering the services, it's like having a well-stocked shop with no shopkeeper," said Dr Mungherera.

 Is there a crisis in Kampala?

The places with greatest need for healthcare investments are in the rural areas. It is disappointing that government is going to spend the biggest proportion of its health resources in the current budget to Kampala, where the least need is according to its own data.

DEATH TRAP: MOTHERS DIE IN LABOUR IN LIRA

Only days after a distraught couple sued the Jinja Regional Referral Hospital over neglect that they allege caused the death of their new born baby, two women who went into labour pains and a baby died at Lira Regional Referral Hospital in similar circumstances.

Ms. Middy Acen reported at the hospital on May 27 2011 was operated on and her baby saved, but she did not live to see the infant. Another expectant mother, Ms. Eunice Acola, 30, reported on May 25, and both mother and child died three days later.

There is outcry in Lira about neglect at the hospital.
But hospital authorities deny any wrongdoing.
The Director, Dr Jane Aceng Ocero, was at first not aware of the deaths when this reporter visited her office on Tuesday but promised to cross check and pass on the information.

She later confirmed there were two deaths and not three, as earlier reported. She said the first woman, whose child was saved, came to the hospital on May 27 in second stage of labour which started from home and she was bleeding.
“She arrived at 10:10pm and it was discovered that she was in second stage of labour, anaemic and the placenta was obscuring the baby’s exit,” Dr Aceng said.

She said the woman was immediately taken to the surgical theatre and operated upon to save the child. She said the mother needed blood but there was no blood at the hospital.
The second mother came on May 25 with fever and was diagnosed with malaria in pregnancy.

Dr Aceng said she was severely anaemic but improved a bit and requested to go back home. The woman returned three days later, and was found to be severely anaemic and in shock after losing blood. The foetus was already dead, according to Dr Aceng.

Last week in Jinja, a couple sought court intervention when they suspected that their new born baby had died out of neglect by hospital staff.

MUSEVENI AIDS MAYUGE MOTHER OF TRIPLETS: WHY I AM SAD FOR THIS GESTURE

State House Comptroller Lucy Nakyobe (extreme right) listening Buluba Administrator Sister Sis. Nahumikya Rosemary (extreme left) while the mother of triplets Nansamba Prossy (centre, covering baby) at the delivery of President Museveni’s financial assistance to the family. Nasamba was stuck in hospital after her and husband Aleka Pascal (on crutches, behind his wife) failed to pay hospital bill of 80,000/= at St. Francis Hospital Buluba in Mayuge district.

President Museveni got to know of the family from a story ran in Sunday Vision of May 25 2011. He sent the State House Comptroller to deliver his financial assistance of 3 million shillings on top of clearing hospital bills and other items. He also pledged to help the family with other assistance to support the family in presence of the Hospital Administrator Sister Nahumikya. 

Why I am sad for this gesture 

The president’s supporters fell over themselves in praising him over this gesture. However, I respectfully beg to differ:

What happened was an extreme example of the catastrophic impact of out-of-pocket payments for healthcare. For many poor Ugandans, falling sick is the quickest route to poverty; imagine if the president had not come to the rescue of this family, they would have been forced to sell off their assets like land, cattle, etc.

I take this opportunity to urge The President to expedite the enactment of some form of community health insurance scheme, and also increase the expenditure of health to 15% of the National Budget as agreed in the Abuja commitments. I have written a proposed framework for what I called, “The Uganda Mutual Health Fund” that has the potential to revolutionize healthcare in Uganda.

For so long, the legacy of The President has been questioned by his detractors; reforming the healthcare delivery system would cement his place in history as the “compassionate president”. We can not develop this country when so many of our people are impoverished because they have failed to pay a hospital bill of 80,000/=.