Thulisile Mapongwana
The state of neonatal care in the Eastern Cape province has come under scrutiny following investigative hearings conducted by the Commission of Gender Equality (CGE) in 2023.
Major hospitals in the region, including Cecilia Makiwane Hospital (CMH), Dora Nginza Hospital (DNH), Bhisho Hospital, and Frere Hospital, were assessed on their performance in maternal and neonatal health services.
The findings paint a concerning picture of the challenges faced by these institutions, particularly regarding governance, staffing, infrastructure, and service delivery.
Cecilia Makiwane Hospital (CMH)
CMH in Mdantsane outside East London is renowned for its modern infrastructure, having opened a state-of-the-art facility in 2017. However, according to the CGe’s report, the hospital's commitment to quality neonatal care is hindered by incomplete documentation and inadequate evidence of service delivery improvements.
According to Commissioner Leonashia van der Merwe, despite conducting weekly perinatal mortality and morbidity meetings, the hospital struggled to provide consistent data supporting these efforts for the investigation.
Key areas recommended for improvement include implementing better infection prevention and control measures and developing comprehensive Quality Improvement Plans (QIP).
Dora Nginza Hospital (DNH)
DNH in the Nelson Mandela Bay operates as a district hospital with 220 beds, serving as a critical point for primary healthcare in the region.
The investigation revealed significant concerns about bed shortages and staffing strain, particularly in the maternity wards. These issues have led to poor patient experiences, including reports of mothers sleeping on the floor due to overcrowding.
While the hospital has a QIP in place, the CGE’s legal officer, Noma-Afrika Wakashe said its effectiveness remains in question, especially in improving care access for individuals with disabilities.
Bhisho Hospital
In the capital of the Eastern Cape, Bhisho Hospital serves a population of around 100,000 people. The commission found notable discrepancies in its quality information systems, with inconsistent reporting and lack of transparency in complaint resolution processes.
According to the report, though Bhisho Hospital has developed a QIP, the results of its implementation have yet to be seen. Improving gender sensitivity among staff and better collaboration with disability organizations were highlighted by Wakashe as critical needs.
Frere Hospital
Frere Hospital, a tertiary teaching hospital in East London, is a major healthcare provider with specialised services, including a well-equipped Neonatal Intensive Care Unit (NICU). However, the hospital was found to have significant governance issues, including allowing only 10 patients to be admitted into the maternity ward daily.
Data management inconsistencies, poor complaint resolution practices, and incomplete implementation of critical QIP measures raised concerns about the hospital’s capacity to deliver high-quality maternal and neonatal care. Specifically, issues surrounding inaccurate reporting on maternal cases and failure to meet maternal mortality reduction goals were reported to be prominent.
Recommendations
The commission made several recommendations across all facilities:
Governance and Leadership: Strengthening governance and accountability mechanisms is critical. Hospitals must prioritise transparency, with clear leadership on service improvements and reporting practices.
Staffing and Infrastructure: Addressing staff shortages, particularly in maternity wards, is a priority. Increased bed capacity and better infrastructure are essential to reduce strain on personnel and improve patient experiences.
Quality Improvement Plans (QIPs): Hospitals must fully implement and monitor QIPs, ensuring they are not only developed but actively pursued with clear timelines and accountability.
Infection Control: The implementation of infection prevention and control measures in line with national standards needs to be improved to protect both staff and patients from preventable infections.
Disability Access: Facilities should engage with disability organisations to ensure healthcare services are accessible to all, particularly for maternity patients with disabilities.
Data Accuracy: Improved data management systems are necessary to ensure that service outcomes, complaints, and patient satisfaction are accurately captured and addressed.
Head of the Health Department, Dr Rolene Wagner, acknowledged the gaps, but also added that CEO’s of these hospitals were already implementing some of the practical recommendations made in the report such as upgrading or fixing elevators in some hospitals.
During the meeting, Dr Wagner presented some of the progress the four hospitals have already achieved. “Raising awareness and being sensitive to gender, improving signage in facilities and increasing the number of beds at Dora Nginza so we can reduce waiting times in our facilities.”
To improve maternity care, Dr Wagner said each year and within the available budget, they have increased the number of community health care workers that go out into households to test young pregnant women and link them to care.
Closing off, Commissioner van der Merwe, said the findings from the investigation reveal systemic challenges, from poor governance and data inaccuracies to inadequate staffing and infrastructure. She acknowledged that these issues can only be resolved through collaborative effort.
“This issue should not just be owned by the Department of Health. Treasury, the Department of Public works should also come forward, because there is the issue of cost and resources, lack of human resources and lack of capacity.”
While hospitals have begun to address some issues, significant gaps remain, particularly in implementing quality control measures and improving care standards.
