Maternal healthcare fails dismally

Namibia fails to reach Millennium Challenge Goals

16 April 2020 | Health

Most expectant mothers are confronted with myriad challenges ranging from the inability to access health facilities, being forced to deliver at home due to limited public transport and the long distances they have to travel to reach health facilities with maternity services.
This, in a nutshell, is Auditor General (AG) Junias Kandjeke’s conclusion after compiling the performance audit report on the provision of maternal healthcare services within the ministry of health and social services (MoHSS) in a report submitted to the National Assembly for scrutiny in March.
The audit was to determine the efficiency and effectiveness of the MoHSS and its stakeholders in providing maternal healthcare services to reduce the maternal mortality rate in the country during three financial years (FYs), namely 2015/16, 2016/17 and 2017/18.
Although the MoHSS covers the 14 political regions, due to limited resources, the auditors only visited six regions for fieldwork based on their population size. The regions are Omaheke, Khomas, Kunene, Kavango East, Kavango West and Erongo.

Volumes
“Khomas had a high volume and Omaheke had the least volume of patients. Therefore, the selected regions represent the whole country,” Kandjeke justified his report.
During the audit, Kandjeke found that 82% of pregnant women are booked late for antenatal care services (ANC), while the majority of these mothers did not attend all the ANC follow-ups due to ineffectiveness of the mechanisms used to sensitise pregnant women, difficulties in accessing health facilities and long waiting times at health facilities.
According to the AG, only 18% of mothers in Namibia attend ANC within the first three months of pregnancy, while the remaining 82% do so after three months of pregnancy detection. This situation has led to the late detection and management of pregnancy complications, therefore affecting the outcome of pregnancies.
As a result, more mothers delivered at home due to difficulties in accessing the health facilities and a lack of maternity shelters, posing a high risk to mothers and newborns. In essence, the ANC includes regular screening that can detect and prevent early complications during pregnancy.

Postnatal care lacking
Moreover, the auditors found health staff did not admit healthy mothers and their newborn babies for 24 hours at the maternity ward for postnatal care services (PNC) due to inadequate capacity in the PNC wards.
Overcrowding of PNC wards, early discharge of mothers and inadequate staff at PNC wards also proved to be a challenge during the audit. “This results in mothers and babies developing obstetric complications at home and further translates into mortality,” Kandjeke added.
Obstetric complications refer to disruptions and disorders of pregnancy, labour and delivery, and the early neonatal period.
In addition, the auditors found that district hospitals are not capacitated in terms of skills and equipment and could not treat maternal complicated cases as they were unable to perform certain signal functions (SFs).
Kandjeke did not shy away from pointing out how dismally Namibia has failed to reduce the infant mortality rate.
“Namibia failed to reduce the infant (0-1) mortality rate (IMR) of 44 deaths for every birth to the target of 30 deaths for every 1 000 deaths by 2015. Namibia failed to meet the Millennium Development Goals (MDGs) target of 28% per 1 000 live births of child (1-5 years) mortality,” the AG said.
IMR is the number of deaths per 1 000 live births of children under one year of age.
He also poked holes in the maternal care system, saying there is inefficient and ineffective health service provision, malnutrition, lack of basic emergency skills, inadequate health infrastructure and “difficulties to access health services for severely poor and marginalised groups”.

HIV impact
Furthermore, the auditors found that the prevention of mother to child transmission (PMTCT) of HIV was gradually introduced and implemented at all health facilities visited during the period under review. Consequently, pregnant women who tested HIV positive were put on anti-retroviral treatment (ART) as per the analysed ANC registers. This helps to minimise the possibility of transmitting the virus to the unborn baby.
However, two clinics in the Kunene Region did not offer the required PMTCT.
The majority of women with unknown HIV statuses were not tested for HIV during their first ANC visits which resulted in an increase in the number of women with unknown status at delivery in juxtaposition with other regions.
During the period under review, 582 (Kunene), 206 (Khomas), 611 (Kavango East), 423 (Kavango West) and 91 (Erongo) women’s HIV statuses were unknown at the time of giving birth.
The Erongo and Khomas regions did not provide information for the 2015/16 and 2016/17 FYs despite requests from Kandjeke’s office to do so.
“For facilities that do not have HIV rapid testing kits, provision is made to take blood samples for a laboratory-based HIV testing called ELISA. In rare [cases] where pregnant women missed HIV testing during ANC or were unbooked, HIV testing is offered during labour or immediately after the baby is born,” health officials indicated.
During the period of the audit, 96% of all the women who attended ANC were tested for HIV and given their results, while at maternity wards, 94% of those presenting with unknown HIV statuses were tested for HIV during the audited period.

Safe deliviers
On the front of safe delivery of babies, it is endeavoured that a skilled attendant is present at each birth, there is expanded access to midwifery care in the community and increased access to essential obstetric care including emergency services.
Documentary evidence, however, suggests that home deliveries remain a common feature in Namibia. Kunene (920) and Kavango East (878) led the pack in terms of home deliveries during the period under review.
“Home deliveries pose a high risk to mothers and their unborn babies,” Kandjeke said.
According to the report, there were no maternal waiting homes in the Kavango East, Erongo and Khomas regions to accommodate pregnant women who were due for delivery. In actual fact, tt the time of the report’s completion, there were only six functional maternity waiting homes countrywide.
Despite the avalanche of shortcomings, the government has deployed concerted efforts to address issues related to maternal healthcare services, chief among which is the introduction of health extension workers in 2014, which includes house-to-house visits, identifying women at the early pregnancy stage and to encourage early attendance of ANC.
Added to this is the mobile outreach programmes which include ANC and PNC, conducted by the district outreach teams to cater to communities in the most remote parts of the country.
“The ministry acknowledges that home deliveries are taking place due to the challenges identified by the audit. In order to address the challenge of late [access] to health facilities and home deliveries due to limited public transport and long distances to health facilities with maternity services, the ministry is collaborating with stakeholders who are supporting provision of maternity waiting homes,” health ministry officials informed the auditors. – Nampa

Similar News

 

Namibia benefits from pharmaceutical agreements

4 days ago - 30 June 2020 | Health

Windhoek • [email protected] with a number of pharmaceutical companies will see access to 20 lifesaving cancertreatments for 26 countries in sub-Saharan Africa including Namibia.“With a...

Doctors support abortion law review

2 weeks ago - 18 June 2020 | Health

Windhoek • [email protected] prominent Namibian medical doctors have come out in support of a petition calling on Namibia to legalise abortion saying the debate is...

Yoga for hope, yoga from home

2 weeks ago - 17 June 2020 | Health

Windhoek • Dr Nikhila Hiremath The rapid changes in today’s world has opened our eyes to the importance of managing positive physical and mental health.With...

Kleintyd droom in eie besigheid verwesenlik

2 weeks ago - 16 June 2020 | Health

Windhoek • [email protected]’n Lewensondersteuningskursus het ’n 15-jarige jong man só beïndruk dat hy jare later sy eieparamedikus-onderneming op die been gebring hetMike Hawkins het in...

Thermal cameras for health ministry

2 weeks ago - 15 June 2020 | Health

The FirstRand Namibia HOPE (Health Optimisation in a Pandemic Emergency) Fund donated 15 fever screening thermal cameras valued at N$1.4 million to the ministry of...

SA hurdles cause medicine crisis

3 weeks ago - 12 June 2020 | Health

Windhoek • [email protected] work by private and government parties is underway to address a crisis that has led to depletion or severe scarcities of a...

Medical students want allowance delays resolved

3 weeks ago - 12 June 2020 | Health

Windhoek • [email protected] health ministry this week confirmed nearly all of the Namibian medicalscholarship students studying in Zambia have received their allowancesfollowing complaints of a...

Renewed call for legal abortions

3 weeks ago - 11 June 2020 | Health

Windhoek • [email protected] women and men have revived a push for government to set aside thecountry’s 45-year-old apartheid-era abortion law that was binned in South...

No safe way to smoke

1 month - 27 May 2020 | Health

Observing World No Tobacco Day on Sunday (31 May), the Cancer Association of Namibia (CAN)reaffirms their position that there is no safe way to smoke.“We...

Specialty training for African doctors

1 month - 22 May 2020 | Health

The Merck Foundation together with African First Ladies continue their strategy to provide specialty training for African doctors by providing a one-year diploma and two-year...

Latest News

Housing initiative to help need

1 day - 03 July 2020 | Local News

Windhoek • [email protected]“The lives of those living in the informal settlements in Namibia are characterized daily by whatseems to be a persuasive idea that they...

Sweet sugar deal signed

1 day - 03 July 2020 | Business

Bokomo Namibia has completed the acquisition of the sugar packaging and distribution business of Tongaat Hulett Namibia (THN), following approval by the Namibian Competition Commission...

What's hot this weekend

1 day - 02 July 2020 | Art and Entertainment

Currently running• Namibian artist Elisia Nghidishange hosts her third solo exhibition, The Insight of Intrusive Women, at the National Art Gallery until 18 July.• The...

Civil servants answer to citizens

2 days ago - 02 July 2020 | Government

Minister of home affairs, immigration, safety and security Frans Kapofi implored civil servants in his ministry to deliver service with integrity and efficiency.Speaking at the...

ICT a catalyst for economic...

2 days ago - 02 July 2020 | Opinion

Windhoek • Llewellyn le HanéNamibia seems to be on the cusp of a major technological revolution; suddenly we have apps for everything, online payment systems...

Early morning deliciousness

2 days ago - 02 July 2020 | Banking

As part of Nedbank’s stakeholder engagement, the bank’s marketing and communication team treated Namibia Media Holdings staff to a hot cup of coffee and a...

Taking a stand for freedom...

2 days ago - 02 July 2020 | Local News

Windhoek • [email protected] an effort to save Namibian women who are losing their freedom due to the criminalisation of abortion, one Namibian is taking the...

Swapo MPs choose 62-day NA...

2 days ago - 02 July 2020 | Government

An attempt by the leader of official opposition to extend the current National Assembly (NA) sitting beyond its envisaged recess date on 8 July fell...

Young Namibian authors awarded

2 days ago - 02 July 2020 | Local News

Winners in a fiction for children writing competition have been awarded, with three winning entries from Namibia.The competition took place under the auspices of the...

Load More