Maternal healthcare fails dismally
Namibia fails to reach Millennium Challenge Goals
16 April 2020 | Health
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.
“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”.
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.
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