Referral hospitals stretched beyond limits

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Kuzeeko Tjitemisa

Windhoek-The Ministry of Health and Social Services says it is finding it difficult to keep the sick away from hospitals, despite advice by the auditor general (AG) Junias Kandjeke to avoid admission of patients beyond ward capacity.

This is contained in the latest audit report of the ministry’s activities of the 2012/13, 2013/14 and 2014/15 financial years submitted to the National Assembly on Tuesday.
According to the report, through observations and interviews conducted at healthy facilities it was found that hospital wards were admitting more patients than bed capacity, and at times patients were accommodated on floors, corridors, in storerooms and in cafeterias.

This problem was mostly experienced at wards dealing with medical emergencies, maternity, surgical and paediatric health, while admission in other wards were within bed capacity most of the time.

“The mixture of patients with different illness and an unconducive health environment could affect their health condition and also result in poor health services,” he said.

Kandjeke suggested that to ensure efficient service delivery the ministry should avoid the admission of patients in wards beyond their capacity as it has an overall negative effect on the health condition of all patients in the same ward.

But the ministry responded by saying this is unavoidable due to insufficient capacity in district hospitals in terms of infrastructure and human resource skills.

The ministry says it is making progress in restructuring and training to improve the situation in districts, which will alleviate pressure on referral hospitals.

Furthermore, the ministry said the outreach programme is bringing much relief through reducing referrals.

Kandjeke further recommended the ministry consider the distance between health facilities and the catchment population when allocating vehicles to different health centres and clinics.

He said the regions have been faced with shortages of fully equipped ambulances and drivers at health facilities.

He said some ambulances are not in good running condition as their mileages are very high and they frequently break down, and as a result pickups (bakkies) were also allocated to health facilities to transport patients.

Interviews and documents, he said, further reveal that Oshakati hospital is experiencing a shortage of fully equipped ambulances especially for long distance referrals to Windhoek, and wishes to have more fully equipped ambulances with carrying capacity for at least two patients.

Kandjeke says auditors’ analysis from the various vehicle reports on mileages and conditions from health facilities indicate there are three ambulances at Katutura hospital with the highest kilometres reading of 349,795 and lowest reading at 135,354; three ambulances in Khomas Region, five in Otjozondjupa Region with the highest kilometres reading at 695,661 and lowest reading at 8,313, and six in Oshana Region.

According to Kandjeke, documents reviewed of health facilities situated in remote areas, especially in Okakarara and Grootfontein districts in the Otjozondjupa Region, indicated the facilities have been allocated transport because of the long distances served by vehicles from district hospitals.

He said other clinics that are near to district centres were not allocated vehicles, therefore they call the district centres in case they need to refer a patient.

“Interviews further revealed that ambulances from the district hospitals take many hours in cases of emergency,” he said, adding that the reason given was that sometimes there were no drivers, or ambulances had gone to other health facilities.

Kandjeke said the current structures did not make provision for positions of drivers at some clinics, therefore it was not possible to allocate vehicles to such facilities.

The health ministry said it appreciates the AG’s advice on the matter, however the ministry’s standard procedure is that requests for vehicles, including ambulances, are received from regions and hospitals that are on the ground and are not determined at the head office.

“A request is sent to the stakeholders annually to indicate their needs. Based on their inputs vehicles, including ambulances, are allocated and distributed but not all needs may be catered for in a particular financial year,” said the ministry.

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