The Health Monitoring Unit (HMU) responded by conducting a monitoring exercise at this hospital with the objectives of verifying if indeed patients were dying as a result of negligence and if so to work with the hospital leadership to address any identified causes
By Dr Jackson Ojera Abusu
On July 2, The New Vision published an article titled: "Patients protest medics no show" in which it was reported that the quality of patient care in Fort Portal regional referral hospital had deteriorated to a level where local politicians could no longer tolerate it.
It was also reported that some local councilors entered the hospital in search of answers why many patients were dying in the hospital, but ended up being arrested and detained at the Police station.
These events, according to reports had further strained the already tense relations between the hospital top leadership and the district political leadership including the LC5 chairperson.
The Health Monitoring Unit (HMU) responded by conducting a monitoring exercise at this hospital with the objectives of verifying if indeed patients were dying as a result of negligence and if so to work with the hospital leadership to address any identified causes; to get the hospital and district top political leadership onto a table of dialogue to solve existing problems and to continue the previously started exercise of auditing the maternal and perinatal deaths in this hospital.
This monitoring exercise was conducted between 9th and July 9-15.
Through several engagements, the following were realised:
Arbitration: The HMU Director, Dr. Jackson Ojera Abusu chaired the meeting between the Fort portal Regional Referral Hospital Director and the Kabarole district chairman, during which most of the mutual misunderstandings were resolved.
It was realised that most of the impasse was based on rumours and false information being fed to leaders.
Without divulging details, communication channels between these officers were reopened, with the district chairman promising to provide an environment conducive for the hospital director and other hospital staffs to work in.
The hospital director also pledged to start attending some council meetings and any other meetings to which she will be invited.
It is not true that doctors and other healthcare workers in Fort Portal regional referral hospital are killing patients as was alleged and reported.
The patients that died on the fateful night and triggered the outcry from the political leadership, died due to known medical causes and the doctors and other officers on duty worked unsuccessfully to save their lives.
It had been alleged that the hospital director, influenced the transfer of healthcare workers from FPRRH and brought in her own staffs.
This is untrue. The transfers of staffs in and out of the hospital are a mandate of the MoH and the recent transfers of healthcare workers was a nationwide exercise and not limited to FPRRH. So, it could not be possible for her to influence transfers of any staffs at the time.
The following strategies have been designed to improve service delivery in the hospital as well as communication between stakeholders.
The process of procuring a private security firm has been started to address the security gaps within the hospital.
A roadmap has been drawn to monitor, supervise and strengthen the functionality of the lower health units to reduce un-necessary referral of patients to Fort portal Regional Referral Hospital.
A draft zero of the hospital communication strategy has been completed.
There will be sharing of the hospital performance reports; carrying out joint monitoring and supervision of lower health facilities; conducting joint radio programs with selected district political leaders.
Human Resource Standing in Fort Portal Regional Referral Hospital:
At Fort portal regional referral hospital, out of the 433 approved positions, a total of 308 are filled, representing a staffing level of 71%. In the recent massive transfer exercise of healthcare workers conducted by the MOH, 39 staff were transferred out of FPRRH (37 reported to their duty stations); out of the 44 staff that were transferred to FPRRH, only 27 reported.
There is still a big need for medical doctors but some of those who had expressed interest in working at this hospital were repelled by the negative media publicity the hospital was receiving. Active steps are currently underway to have more doctors and other healthcare workers recruited to bridge the existing gap and consequently improve upon the quality of the services offered.
Maternal Deaths at Fort Portal Regional Referral Hospital
Fort portal hospital has in the recent past been registering the highest number of maternal deaths among all the regional referral hospitals in the country.
In a survey conducted by HMU in the recent past, it was noted that 62 and 53 mothers died at this hospital in the calendar years 2016 and 2017 respectively. In 2018 by end of June, 27 mothers had already died.
This means that every week since January 2016 to date, a mother has been dying at this hospital due to pregnancy related causes.
It was also noted that many mothers were dying within less than 3 hours after being admitted to Fort portal regional referral hospital, implying that they delayed at their referring centers or in transit and were not salvageable at admission to the main referral hospital.
Many of these maternal deaths recorded at the referral hospital were coming from the districts of Kyenjojo, Kamwenge and Kabarole itself, with a few from Kyegegwa, Bundibugyo and Kagadi districts.
There is an ongoing monitoring exercise to assess the factors that are negatively affecting maternal health in these districts with the resultant maternal (and perinatal) mortalities and morbidities, and the leadership of Fort Portal regional referral hospital has made it a top priority.
A general upward trend in the number of maternal deaths has been recorded with the number of deaths in 2016 exceeding four times that of 2012.
This trend could be attributed to several factors one of which has been a general increase in the size of the catchment population that has followed the increasing number of refugees from the neighboring countries and are settled in the Rwenzori region.
Generally, the factors that contribute to maternal deaths (the three stages of delay) are well documented and all are at play in the case of FPRRH as was reflected in some of the maternal death review meeting findings.
Maternal deaths at this hospital are still alarmingly high and it is going to take special interest and efforts of all the concerned parties to address the problem.
The hospital leadership and district leadership must work together to deliver quality healthcare services to the people. A good working relationship has since been re-established and services are being delivered to the people.
The challenges affecting the hospital are varied and not unique or new; the hospital and district leadership have the capability to address most of them.
Healthcare workers in Fort portal regional referral hospital have never intended to harm or kill patients as was alleged. In fact, they are working hard to take care of large patient load even while the hospital is understaffed.
To address the high maternal (and perinatal) mortality rate in FPRRH and the region, different stakeholders have to purposefully and quickly engage and address all the identified challenges. The leadership of FPRRH has made this a top priority
The Health Monitoring Unit will continue to support health sector to address existing challenges and engage in processes that will improve the quality of healthcare services offered to Ugandans.
For God and My Country.
Dr. Jackson Ojera Abusu, Director, Health Monitoring U