A public outcry on the deficiencies of Princess Marina Hospital’s capacity to handle high risk patients has been validated by a report titled ‘Quality Improvement Initiatives at the facility’ compiled by Dr Tjeza Matenge.
The report which has been anticipated for some time, was comparing the “ideal Princess Marina Hospital to the current state of the hospital”. This study depicts a deep-seated problem in Botswana’s flagship hospital, a situation which calls on government to make amends if the health care system is to offer meticulous health services to the citizens.
For some time the hospital has been under scrutiny with the numbers of negligence and mortality cases increasing. The ever increasing cases of negligence at Princess Marina have earned the hospital a bad reputation, with some expressing misgivings about its inability to deal with most common diseases. This week at the hospital’s Pitso addressed by stakeholders including the minister of Health and Wellness, councilors and health experts, a new damning report was released. The main aim of the meeting was to deliberate on solutions to overcrowding, referral system, shortage of medicines, health system shortfalls, maintenance of facilities and staff burnout among others.
At the very top in the report is the congestion issue at the hospital’s maternity ward. This is caused by added beds, floor beds with patients in labour pains sitting on chairs. This has contributed to morbidity and mortality incident reports. The report further highlighted that there is fatigue and burnout from the staff which leads to poor monitoring and more mistakes that end up compromising people’s health. “Hygiene is also compromised and transmission of nosocomial infections,” the report states.
The congestion is said to be caused by “low midwife numbers, low bed capacity yet high number of deliveries and congestion of hospital’s wards. Less transfer to clinics and less number of deliveries by District Health Management Team (DHMT) clinics despite higher number of midwives and beds are other factors contributing to crowding”. Transport and poor communication, confusion of staff regarding discharge status of patients referred to clinics are also hinted as additional causes of the anomaly.
“Ante Natal Ward’s Ideal bed capacity is 30 but now it has 18 additional beds which make the total to 48. On average, four patients in labour pains idle on chairs daily,” said the report. “The post-natal ward ideal bed is 52, with 22 additional beds and 18 floor beds making the total to 92. These are some of the factors that lead to high mortality rates as personnel – patients’ ratio is unbalanced,” added Matenge.
Marina, according to the research paper, has a total of 75 midwives. On average, the midwife-patient ratio at the hospital’s Ante Natal Ward is 1:12; in labour ward 1:4 and in Post Natal Ward is 1:23. Ideal nurse patient ratio in a general ward should be 1:8 according to Dr Matenge. On the other hand the Australian nursing and midwifery federation recommends 1:4 in a medical or surgical ward and 1:3 in specialized nursing areas like delivery suites, emergency departments because of high acuity.
On average Marina records 576 deliveries monthly while primigravida (first time mothers) is 129 on monthly average. While the short-term interventions continue to get intensified, the hospital wants long-term definitive strategies to be put in place. “To have the capacity of the building (Marina hospital) expanded,” one recommendation says. “We should have an MOU (midwife-obstetric unit) for greater Gaborone which admits intermediate risk patients only, such that Marina admits only high risk patients,” reads the report under recommendations.
Currently Marina admits both intermediate and high risk patients. It is said, this could take one of the clinics to be converted into an obstetrics primary clinic with theatre facilities or a new building altogether. The clinic could even become an obstetric center of excellence and can be run by family physicians and midwives.
The report recommends units like Marina which are delivering more than 6000 per annum, should aim to reach full consultant obstetric presence (168 hour cover per week). It was further said a “24 hour consultant obstetrician based should always be in the labour ward. The consultant obstetrician should be backed by 2-3 specialist trainees 4 of which our equivalent is medical officers.”
Former Umbrella for Democratic Change (UDC) Member of Parliament for Gaborone North, Haskins Nkaigwa has confirmed his departure from opposition fold to re-join the ruling Botswana Democratic Party (BDP).
Nkaigwa said opposition is extremely divided and the leadership not in talking terms. “They are planning evil against each other. Nothing much will be achieved,” Nkaigwa told WeekendPost.
“I believe my time in the opposition has come to an end. It’s time to be of value to rebuilding our nation and economy of the country. Remember the BDP is where I started my political journey. It is home,” he said.
“Despite all challenges currently facing the world, President Masisi will be far with his promises to Batswana. A leader always have the interest of the people at heart despite how some decisions may look to be unpopular with the people.
“I have faith and full confidence in President Dr Masisi leadership. We shall overcome as party and nation the current challenges bedevilling nations. BDP will emerge stronger. President Masisi will always have my backing.”
Nkaigwa served as opposition legislator between 2014-2019 representing Botswana Movement for Democracy (BMD) under UDC banner. He joined BMD in 2011 at the height public servant strike whilst Gaborone City Deputy Mayor. He eventually rose to become the mayor same year, after BDP lost majority in the GCC.
Nkaigwa had been a member of Botswana National Front (BNF), having joined from Alliance for Progressives (AP) in 2019.
Botswana has received assistance worth over P100 million from Japanese government since 2019, making the latter of the largest donors to Botswana in recent years.
The assistance include relatively large-scale grant aid programmes such as the COVID-19 programme (to provide medical equipment; P34 million), the digital terrestrial television programme (to distribute receivers to the underprivileged, P17 million), the agriculture promotion programme (to provide agricultural machinery and equipment, P53million).
“As 2020 was a particularly difficult year, where COVID-19 hit Botswana’s economy and society hard, Japan felt the need to assist Botswana as our friend,” said Japan’s new Ambassador to Botswana, Hoshiyama Takashi.
“It is for this reason that grants of over P100 million were awarded to Botswana for the above mentioned projects.”
Japan is now the world’s fourth highest ranking donor country in terms of Official Development Assistance (ODA).
From 1991 to 2000, Japan continued as the top donor country in the world and contributed to Asia’s miracle economic development.
From 1993 onwards, the TICAD process commenced through Japan’s initiative as stated earlier. Japan’s main contribution has been in the form of Yen Loans, which are at a concessional rate, to suit large scale infrastructure construction.
“In Botswana, only a few projects have been implemented using the Yen Loan such as the Morupule “A” Power Station Rehabilitation and Pollution Abatement in 1986, the Railway Rolling Stock Increase Project in 1987, the Trans-Kalahari Road Construction Project in 1991, the North-South Carrier Water Project in 1995 and the Kazungula Bridge Construction Project in 2012,” said Ambassador Hoshiyama.
“In terms of grant aid and technical assistance, Japan has various aid schemes including development survey and master planning, expert dispatch to recipient countries, expert training in Japan, scholarships, small scale grass-roots program, culture-related assistance, aid through international organizations and so on.”
In 1993, Japan launched Tokyo International Conference on African Development (TICAD) to promote Africa’s development, peace and security, through the strengthening of relations in multilateral cooperation and partnership.
TICAD discuss development issues across Africa and, at the same time, present “aid menus” to African countries provided by Japan and the main aid-related international organizations, United Nations (UN), United Nations Development Programme (UNDP) and the World Bank.
“As TICAD provides vision and guidance, it is up to each African country to take ownership and to implement her own development following TICAD polices and make use of the programmes shown in the aid menus,” Ambassordor Hoshiyama noted.
“This would include using ODA loans for quality infrastructure, suited to the country’s own nation-building needs. It is my fervent hope that Botswana will take full advantage of the TICAD process.”
Since then, seven conferences where held, the latest, TICAD 7 being in 2019 at Yokohama. TICAD 7’s agenda on African development focused on three pillars, among them the first pillar being “Accelerating economic transformation and improving business environment through innovation and private sector engagement”.
“Yes, private investment is very important, while public investment through ODA (Official Development Assistance) still plays an indispensable role in development,” the Japanese Ambassador said.
“For further economic development in Africa, Japan recognizes that strengthening regional connectivity and integration through investment in quality infrastructure is key.”
Japan has emphasized the following; effective implementation of economic corridors such as the East Africa Northern Corridor, Nacala Corridor and West Africa Growth Ring; Quality infrastructure investment in line with the G20 Principles for Quality Infrastructure Investment should be promoted by co-financing or cooperation through the African Development Bank (AfDB) and Japan.
Japan also emphasized the establishment of mechanisms to encourage private investment and to improve the business environment.
According to the statistics issued by Japan’s Finance Ministry, Japan invested approximately 10 billion US dollars in Africa after TICAD 7 (2019) to year end 2020, but Japanese investment through third countries are not included in this figure.
“With the other points factored in, the figure isn’t established yet,” Ambassador Hoshiyama said.
The next conference, TICAD 8 will be held in Tunisia in 2022. This will be the second TICAD summit to be held on the African continent after TICAD 6 which was held in Nairobi, Kenya, in 2016.
According to Ambassador Hoshiyama, in preparation for TICAD 8, the TICAD ministerial meeting will be held in Tokyo this year. The agenda to be discussed during TICAD 8 has not yet been fully deliberated on amongst TICAD Co-organizers (Japan, UN, UNDP, the World Bank and AU).
“Though not officially concluded, given the world situation caused by COVID-19, I believe that TICAD 8 will highlight health and medical issues including the promotion of a Universal Health Coverage (UHC),” said Hoshiyama.
“As the African economy has seriously taken a knock by COVID-19, economic issues, including debt, could be an item for serious discussion.”
The promotion of business is expected to be one of the most important topics. Japan and its partners, together with the business sector, will work closely to help revitalize private investment in Africa.
“All in all, the follow-up of the various programs that were committed by the Co-Organizers during the Yokohama Plan of Actions 2019 will also be reviewed as an important item of the agenda,” Ambassador Hoshiyama said.
“I believe that this TICAD follow-up mechanism has secured transparency and accountability as well as effective implementation of agreed actions by all parties. The guiding principle of TICAD is African ownership and international partnership.”
Directorate on Intelligence Services (DIS) Director General, Brigadier Peter Magosi is said to be hell-bent and pushing President Mokgweetsi Masisi to reshuffle his cabinet as a matter of urgency since a number of his ministers are conflicted.
The request by Magosi comes at a time when time is ticking on his contract which is awaiting renewal from Masisi.
This publication learns that Magosi is unshaken by the development and continues to wield power despite uncertainty hovering around his contractual renewal.