Council mulls closing four clinics

THE Bulawayo City Council (BCC) is considering closing four of its clinics as the staffing situation within its health services department continues to deteriorate.

Last year, the local authority reported that it was considering approaching the Government to get a fresh mandate to employ more nurses with reports that the establishment was operating with a shortfall of 134 nurses, a situation that has hampered health delivery in the city.

In a report on the state of the city's health services department, the director of health services, Dr Edwin Sibanda, said the local authority was working with an establishment of 43,9 percent of nursing personnel meaning there was a shortage of 56,1 percent this thereby negatively affecting the city's health delivery services.

He said the situation has further been compounded by the resignation of four sisters in charge and two community health sisters resulting in a severe management gap at the clinics.

"Resignations of four sisters in charge and two community health sisters have resulted in a severe management gap at the clinics. The lack of such front line managers may lead to a lot of inefficiencies and lack of accountability and continuity. The severe staff shortage in this period when there is increased work burden and responsibility may lead to reduced quality of care, mitigation against Council by the community and staff burnout," reads Dr Sibanda's report.

The local authority noted that with the continued shortages being experienced with the health services department there was a need to either employ or close four clinics and spread the nurses to the other clinics.

"Covid-19 vaccinations have resulted in further shortage as Community Health sisters were allocated outreach vaccination sites with three nurses per site. All clinics are also vaccination sites and three nurses are expected to vaccinate for Covid-19. Nurses also make up part of the Rapid Response Team.

"The department humbly requests replacement of Sisters in charge and Community Health sisters and employ the Registered General Nurses to man the clinics professionally. If there is no solution to the recruitment, the other proposal would be close four clinics and pull nursing staff on the ground to the few clinics where they can effectively perform the required duties," said Dr Sibanda.

It was further revealed that the four maternity centres – Nkulumane, Luveve, Pelandaba and Northern Suburbs – of the required 131 nurses had only 59 meaning they are operating with a staff establishment of 45 percent while the non-maternity centres with 85 out of the required 199, were operating with an establishment of 42,7 percent.

"Maternity Centres should have four shifts. These shifts should have a minimum of four nurses each to ensure adequate staff coverage so that midwives do not leave a woman in labour unattended. One nurse in the first stage room, the delivery should be attended by at least two midwives and post-natal ward one nurse.

"In the first stage of labour observations are done every 30 minutes and a midwife cannot attend to more than three patients in labour as the midwife has to monitor and record those observations. It is therefore required that two midwives be in attendance in the first stage labour room as per midwifery practice regulations as there would be six-10 beds in the first stage room," reads the report.

"If there is a patient in labour and infected with Covid-19 midwives taking care of a patient with an infectious disease should not be exposed for more than six hours. The proper four shift duties need 20 midwives to man the maternity side of the clinic and 15 to work in the Outpatient side. The continued Covid-19 pandemic has also resulted in more pressure to the already severely under staffed facilities who are at less than 50 percent of the establishment," said Dr Sibanda.

Regarding non-maternity centres, Dr Sibanda said of the 42,7 percent staff they had, 40,9 percent was covered by locum nurses. A locum nurse is essentially a temporary nurse, who covers the duties of another nurse.

"For a non-maternity clinic to run efficiently, there should be a minimum of 14 nurses. Each work station should have one nurse doing antenatal care, one nurse doing post-natal care, two nurses doing EPI and one nurse treating TB patients.

"Two nurses should be providing Opportunistic Clinic/Anti-Retroviral Therapy (OI/ART) services, two nurses consulting sick patients, one nurse dispensing medicines and two nurses doing Visual inspection with acetic acid and cervicography in some centres. Leave should also be planned for.

"Thorngrove hospital TB wards need to have a four shift duty roster like maternity centres with two nurses manning each of the two wards per shift," said Dr Sibanda.