Midwives shortage hits Bulawayo

BULAWAYO is facing a critical shortage of midwives at council-run clinics which has seen maternity centres operate with just half of the needed staff, putting pregnant women and unborn babies at risk.

The shortage has also been worsened by recent resignations received by the local authority and the outbreak of Covid-19 as some staff members are now in charge of rolling out the vaccine.

Statistics from recent council minutes show that there are only 59 midwives, nurses and other healthcare staff at council maternity centres instead of 139 according to the staff establishment.

Crippled maternity services in councils often mount pressure on central hospitals who then have to deal with more pregnant women leading to crowding in wards.

Shortages of skilled personnel has also been linked to the high maternal mortality rate in the country which is the fifth highest in the region.

A United Nations report issued last year titled, ‘‘Maternal Mortality in Zimbabwe: Evidence, Costs and Implications,'' indicated that Zimbabwe's fight to lower maternal mortality rate was failing due to growing social inequalities, Aids and lack of access to emergency professional medical, as well as surgical care for pregnant women with a special focus on the delivery and immediate after delivery period.

Bulawayo's has four maternity centres at council-run council clinics in Pelandaba, Nkulumane, Luveve and North End.

Ideally, maternity centres should have four shifts consisting of morning shift from 7.30am-4pm, afternoon shift from 1pm- 7.30pm, and night shift from 7.30pm-7.30am.

These shifts according to the council should have a minimum of four nurses each to ensure adequate staff coverage so that midwives do not leave a woman in labour unattended.

The delivery should be attended by at least two midwives and a nurse while in the post-natal ward, one nurse is needed every time.

In his report, director of health services Dr Edwin Sibanda said council was in need of more midwives and nurses so that the current healthcare workers can cope with the workload.

He said 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 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. Currently, the situation is that there are three shifts instead of four and two to three midwives on duty for 12 hours to do all the duties," said Dr Sibanda.

"Patients in labour are supposed to be accompanied to the referral hospital and when one nurse accompanies the patient, only one remains looking after the patients in the first stage, delivery room and post-natal ward, exposing the patients to danger."

He said 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.

He added that non-maternity centres are also severely short staffed with 42,7 percent of staff establishment.

"Workload has increased with programmes being added on since the establishment was done. For a non-maternity clinic to run efficiently, there should be a minimum of 14 nurses. Covid-19 vaccinations have resulted in further shortage as Community Health sisters were allocated outreach vaccination sites with three nurses per site," said Dr Sibanda.

He also said all clinics are also vaccination sites and tree nurses are expected to vaccinate for Covid-19 which then cripples other services as there are shortages.

Dr Sibanda's report shows that nurses also make up part of the Rapid Response Team which are responsible for the prevention and management of Covid-19 cases in Bulawayo.

"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.

"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 to close four clinics and pull nursing staff on the ground to the few clinics where they can effectively perform the required duties," he said.