PPP maternity mess

It’s more often than not, we are bombarded with PPP disinformation, making ludicrous claims of reforming a Healthcare Sector, supposedly mismanaged by APNU+AFC. However, faced with these painful realities, we are forced to question, if the Healthcare Sector they’ve reformed, why death is forever at our doorsteps? In fact, if the Healthcare Sector they’ve reformed, why so many of our mothers are dying in childbirth?

But even as we interrogate PPP astronomical maternal deaths, the Auditor General Office, through a recent performance audit, has illuminated some of the underpinning reasons for these excruciating numbers. For this report, brought to the fore what we already know, the GPHC maternity unit and the Health Ministry as a whole, lack competent leadership, evidenced by the absence of comprehensive updated staff policies and guidelines, representing an unpardonable transgression of the Health Facility Licensing Regulations.

The fact is, GPHC management, with supposed leadership from the PPP installed government, is responsible for ensuring that all women, regardless of political affiliation or social status, experience only compassionate high-quality care. And to achieve this, comprehensive policies and guidelines should’ve been established, providing maternity staff with the necessary clinical tools, to effectively perform their duties. Where these policies, as would be expected, should’ve been periodically appraised, ensuring they are of a benchmark, consistent with the evidence-based practice of the day.

However, despite the critical role these guidelines and protocols play in clinical practice, the audit office astonishingly noted, that a comprehensive manual of administrative procedures wasn’t in place. As a matter of fact, as further highlighted in the report, the ward protocols and guidelines, constituted in the ward manual, weren’t regularly appraised and updated. Thus, as would be expected, with the absence of said manual, there is compromise in the quality-of-service GPHC delivers, translating to a deficiency in compassionate high-quality patient care.

In fact, as articulated in the report, it’s established practice that, protocols for each area within the Maternity Unit are developed by management and approved by the Medical Advisory Committee, with oversight from the Health Ministry. However, of grave concern, management has communicated that these protocols, mandated to be appraised every 3yrs, were only appraised and updated on an ad hoc basis.

Moreover, these protocols and guidelines, critical for the operation of the Maternity Unit, are integral to the delivery of safe, uptodate, compassionate and high-quality care of patients. Having said that, medicine as a science, has its evolution through research and clinical experience, mandating that our practice undergoes this necessary clinical development. For the fact is beyond doubt, that through this evolution of clinical care, the medicine practiced in the 90’s is vastly different to the medicine practiced today.

And it’s for these underpinning reasons, the absence of evidence-based guidelines and protocols, coupled with a severe shortage of maternity staff, are modifiable factors contributing to our maternal mortality registering as one of the worst, in Latin America and the Caribbean. Where the absence of these critical protocols and guidelines, mean maternity professionals in managing patients, lean on to anecdotal practises, which by their very nature aren’t evidence based.

As a matter of fact, under APNU+AFC, with superior leadership at GPHC and the Health Ministry as a whole, meant maternal mortality was evidencing a downward trajectory at 112 per 100,000 live births. However, with PPP having been installed, and the associated mismanagement at the Health Ministry, saw the exponential increase of maternal mortality at 169 per 100,000 live births. In fact, with PPP in power 27 out of the past 32yrs, means the burden for these absent guidelines and protocols, associated with the astronomical maternal deaths, has to be laid squarely at their feet.