News24.com | Gauteng health dept was warned many times about serious nurse shortage at Rahima Moosa Hospital - ombud

Rahima Moosa Mother and Child Hospital.

• The health ombud found that several attempts were made to alert the Gauteng health department about nursing shortages at Rahima Moosa Mother and Child Hospital.
• Health ombud Professor Malegapuru Makgoba said the department had failed expectant mothers by not taking reasonable legislative measures. 
• A doctor at the hospital estimated that more than 40% of patients admitted were foreign nationals.

Over the years, several attempts had been made to alert the Gauteng health department about a "serious" nursing shortage in the maternity ward of the Rahima Moosa Mother and Child Hospital (RMMCH) in Johannesburg, the health ombud has found.

On Tuesday, health ombud Professor Malegapuru Makgoba released a report on his office's investigation into mismanagement, overcrowding and failures at RMMCH.

Makgoba said the hospital had relied on "Agency Nurses" to address needs due to the longstanding nursing staff shortage.

He said the department had failed expectant mothers by not taking reasonable legislative and other means within its available resources to achieve the realisation of the right to access healthcare services.

"The issue of overcrowding at RMMCH is a longstanding challenge," he added.

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"It also indicates that the hospital does not comply with the prescribed Regulation 8(1) of the Norms and Standards Regulations Applicable to Different Categories of Health Establishments (Norms and Standards Regulations), published on 02 February 2018, which requires health establishments to maintain an environment which minimises the risk of disease outbreaks and transmission of infection to users, healthcare personnel, and visitors.

"Overcrowding poses a high risk of disease outbreak and infection transmission not only to healthcare users but also to healthcare personnel and visitors. In the case of RMMCH, this risk would include neonates, who are at greater risk."

Shortage of space and overcrowding

The ombud launched the investigation after reports that pregnant women were sleeping on the floor, and allegations that the chief executive, Dr Nozuko Precious Mkabayi, had not been at work as expected.

Makgoba said 34 people had been interviewed between August and 29 November 2022.

Frew Gerald Benson, a doctor at RMMCH, estimated that more than 40% of patients admitted at the hospital were foreign nationals.

Benson indicated that RMMCH was still operating under the auspices of the 1996 Service Plan and could not deal with the number of patients admitted.

Dr Nomathemba Emily Mokgethi, a member of the Gauteng legislature and a former health MEC, said the issue of foreign nationals was the leading cause of overcrowding at Gauteng hospitals.

A video which went viral in April depicted pregnant women sitting on chairs and sleeping on the floors on the night of 31 March 2022 and 1 April 2022.

The ombud's probe found that this was partly due to shortage of space and overcrowding.

Mokgethi said overcrowding at RMMCH was worsened on 1 April 2022 when two Gauteng hospitals - Chris Hani Baragwanath Hospital and Charlotte Maxeke Johannesburg Academic Hospital - diverted patients to there on the day before.

Mokgethi also called for a policy change.

Dr Nomonde Nolutshungu, head of the Gauteng Department of Health, said that foreign nationals put pressure on hospitals as they were not catered for in the budget.

Department 'welcomes' report

Makgoba’s investigation found that there had never been a documented Divert Policy at RMMCH, and despite several requests during the investigative period, no document had been submitted to the ombud.

"Accordingly, the investigation found that there was no investigation report into allegations against Rahima Moosa Mother and Child Hospital (RMMCH) written Divert Policy/SOP at the time of the incident.

"Following the lodgement of the complaint and OHO intervention, an RMMCH Divert Procedure was developed and signed off on 20 June 2022," the health ombud said.

Dr Thomas Kleyenstuber, head of anaesthetics at RMMCH, indicated that the hospital’s overcrowding issue was compounded by the cancellation of elective caesarean section (C/S) cases to accommodate emergency C/S ones.

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Kleyenstuber said that the obstetric doctors had booked more elective caesarean procedures than the hospital could accommodate.

This had been corroborated by the prenatal ward supervisor, who indicated that "doctors admit patients knowing very well that there are no vacant beds", the health ombud said.

The Gauteng health department said it welcomed the report, adding that plans were being implemented in the "immediate and long-term period".