Absentee doctors blamed for high maternal death rates
Monday 2 July 2018
HIGH death rates among women giving birth in developing countries can be partly blamed on the number of doctors not showing up to work, according to a University of Salford academic.
Professor HelenLouise Ackers, who has spent the last decade working on projects to improvehealthcare in Uganda as part of the University’s Knowledge For Change (K4C)charity, says absenteeism rates are a major problem in the country.
Writing in the British Medical Journal Opinion blog, she cites research she has carried out with colleagues James Ackers-Johnson, K4C Project Manager at the University of Salford, and Robert Ssekitoleko, research fellow at Makerere University in Kampala.
Professor Ackers, chair in social policy at the University of Salford, writes: “Published figures are hard to come by and would undoubtedly underestimate the level of absenteeism.
“However, our own research findings show that on a typical day in Ugandan public health centres,it is not unusual for no doctors to be present for work. This has led to a total breakdown in referral systems and highly congested referral hospitals where women are treated by intern doctors and students, usually with no supervision. This problem is as acute in urban and rural areas.”
She goes on to write that senior managers in Uganda have told her they estimate that, on an average day, they expect a generic health worker absenteeism rate of about 60–85 per cent.
Undermining foreign aid efforts
And although all health workers in the African country are poorly paid, those who have the lowest pay rates – nurses and midwives – turn up far more regularly than much more senior doctors.
This undermines much of the aid work provided by the UK, as British doctors – deployed through K4C and similar programmes – are unable to offer their clinical expertise if their Ugandan counterparts are absent.
She suggests these high absenteeism rates are one of the reasons why progress on reducing maternity mortality rates in the country remains ‘stagnant’ despite substantial on-going international investment.
Dangerous country to give birth
While the World Health Organisation (WHO) indicates a mortality rate of 343 deaths per 100,000 live births, her own analysis shows much higher levels of 1,000 deaths per 100,000 – making Uganda one of the most dangerous countries in which to give birth.
Prof Ackers says the crisis in maternal health in Uganda, as in many other low to middle income countries, is fundamentally a human resource management crisis, and the domination of global health agendas by the medical profession is one reason why this has never been addressed.
The failure of doctors to present themselves for work is one of the primary causes of maternal mortality in Uganda
She writes:“Doctors are nurtured and embedded in a medicalised culture that significantly restricts their ability to ‘see’ and really comprehend systems failures. They are, necessarily, trained to hone in on clinical causes.
“Our research suggests that the failure of doctors to present themselves for work is one of the primary causes of maternal mortality in Uganda.
“UKAid interventions should focus on providing support with and enforcement of effective human resource management and accountability systems as anon-negotiable conditionality principle. This can only be achieved through more genuinely democratic, multi-professional, and multi-disciplinary team-working.”
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