Hospitals In Crisis: Women Give Birth On The Floor

According to UNICEF, Togo has an infant mortality rate of 43 deaths per 1000 live births and a neonatal mortality rate of 24 deaths per 1000 live births, which refers to infants who pass away before they turn 28 days old. In Togo, there are 399 maternal deaths for every 100,000 live births, which is a high rate.

In February and March 2023, news source delegates interviewed 21 people, including 13 patients, four midwives, and four doctors, at five public healthcare facilities in Lomé, the nation’s capital, and Aného, a town in southeast Togo. 

News source delegates observed a lack of staff, outdated equipment, and subpar care in the majority of healthcare facilities.

Article 12 of the African Charter on Human and Peoples’ Rights, Article 16 of the International Covenant on Economic, Social, and Cultural Rights, Article 14 of its Additional Protocol on the Rights of Women, and Article 16 of the Togolese Constitution all guarantee the right to health. Every pregnant woman in Togo has the legal right to “good pregnancy monitoring, safe childbirth, and postnatal care for herself and her child,” according to Article 97 of the country’s Health Code.

Lack of personnel and subpar medical equipment

The maternity units visited lacked sanitary facilities, adequate equipment, and enough staff. The few midwives who were employed consequently struggled to handle their heavy workloads. According to three midwives, on-call duty frequently lasts longer than 15 hours. For every 10,000 people in Togo, there are only two midwives, according to the United Nations Population Fund.

According to a member of the Togo Association of Midwives, the lack of regular examinations for entry into the public service makes it difficult to hire recent graduates of midwifery schools, which contributes to the shortage of midwives. Additionally, there aren’t many gynecologists in public hospitals.

We found in the report presented by a reputed news source that gynecologists are frequently worn out. The report said that they participate in consultations, surgical procedures, challenging deliveries, etc. Gynecologists are therefore uncommon in the public sector. They enter the private sector in an effort to recover their investment. For instance, the public hospital in Bè has just two. Some [public hospitals] lack gynecologists but have operating rooms.

Only 25 of the 127 gynecologists registered with the Togolese National Medical Association work in public hospitals, according to the Secretary General of the National Union of Hospital Practitioners of Togo, who posted the statistic on social media.

Additionally, none of the maternity units we visited had the fundamental tools required to welcome patients or administer care. The antenatal consultation room in one of the Socio-Medical Centres (CMS) in Lomé had deteriorated exam tables, and midwives were forced to conduct consultations using torches from their mobile phones due to a lack of surgical lamps.

One CMS midwife reported that there was only one delivery table available and that other tools like resuscitation balloons, mucus aspirators, and episiotomy scissors were either broken or in short supply.

Another medical facility visited was Sylvanius Olympio University Hospital, where a midwife stated: “You can see women giving birth on the floor, on mattresses, and sometimes even just on a piece of cloth when there is no mattress. There are brand-new delivery tables as well as rusted-out, moldy older models. ”

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Poor patient-staff relationships

The standard of care provided to patients during prenatal appointments and childbirth has also been negatively impacted by the shortages of staff and equipment.

“In pediatrics, there isn’t always room for a mother to bring her child,” one patient complained in the report. A chair was a necessity. Women are occasionally made to stand with their kids.

Patient-staff relations have suffered as a result of poor working conditions. Many patients told news sources that staff had verbally harassed or degraded them.

Additionally, midwives told news sources that patients or their relatives frequently threaten them verbally and occasionally physically.

Affordable healthcare is available

The Togolese government improved women’s access to maternal healthcare services in August 2021 by launching the “Wezou” (life) national support program for expectant mothers and new parents. This program’s goal is to “reduce maternal and neonatal mortality rates” by enabling women to access maternal healthcare services at a reduced cost.

The program was highly visible in the five maternity units that were visited, according to news sources, and several patients claimed to have benefited from it.

However, official websites stated that the program would offer “free care for pregnant women” prior to Wezou’s launch. In reality, only some services—and only for women over the age of 18—are provided without charge. The Wezou plan does not include antibiotics, which are frequently needed after childbirth.

The Wezou initiative is a significant step in the right direction, but there is still room for improvement. The Togolese government is being urged by news sources to respect, safeguard, and uphold the right to health by providing patients with a sufficient supply of qualified medical personnel. In accordance with the commitments made in the Abuja Declaration, which the African Union adopted in 2001, they should also make sure that programs designed to make healthcare more affordable are accessible to all people, without discrimination, and allocate at least 15% of the State budget to the health sector.