I was concerned to see an undated notice pinned to the wall in my consultation room relating to a visit by Dr Aaron Mujajati the Chief Executive Officer and Registrar of the Health Professions Council of Zambia. I suppose this is akin to being inspected by the Care Quality Commission in the UK.
It summarised six areas in which our clinic was failing. First of all, it appears that the government health facility didn’t have an operational license (contrary to Section 36(1) of the Health Professions Act No 24 of 2009). This resulted in the clinic being charged under Section 36(2) of the same Act.
Then there was no evidence that the facility had a Dangerous Drugs Cupboard (presumably under lock and key with a register of drugs). I wasn’t surprised at this, as we don’t have any dangerous drugs. Indeed, the strongest painkiller we have is paracetamol, and we ran out of that earlier this month. But the fact remains, a health centre must have a secure box to store dangerous drugs should we be issued them.
There was criticism that most wards did not have emergency trays and most emergency drugs were out of stock. Well, we only have two wards with neither having a secure storage cupboard in which to keep an emergency tray. Even though we don’t have any emergency drugs. I thought it was a tad unfair to lay the blame at the pharmacist for not ensuring there are emergency drugs when the orders he had submitted were not filled.
Some standard operating procedure (SOPs) manuals were not available at the facility. The problem is that there are so many SOPs with nowhere to store them. The consultation room desk has a pile of SOPs a foot high. Together with the British and Zambian National Formularies, the registers for Sexually Transmitted Diseases, the inpatient record files, the referral ledger, the TB register and several others I have forgotten about, there is hardly space to leave a stethoscope.
Seriously, there was no evidence of safe drinking water at the facility. We have a borehole which pumps clean water into a water tower which supplies the neighbourhood, including the local police station. But we couldn’t produce evidence of its sterility.
Finally, we were not insisting that all patients living with HIV (and others) should take isoniazid prophylaxis (IP) to reduce the risk of tuberculosis. All staff need to be trained how to do this and we should have a committee to ensure adherence to standards. Although this is standard WHO and Zambian Ministry of Health policy, it is very unpopular among patients. Even when an excellent, non-government organisation, such as Medecins Sans Frontieres, is running a health centre in Africa, adherence to IP is problematic.
The report ended by stating that Kakumbi Rural Health Centre posed a moderate risk to patients and visitors, with a risk grading of 66.8%. Because of the clinic’s major violations of the HP Act No 24 of 2009 of the Laws of Zambia, the Registrar ordered immediate closure, pursuant to Section 50(1) of the same Act.
I’m glad I wasn’t working at Kakumbi when the Registrar did this inspection. The local populace would have been up in arms about the closure. Although we could have acquired a lockable box in which to store carbamazepine (which is classified as a dangerous drug in Zambia), sent a sample of tap water for bacteriological testing, hunted out the SOPs which were missing and labelled a tray as “emergency drugs” in each ward, that all might not be enough. I presume that getting the Ministry of Health to grant a license (sic) should be easy enough, but perhaps not when the clinic had been officially closed.
I have since heard that the official has moved to another position, in one of the hospitals which he ordered closed.