The JC Coetzee Memorial Lecture : Maternal Health in Primary Care: are we Providing Safe Maternity Units?

ABSTRACT

The Service Level Agreement of the Minister of Health provides; as one of its aims; to reduce the number of deaths of pregnant women and their babies. Over 60 of the births in South Africa; one third of all maternal deaths; and 62 of the perinatal deaths; occur at the prilevel of care. The numbers are far too high for a service which is supposed to cater to low-risk maternity cases. The Lives Saved Tool is a programme which can model the potential number of lives that can be saved depending on the pattern of disease; interventions used and coverage of these interventions. This tool has been used to select which interventions would be most effective in reducing maternal and perinatal mortality. If the effects of human immunodeficiency virus are excluded; the intervention that would save the most lives would be that of improving maternal and neonatal emergency care. A survey was conducted on the ability of healthcare facilities in 12 districts to provide essential emergency care services to pregnant women and their babies. It was found that the vast majority of the community healthcare facilities could not provide the seven lifesaving services needed for basic emergency obstetric care; and less than half of the district hospitals could provide the nine life-saving services required for comprehensive emergency obstetric care. Lack of knowledgeable and skilled staff; inadequate equipment and human resources; as well as poor emergency transport services at the sites are the main reasons for these unsafe maternity units. Realignment of the services might improve the ability of the districts to provide a safe maternity service