Municipal community obstetrics in a developing country.

Abstract

In 1971 the maternity care delivery system in Salisbury, Zimbabwe was reorganized. Prior to that time, all maternity services were provided by the Harare Maternity Hospital but the facility was not able to adequately meet the needs of the community. In 1970 the problem was studied and a design for a new system was adopted. This system was described and the system's service statistics for 1973-1977 were provided. Under the new system 7 minicipal maternity units were established in different parts of the city. These units provide prenatal, delivery, and postnatal care for all low risk pregnancy cases in the community. The units are staffed by 3 sisters trained in general nursing and midwifery, 6 midwifery assistants, and 3 maids. Patients at these units receive highly personalized services. Pregnant women in the community initially present at the municipal unit in their area. The patient is screened and if judged to be a high risk case the patient is transferred on to the Harare Maternity Hospital. Efforts are made to promote cooperation between the personnel in the units and the personnel at the hospital and to provide continuing education for personnel at all levels. The system is functioning well and both the patients and the service providers are satisfied with the new arrangement. In 1977, 8949 deliveries were performed at the hospital and 9386 at the municipal units. The stillbirth rate/1000 live births was 54.5 among hospital patients and 2.0 among municipal unit patients. The perinatal mortality rate/1000 live births was 88.6 among hospital delivered infants and 6.1 among municipal unit delivered infants. Prenatal clinic attendances increased from 61,758 in 1973 to 113,899 in 1977.