AIM. To assess the functionality of healthcare facilities with respect to providing the signal functions of basic and comprehensive emergency
obstetric care in 12 districts.
SETTING. Twelve districts were selected from the 52 districts in South Africa, based on the number of maternal deaths, the institutional
maternal mortality ratio and the stillbirth rate for the district.
METHODS. All community health centres (CHCs) and district, regional and tertiary hospitals were visited and detailed information was
obtained on the ability of the facility to perform the basic (BEmONC) and comprehensive (CEmONC) emergency obstetric and neonatal
care signal functions.
RESULTS. Fifty-three CHCs, 63 district hospitals (DHs), 13 regional hospitals and 4 tertiary hospitals were assessed. None of the CHCs
could perform all seven BEmONC signal functions; the majority could not give parenteral antibiotics (68%), perform manual removal of
the placenta (58%), do an assisted delivery (98%) or perform manual vacuum aspiration of the uterus in a woman with an uncomplicated
incomplete miscarriage (96%). Seventeen per cent of CHCs could not bag-and-mask ventilate a neonate. Less than half (48%) of the DHs
could perform all nine CEmONC signal functions (81% could perform eight of the nine functions), 24% could not perform caesarean
sections, and 30% could not perform assisted deliveries.
CONCLUSIONS. The ability of the CHCs and district hospitals to perform the signal functions (lifesaving services) of basic and comprehensive
emergency obstetric care was poor in many of the districts studied. This implies that safe maternity care was not consistently available at
many facilities conducting births.