North West Province is the sixth most populous province. The population lives mainly in a rural setting. There are no level 3 hospitals in the province and patients are referred to Gauteng when they require tertiary services.
A number of problems were experienced with the collection and assessment of maternal deaths in the province. Reporting of deaths was poor from a number of institutions. Strenuous efforts were made by the MCWH unit to correct this by holding workshops and visiting health institutions to inform all health workers about the maternal death notification process. The effect of this can be seen by improved reporting in the second half of the year. Unfortunately, there was also a problem in communication between the MCWH unit, the assessor and the NCCEMD office. This resulted in 58 deaths being reported but the NCCEMD only receiving 26 by the time the data was analysed for this report. For this reason the pattern of disease shown in Table 12f.1 must be viewed with caution.
Due to the low numbers assessed, data regarding avoidable factors, missed opportunities and substandard care could not be assessed.
The people of North West live in mainly rural settings; hence the problems experienced by the province are likely to be similar to those experienced by the Eastern Cape, Mpumalanga and KwaZulu-Natal. Their recommendations of requiring guidelines and protocols, referral routes and criteria for referral and a skills and human resources audit would most likely apply to North West as well.
The links with the NCCEMD and problems with assessing cases has been solved. Reporting for 1999 is progressing well.