The National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) of South Africa published its first report in April 1988 (the First Interim Report on Confidential Enquiries into Maternal Deaths in South Africa). This report "Saving Mothers" is a more in-depth analysis of all maternal deaths for the period 1998. Although there are weaknesses in the reporting and the number of deaths may be an under estimate, the number of maternal deaths are large enough to show trends and for the chapter-writers to evaluate avoidable factors, missed opportunities and substandard care. Thus the recommendations suggested are based on clinical data assessed by maternity services experts. The latter comprised of equal numbers of midwives and doctors and their distribution in all provinces was equally good. All assessors were helped initially, through the process of assessment of maternal deaths by members of the NCCEMD who had had extensive experience in auditing. All assessments of maternal deaths were done on a Provincial basis. Recommendations outlined in this report were discussed at a National Assessors Meeting in June 1998, at which the NCCEMD, all Provincial Assessors and the Co-ordinators of Provincial MCWH units were present (Appendix 2). Consensus was reached on all the Key Recommendations. It is believed that if the recommendations are implemented, there will be a substantial decrease in maternal deaths in South Africa.
The challenge for the next few years is to implement these recommendations. The recommendations have taken into account the present unique circumstances that face the health services of our country. The NCCEMD, however, believes the recommendations are practical and will help all health professionals to improve maternity services and reduce maternal deaths for the women they serve.
Further, we obviously can improve the workings of the NCCEMD in the coming years, by notifying all deaths. It must be stressed that all maternal deaths are notifiable by law. Although we have had deaths reported from private institutions and "at home", the NCCEMD believes these are an underestimate. Practical mechanisms to improve this reporting are being implemented. Information is being provided to the general public through the mass media and to private hospital organisations. So called "verbal autopsies" have their drawbacks and a number of South African studies on this technique, highlight shortcomings of this approach. This will need more thought. An aspect where health professionals are poor, is in the proper documentation of clinical details. A strong plea is made to all health professionals to help in providing appropriate information in the case notes / bed letters of patients. Health professional education and training institutions are requested to place more emphasis on this aspect of professional development and to stress the medico-legal implications of note keeping.
Finally, we would like to thank all those who have contributed to the deliberations of the NCCEMD and to the formulation of this report.
Jack Moodley
Chairman: NCCEMD
Editor's Note
This report contains an enormous amount of information and may be considered top-heavy with respect to tables and data. Providing as much data as possible was a deliberate policy of the report. Data pertaining to this report were destroyed once the Minister of Health accepted the report, as is the policy of the NCCEMD. Hence the only reference point remains this report.
This report will be electronically published. The internet address will be advertised as soon as it is available. Once information regarding the key recommendations becomes available, e.g. the guidelines relating to managing hypertension in pregnancy, these will be published on the Internet as an addendum to this report. We hope this will make the
report and progress related to implementing the recommendations available to everyone.
Bob Pattinson
Editor