Supervision of Peripheral Obstetric Units

Overall quality of obstetric care in developing countries depends on the quality of care at a number of levels. The doctor must involve himself in the supervision of every peripheral unit that refers to the base hospital if he is to be succesful in providing the highest quality of care possible. Early diagnosis and correct assessment at the periphery makes for early and less expensive treatment. When planning the supervision of peripheral units, 2 important mistakes must be avoided. The 1st is to delegate supervision to the newest and most inexperienced member of the obstetric team. It is also a mistake to set out to visit and supervise peripheral units without 1st deciding the role and function of each within the system. The supervision of peripheral units must be directed by someone who has already acquired considerable local knowledge regarding the geography and communications of the region, what health providers are active there, and what their strengths and weaknesses are. Problem-oriented management protocols should be used. They can be developed to deal with problems that cannot be simply placed on a list, e.g. the management of the mother with lower abdominal pain in the antenatal clinic. They form the standing orders for treating such patients, and also provide an excellent basis for teaching midwives. The doctor's supervisory visit should have 6 goals in view: he must act as a consultant, to help with the more difficult clinical problems; he has a responsibility to assess the quality of care being delivered by the unit; he has an ongoing responsibility to provide inservice education for the midwives; he has a responsibility to the midwives to ensure that they have the best equipment possible; he has the responsibility of interpreting the needs of midwives to health care authorities; and he has a responsibility to support the midwives in their contacts with the community.