'University of Sarajevo Faculty of Health Sciences'
There is a perception that some of the pregnant women referred from district to regional hospitals should have been managed at the former hospitals. To establish the truth of this perception, a quantitative, exploratory, descriptive and contextual study was undertaken to determine to what extent pregnant women admitted to a regional hospital are appropriately referred from district hospitals according to criteria described in the Guidelines for Maternity Care in South Africa and in the Primary Health Care Package for South Africa. Maternity case records of two hundred and eighty pregnant women admitted to a regional hospital in the Eastern Cape Province following referral from district hospitals between 1 July 2005 and 31 December 2005 were reviewed and analysed. The majority of these women were referred for medical complications, previous caesarean section, failure to progress in labour, obstructed labour, preterm baby and eclampsia. The commonest reasons cited for the transfer of these patients were shortage of maternity care providers in maternity units and lack of expertise at district hospital level. A lack of drugs and equipment were less commonly cited as the reason. Criteria for referral from district to regional hospitals were fulfilled in only 78 (34.2%) of the referrals. This low level of fulfillment of the criteria is attributed to the apparent lack of feedback processes between district and regional hospitals. This in turn limits the opportunity to develop competencies and skills of staff at these maternity units. To address this issue a referral strategy for implementation in the Eastern Cape Province was developed and presented in this study