Safe motherhood and district health systems

Although WHO and many countries are intensifying their efforts to improve the performance of district health systems, a lot remains to be done. The district is the most peripheral fully-organized unit of local government. As it is small enough for health staff to observe and understand major problems and developments, the district offers great opportunities for action on maternal mortality. A number of these potentials are elaborated. They include the availability of intersectoral mechanisms, a network of health facilities with at least a district hospital, the presence of non-governmental organizations, and other informal mechanisms that will enable "counting and accounting' of maternal deaths to be made. Reduction in maternal mortality is a good indication of improved performance of district health systems. It will be argued that the "district focus' is the way forward in the fight against maternal mortality.