REQUIREMENTS FOR OBSTETRICAL INTERVENTION S - AN APPROACH BASED ON SPATIAL-ANALYSIS OF DEFICITS IN MOROCCO

One of the indicators of health system effectiveness with regard to ma ternal health is the maternal mortality ratio. Measuring this ratio in developing countries is, however, not art easy task since reliable in formation on mortality is rarely available. An alternative to the mate rnal mortality ratio measurement, as an indicator of effectiveness, is the assessment of the coverage of obstetrical intervention needs. The authors chose to restrict the notion of << needs >> to the obstetrica l interventions carried our in order to save a mother's life, Using da ta from a survey by the Ministry of Health of the Moroccan Kingdom on all the obstetrical interventions carried out in 1989, obstetrical int ervention rates for << absolute maternal indications >> are analysed a ccording to the mother's origin, by province and urban/rural environme nt. The spatial analysis of these rates showed large variations in eac h of the environments (0 to 2.14 % of the expected births in urban are as and 0 to 1.25 % in rural areas) and a significative difference betw een the rural and urban distributions (median 0.80 % in urban areas ve rsus 0.30 % in rural areas). Applying a reference rate of 1 %, deficit s between the expected numbers of needed obstetrical interventions and the observed numbers were calculated for every province in both urban and rural areas. In the whole of Morocco, intervention rates are mark edly below what is expected. The spatial analysis of the deficits help s to identify the provinces where the problem is the most prominent in terms of numbers of women whose intervention needs have to be covered . The authors discuss the validity of the reference rate and suggest s everal strategies to solve the problem. They conclude that the deficit s map is a useful tool to decide on priorities for planning and monito ring of strategies to be implemented The spatial analysis of obstetric al intervention deficits seems to be an instrument both cheaper and mo re relevant than a maternal mortality estimates survey.