Background A needs assessment of women's health services was conducted in support of a WHO sponsored link between Guys and St. Thomas' Hospital, London, and Ndola Central Hospital, Zambia. Ndola Central Hospital is one of five tertiary hospitals in Zambia taking referrals from 23 surrounding rural clinics. The maternal mortality ratio for Zambia was 591/100000 in 2007.1

Method Information was gathered via interviews with staff in the top ten referral clinics and at Ndola Central Hospital, and by auditing patient referral instructions for May 2011. Services available at clinics were described and data was grouped into categories for reason for referral. Referral practices were compared to District Health Office guidelines.

Results Antenatal visits, health screening tests and education of expectant mothers were carried out within clinics, but specific services varied at each location. Largely, referral guidelines were followed but some normal deliveries were referred from clinics that weren't equipped as delivery centres. Additionally, large numbers of women self-referred to Ndola Central Hospital, bypassing clinic services. Some larger clinics acted as primary referral centres from non-delivery centre clinics or for HIV related services. Finally, there were frequent problems with transport for referrals as there is only one ambulance which serves all the rural clinics.

Discussion Ndola Central could keep a register of women who are self referring, using this information to apply for increased staff budget from the Ministry of Health. Time recommendations could also be added to the guidelines to reduce time delays in accessing specialist care.