Pyramidal referrals also contributed, as many women had been initially referred to hospitals where their condition could not be successfully managed. While generic quality improvement measures, significantly coaching and monitoring for rigorous software of scientific protocols will help improve the scenario, the districts and hospitals have to develop capacity to evaluate their local scenario. Unless local organisational components, workers knowledge and skill, blood and blood product availability, and native reasons for delays in providing care are recognized, it will not be attainable to effectively scale back the antagonistic being pregnant outcomes. An necessary limitation was we did not have access to the medical records at the frontline hospitals. Organisational and personnel elements, at both major care and in the hospitals, now contribute to nearly all maternal deaths in Indonesia.
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