This thesis is a critical evaluation of the impact of service delivery shifts within maternity care
on the clinical governance of a well-defined geographical service delivery area (Metro East
section of the Cape Town health district) during 2007 to 2012. This period saw the
implementation of a comprehensive health plan that envisaged the provision of safe
maternity care at a non-specialist hospital within the metropolitan area. The data presented
in the first part of the thesis shows that well defined levels of maternity care can provide safe
management of pregnancies in a large, well-functioning district hospital. A central event in
this time period was the opening of a newly-built district hospital in Khayelitsha and the major
change in the drainage boundaries of Tygerberg hospital to include referrals from this new
hospital. The thesis presents all the clinical governance aspects that went into the planning
and eventual execution of a maternity service and the impact it had on the base hospital.