Original Article She may reach a facility but will still die! An analysis of quality of public sector maternal health services, District Multan, Pakistan Fariyal F. Fikree 1 , Ali M. Mir 2 , Inaam-ul Haq 3 Director, Regional Health Programs, West Asia and North Africa, Population Council, Cairo 1 , Population Council 2 , Pakistan, Senior Health Specialist, World Bank Pakistan 3 Abstract Objective: To assess the availability, utilization and functional capacity of the public health delivery system in terms of human resources, equipment, supplies and health provider knowledge regarding management of obstetric complications. Methods: A cross-sectional study was conducted in March 2003 for Multan's public health delivery system. A complete inventory of equipment, supplies, drugs, staff availability and knowledge of obstetric complications management were assessed. Results: The number and distribution of public sector facilities serving a population of 3.2 million was well beyond the minimum requirement for basic obstetric care but fell short for comprehensive Emergency Obstetrical Care (EmOC). Utilization patterns were skewed to the tertiary facility for normal and complicated deliveries. Partograms were not available, magnesium sulphate was only available at the tertiary facility, while basic sup- plies like iron and folate tablets, broad spectrum antibiotics, oxytocics, gloves and sutures were not available at primary or secondary facilities. Knowledge scores regarding management of obstetric complications were less than average, especially among nurses at basic or comprehensive EmOC facilities. Intensity of labour pains (nurses 59%) at basic EmOC facility and cervical dilatation by doctors at basic and comprehensive facilities were the most frequent responses for monitoring in labour. Conclusion: Strengthening the four interlinked health system elements - human resources, access to, use and quality of services is essential though not sufficient (JPMA 56:156;2006). Introduction The target of 75% reduction in maternal mortality ratios by 2015 is one of the three health related UN Millennium Development Goals, the 191 UN member states have pledged to in 2000. 1 Notwithstanding, the tragedy of unnecessary high death rates for women during pregnancy, childbirth and the puerperium continue unabated in South Asia, sub-Saharan Africa and Latin America. In the devel- oping world, measurement of maternal mortality has met with limited success due to a variety of issues including a high degree of underreporting, misclassification and ineffi- cient estimation techniques. Furthermore, the lack of time- ly availability of reliable and valid data to assess progress and evaluate results of ongoing Safe Motherhood pro- grammes and interventions creates a lacuna that must be met for evidence-based policy decision making. The UN process indicators 2 were developed in 1997 to monitor the progress of Safe Motherhood intervention programmes by measuring the availability, utilization and quality of obstetric services. Their recommended levels pro- vide guidelines for monitoring and evaluating the effective- ness of maternal health services and Safe Motherhood pro- grammes. The indicators assessed include the number and distribution of facilities that provide 156 J Pak Med Assoc