CLEVER Maternity Care

Improvement of the quality of obstetric care in midwife-led obstetric units, and in their referral district hospitals, using a geographical catchment area approach within the health districts. 

A CLEVER way to reduce maternal and perinatal mortality and morbidity: essential respectful high-quality obstetric care to birthing mothers is presented innovatively to address the local barriers in the health system, the blind spots in critical thinking during obstetric care and the preferences of the individual clients and their cultures. The package called ‘Working CLEVER’ in delivery units provides a framework for a turn-around within individual labour ward units that reinforces needed routines (including pre-referral care and referrals) and improves practical health worker skills levels through local monitoring and coaching. The package can be disseminated during master training workshops and implemented by district clinical specialist teams and other relevant local clinicians in South Africa.




MSD for Mothers Global Giving

MSD for Mothers has established a 10-year, $500m global initiative to create a world where no woman dies giving birth.


Oosthuizen SJ, Bergh AM, Silver A, Malatji RE, Mfolo V, Botha T. The COVID-19 pandemic and disruptions in a district quality improvement initiative: Experiences from the CLEVER Maternity Care programme. South African Family Practice. 2022;64(1). DOI: 10.4102/safp.v64i1.5359

Oosthuizen SJ, Bergh AM, Grimbeek J, Pattinson RC. CLEVER maternity care: A before-and-after study of women's experience of childbirth in Tshwane, South Africa. African Journal of Primary Health Care and Family Medicine. 2020 Jan 1;12(1): 1-8. DOI:

Oosthuizen SJ, Bergh AM, Grimbeek J, Pattinson RC. Midwife-led obstetric units working ‘CLEVER’: Improving perinatal outcome indicators in a South African health district. South African Medical Journal. 2019 Mar 7;109(2):95-101.DOI:

Oosthuizen SJ, Bergh AM, Pattinson RC. Systems thinking: A turning point for improving respectful obstetric care in South African health districts. South African Medical Journal. 2018;108(11):910-4. DOI: 10.7196/SAMJ.2018.v108i11.13312

Oosthuizen SJ, Bergh AM, Pattinson RC, Grimbeek J. It does matter where you come from: mothers’ experiences of childbirth in midwife obstetric units, Tshwane, South Africa. Reproductive health. 2017 Dec;14(1):1-1. DOI:

Pattinson RC, Bergh AM, Ameh C, Makin J, Pillay Y, Van den Broek N, Moodley J. Reducing maternal deaths by skills-and-drills training in managing obstetric emergencies: A before-and-after observational study. South African Medical Journal. 2019 Apr 1;109(4):241-5. DOI:

Malatji R, Madiba S. Disrespect and abuse experienced by women during childbirth in midwife-led obstetric units in Tshwane District, South Africa: a qualitative study. International journal of environmental research and public health. 2020 Jan;17(10):3667. DOI:

Media articles


- Author Sarie Oosthuizen

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