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Objective: To determine the number of deliveries, the low-birth-weight rate and the perinatal mortality rate at provincial and province-aided hospitals and clinics in each planning region of the Cape Province., Design: A record of the number of deliveries, low-birth-weight infants, stillbirths and early neonatal deaths in provincial and province-aided hospitals and clinics in each planning region of the Cape Province between 1 January 1989 and 31 December 1991., Setting: All provincial and province-aided hospitals and clinics in the Cape Province., Participants: Hospital and clinic staff of all provincial and province-aided hospitals and clinics in the Cape Province., Main Outcomes Measured: Number of deliveries, low-birth-weight infants, stillbirths and early neonatal deaths in each planning region of the Cape Province., Results: A total of 373,768 births were recorded during the 3-year period with a low-birth-weight rate of 14.7%, a stillbirth rate of 17.9 per 1,000 and an early neonatal mortality rate of 9.1 per 1,000. All rates differed widely between regions. The regions with the highest perinatal mortality rates were in the northern and eastern Cape., Conclusion: The perinatal demographics of most regions in the Cape Province are typical of a developing country. Regions which have been identified as having the highest low-birth-weight, stillbirth and early neonatal mortality rates are in greatest need of improved perinatal health care.

Geographical areas in the Cape Province are ranked by their need for resources for child health care as determined by several proxy indicators of child health. Low birthweight and perinatal mortality rates for 1989, infant and age-specific childhood death rates, as well as death rates for tuberculosis, gastroenteritis and measles for 1985 are used as indicators of need. The ten magisterial districts having the highest priority for resources are, in decreasing order of need: De Aar, Colesberg, Uitenhage, Sterkstroom, Gordonia, Prince Albert, Philipstown, Victoria West, Kirkwood and Richmond. Limitations in the data are: wide, unquantifiable confidence limits, non-independence of different indicators, lack of timeliness, and incomplete statistics. Despite these problems with the data there are several reasons for employing them. Firstly, the quality of the data is only likely to be improved if they are actually used, and, secondly, there is no alternative. Areas identified as high priority need investigation in situ because corrective action is required for either the data collection system, or child health. Recommendations for improvements in resource management in child health care are: regionalisation of a unitary health care service, more timely data collection in geographically standardised regions, introduction of management objectives, and resource allocation guided by health status indicators.