Karawa Health Zone (KHZ) located in northwestern Zaire, comprises 19,000 km2 with about 340,000 inhabitants. As part of an expanding primary health care program, KHZ officials instituted an extensive outreach program to increase access of women to maternity care. General practitioner (GP) doctors, nurses, midwives, auxiliaries, and traditional birth attendants share responsibilities in delivering maternity care services. Nurses and midwives perform most of the obstetric functions at the Karawa Hospital Maternity Center. Data from 1988 to 1990 show that nurses and midwives attended 98% of normal deliveries and 81% of the complicated ones. Selected nurses performed cesarean section routinely. There was no significant difference in maternal and neonatal outcomes for cesarean section performed by nurses and GPs. Physicians on staff provided support through monitoring, supervision, training, and care for the most complicated cases.