MDSR in Malaysia is in its fourth year of inception. It complements the Confidential Enquiry into Maternal Deaths that has been in existence since 1991. As part of MDSR feedback, we have weekly updates on the most recent data on maternal deaths for the week and compare this data to the same week the previous year. Based on the findings of the MDSR committee (which meets at least four times a year) a near miss registry is being formed and the ground work is completed. As we leave the Millennium Development Goals and move on to the Sustainable Development Goals we see a greater role for MDSR.
Update from Dr Ravichandran Jeganathan, National Head of Obstetrics and Gynaecological Services at the Ministry of Health.
At national level, the Federal Ministry of Health (FMOH) is planning to institutionalise Maternal and Perinatal Death Surveillance and Response (MPDSR) in Nigeria. As part of this, the FMOH carried out four zonal orientation meetings of representatives of the 36 State Steering Committees and the FCT, on MPDSR in Lagos, Port Harcourt, Jos and Kaduna in early November, which covered in-country experiences of implementing MPDSR at the facility and community level. The meetings were attended by a variety of stakeholders, including representatives from the FMOH, the World Health Organization, Save the Children, Evidence for Action (E4A), UNICEF and the Society of Gynaecology and Obstetrics of Nigeria.
At sub-national level, in Ondo State, the first zonal facility MDR training has taken place for MDR agents, who included Chief Medical Directors, heads of the Obstetrics and Gynaecology departments, and the nurse/midwife or matron in charge of the hospital labour ward. In Kano, a two-day MDR review meeting has taken place for the State and Facility MDR Committees, which resulted in the development of a workplan for August 2015 to February 2016. In Bauchi State, the Technical Working Group on MDRs successfully trained 131 Facility MDR Committee members from 25 out of the 26 General Hospitals in the State. The committees have drawn up workplans to begin reviews in their facilities.
Update from Dr Tunde Segun, County Director E4A-Nigeria
At national level, the National Committee for Confidential Enquiries into Maternal Deaths (NCCEMD) quarterly update meeting took place at the end of August. The meeting focussed on revising the Terms of Reference of the NCCEMD members and how they should be reporting. MDSR tools have also been reviewed in Malawi in order to integrate duplications in data collection and lessen the burden on those reporting. Now the MDSR form in the DHIS II system will not be filled in, but instead all MDSR variables have been integrated into the Maternal and Newborn Health form in DHIS II. Another form has also been created to track recommendations at district level.
At sub-national level, in Kasunga, four more community MDSR (cMDSR) committees were trained in the area of Senior Chief Kaomba. The senior chief dedicated his time as one of the participants for the three day training.
Update from Lumbani Banda, Project Manager for Evidence for Action-Malawi
The Ministry of Health and Social Welfare (MOHSW), in collaboration with several stakeholders including the World Health Organization, UNFPA, UNICEF, Evidence for Action (E4A), national professional bodies, and Tanzanian and international research institutions, have updated the existing Maternal and Perinatal Death Review system to Maternal and Perinatal Death Surveillance and Response (MPDSR) in light of latest technical guidance. The updated MPDSR guidelines were approved in November by the MOHSW and are now being rolled-out across Tanzania through a phased approach, starting in Mara region. To read more about Tanzania’s MPDSR guidelines, take a look at this case study by E4A.
Update from Dr Moke Magoma, Evidence Advisor for E4A-Tanzania
The Philippines is a small country with a complicated political structure. We have a decentralised health system which makes program implementation sometimes difficult to follow up. But modesty aside, we are making some success in the safe motherhood programme. MDSR is among the provisions of Republic Act 10354 or the Philippine Responsible Parenthood and Reproductive Health Law of 2012. Our local government units are actively participating in MDSR and slowly but surely systems reforms are happening on the ground.
Update from Zenaida Dy-Recidoro, Chief Health Programme Officer at the Department of Health
On 4th October 2015, an MDSR workshop took place at the FIGO World Congress led by the World Health Organization and UNFPA in collaboration with FIGO (the International Federation of Gynecology and Obstetrics). The workshop aimed to identify opportunities to strengthen MDSR implementation and the contribution of MDSR to Ending Preventable Maternal Mortality beyond 2015 by:
Providing a forum to discuss and identify the opportunities and challenges facing MDSR implementation post-2015
Sharing lessons from the field on selected key topics relevant to sustained MDSR implementation
Identifying mechanisms and activities to strengthen global collaboration in MDSR implementation.
The workshop included presentations and “marketplace” discussion sessions on five themes. Please follow links to resources available from, or associated with, these sessions.
Data innovations and visualization: Using scorecards to measure the strength of Maternal Death Review (MDR) systems in Nigeria and inform MDSR in Sierra Leone. Hosted by Tunde Segun (E4A) and Mohamed Yilla (E4A)
Data innovation and communication: Experiences from India. Hosted by Ajey Bhardwaj (Federation of Obstetric and Gynaecological Societies of India). Click here to read a related article on the development of an electronic MDR system in India.
The role of funding agencies in MDSR support. Presented by USAID.
Professional society involvement:
The role of professional bodies and government agencies in MDSR: The Malaysia Experience. Presented by DrRavichandran Jeganathan (Ministry of Health, Malaysia).
Professional society involvement: The UK experience. Hosted by Dr Paul Fogarty (Royal College of Obstetrics and Gynaecologists). The Royal College of Obstetrics and Gynaecologists (RCOG) works to improve women’s health care across the world. Founded in 1929, the RCOG now have over 13,500 members worldwide and works with a range of partners both in the UK and globally to improve the standard of care delivered to women, encourage the study of obstetrics and gynaecology (O&G), and advance the science and practice of O&G. Click here to read more about the Royal College of Obstetrics and Gynaecologists.
Going to scale: experiences from Tanzania and Ethiopia (see implementation coverage for 2014 and 2015). Hosted by Moke Magoma (E4A) and Azmach Hadush(E4A).
This article by Kate Kerber and colleagues in BMC Pregnancy & Childbirth presents the findings of a review and assessment of evidence for facility-based perinatal mortality audit in low- and middle- income countries, including their policy and implementation status on maternal and perinatal mortality audits.
The authors found that only 17 countries have a policy on reporting and reviewing stillbirths and neonatal deaths despite evidence suggesting that birth outcomes can be improved if the audit cycle is completed. Key challenges in completing the audit cycle and where improvements are needed were identified in the health system building blocks of “leadership” and “health information systems”. Evidence based solutions and experiences from high-income countries are provided to help address these challenges.
The authors conclude that the system needs data mechanisms (e.g. standardised classification for cause of death and best practice guidelines to track performance) as well as leaders to champion the process (e.g. bring about a no-blame culture) and access decision-makers at other levels to address ongoing challenges.
This article by Animesh Biswas and colleagues in PLoS ONE presents findings of a qualitative study with healthcare providers involved in Facility Maternal and Newborn Death Reviews (FDRs) in two districts in Bangladesh: Thakurgaon and Jamalpur. The study aimed to explore healthcare providers’ experiences, acceptance, and effects of carrying out FDRs.
The study found that there was a high level of acceptance of FDRs by healthcare providers and there were examples of FDRs leading to improvements in quality of care at facilities, such as the use of FDR findings in Thakurgaon district hospital which ensured that adequate blood supplies were available, which saved the life of a mother who had severe post-partum bleeding. The article also identified gaps and challenges in carrying-out FDRs to consider for future efforts, including ensuring incomplete patient records and inadequately skilled human resources to carry out FDRs.
The authors conclude that FDRs are a simple and non-blaming mechanism to improving outcomes for mothers and newborns in health facilities.
To read more about maternal and newborn death reviews in Bangladesh, take a look at several case studies: two from the MDSR Action Network website: “Mapping for Action” and “eHealth to support MPDRs”; and another in the WHO’s global MDSR report here.
The reports present findings from confidential enquiries that took place in the United Kingdom and/or Ireland on stillbirths and maternal deaths. In addition to presenting key findings, the reports provide key recommendations for action aimed at a variety of stakeholders.
This article by Matthews Matthai and colleagues in the International Journal of Gynecology and Obstetric’s October supplement World Report on Women’s Health 2015 describes the MDSR system, explaining its role as a mechanism for strengthening accountability and ending preventable maternal deaths. The article also provides updates from around the world on how far the system is being implemented using findings from the WHO Global Maternal, Newborn, Child and Adolescent Health (MNCAH) policy survey 2013-2014. This information has since been updated with findings from the MDSR implementation monitoring survey (April-Sept 2015) presented in the WHO’s latest online report on the status of MDSR implementation globally.
The article highlights that around the world countries are adopting MDSR into policy. However, there is a gap between policy development and placing it into practice:
Findings from the MNCAH policy survey found that three-quarters of high-priority countries surveyed had a policy stating that all maternal deaths must be reviewed and yet less than a third had a national MDR committee that meets on a quarterly basis.
More recent findings from the MDSR implementation monitoring survey has found that 90 per cent of countries surveyed had a policy stating that all maternal deaths must be reviewed and yet 42 per cent had a national MDR committee that meets at least biannually.
The authors conclude that training more health workers, monitoring and evaluation, and building partnerships with technical experts are recommended to support greater up-take of MDSR.