As part of its efforts to improve accountability for women and children’s health, Malawi classified maternal death as a notifiable event in 2003, and the National Committee on Confidential Enquiry into Maternal Deaths (NCCEMD) was established in 2009. Like many other countries, from 2013, Malawi moved from maternal death reviews (MDRs) to the more robust system of maternal death surveillance and response (MDSR), which entails not only that maternal deaths are notifiable, but also places greater emphasis on response, and on the monitoring and evaluation of MDSR itself.
MDSR meetings create a forum for sharing best practices and discussing solutions to challenges in maternal and child health. In the northern zone (covering seven districts and 126 health facilities), these meetings started in 2014, and involve District and Zone Health Teams and several partners, including Evidence for Action (E4A)-MamaYe, the Malawi Health Sector Project, and the Malawi Blood Transfusion Services.
In a relatively short time span, MDSR has been institutionalised in the northern zone: all districts have functional MDSR committees, which is further galvanising commitment and support from health authorities and partners to act upon the evidence generated.
A dashboard, which E4A helped introduce, presents data on maternal deaths and stillbirths in a user-friendly way. The latest MDSR report (January – March 2017) based on this system was recently released, together with reports covering three financial years (2013-14 to 2015-16), and the period of July – December 2016. The reports have been disseminated during MDSR review meetings, zonal DHMT meetings, partner coordination forums and at the NCCEMD. An annual MDSR review meeting is planned for August 2017.
It is a significant achievement that data on facility-based deaths in the zone is now regularly available, analysed and disseminated, and with continuous support from partners and the ongoing strengthening of capacities in district and facility staff, we expect the process will become more regular.
The reports highlight that there has been little change in the number of facility-based maternal deaths reported in the Northern Zone over the past three financial years. Mothers continue to die of preventable causes, i.e. haemorrhage, sepsis and hypertensive disorders in pregnancy, and factors related to poor quality of care provided in health facilities are major contributing factors. Action plans are being developed to respond to these findings, which will be overseen by the zonal team.
As in many similar settings, activating the appropriate response remains a challenge in the northern zone of Malawi, partly due to funding gaps. Going forward, it will be important to review factors contributing to maternal deaths in more depth to plan appropriate responses. For example, are inadequate assessments of mothers on arrival due to poor skills or staff shortages? Improving quality and use of data is also an ongoing priority to strengthen MDSR implementation.
The MDSR reports help focus the attention of health authorities and partners on the key priorities to reduce maternal and perinatal mortality. As the MDSR system continues to improve in coverage and quality, we will continue to capitalise on the commitment of health authorities and partners to strengthen coordination and take the necessary action to prevent avoidable maternal and perinatal deaths.
This blog was written by Dr. Owen Musopole (MBBS, MSc), Northern Zone Health Officer, Ministry of Health.
To find out more about MDSR in Malawi, you can read: