Case studies

Legal and policy frameworks supporting MDSR in Latin America and the Caribbean

Synthesis of case studies from Brazil, Mexico, Jamaica, El Salvador and Colombia

Background

According to the World Health Organisation (WHO),

Taking a human-rights based approach to health, making maternal death a notifiable event in law, and supporting this with policies for maternal death review, analysis and follow-up action, creates the preconditions necessary for successful implementation [of maternal death surveillance and response (MDSR)]”1 (p.31).

While death review systems may draw from international guidance and be standardised to an extent across countries, legal regulations can vary and can support or hinder access to information, the conduct of an audit and the response to findings2. Fear of litigation, can prevent the objective review of maternal deaths3, so having legal protection in place and ensuring an anonymous environment can encourage the sharing of information and involvement of health care workers in the MDSR system3. Similar principles can also support the investigation of stillbirths and neonatal deaths 2. Continue reading

How legal and policy frameworks support MDSR in Jamaica

Image_map of JamaicaProfessor Affette McCaw-Binns, a Reproductive Health Epidemiologist at the University of the West Indies (Mona) and Dr Simone Spence, Director of Family Health Services at the Ministry of Health in Jamaica explain how legislation and policy strengthened the reporting of maternal deaths in Jamaica. This case study describes how the policy framework was amended to improve the reporting of maternal deaths and how other interventions implemented simultaneously together strengthen the maternal death surveillance and response (MDSR) system. Continue reading

Developments in PNDSR in South Africa

Scale of the problem

In South Africa, perinatal deaths are defined as all stillbirths and early neonatal deaths (from live birth to seven full days after birth). While the country has accepted the definition* of reporting and recording all deaths (foetal and neonatal) weighing more than 500 grams, it is uncertain if all hospitals where deliveries take place are correctly reporting all deaths weighing less than 1000 grams, especially stillbirths. This may be influenced by a South African law that requires all defined stillbirths to have a burial and notification of death. In rural areas and busy hospitals, this may be seen as labour intensive for already overworked staff. Continue reading

Piloting PNDSR in Tigray region to inform national implementation – Part 1

This case study is the first of two. The second part will be published in 2017 and will report on progress toward scaling up perinatal and neonatal death surveillance and response (PNDSR) across the country.

BACKGROUND

In December 2015, Ethiopia began piloting a perinatal and neonatal death surveillance and response system in Tigray region in response to national commitments to improve newborn survival. The perinatal mortality rate in Ethiopia is high, estimated 46 per 1,000 births in 2011)[1]. The Tigray Regional Health Bureau (RHB) initiated the implementation of PNDSR after learning the importance of maternal death surveillance and response to generate evidence to save pregnant women’s lives following the scale up and national launch of maternal death surveillance and response (MDSR) in May 2013. The World Health Organization (WHO) has been supporting the region following its good performance during the initial phase of MDSR implementation.

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Social autopsy as an intervention tool in the community to prevent maternal and neonatal deaths: experiences from Bangladesh

Social autopsy in maternal and neonatal health

Social autopsy (SA) is an innovative strategy whereby a trained member leads a group within a community through a structured, standardised analysis of the root causes of a death or serious, non-fatal health event. Continue reading

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MDSR in Ethiopia: three years on

E4A has been providing technical assistance for the introduction, implementation and scale-up of Ethiopia’s national Maternal Death Surveillance & Response (MDSR) system since 2012.

At national level, this has involved contributing to the development of the MDSR Guidance, data collection tools and database, and training curriculum, participating as active members of the MDSR task force, and representing the programme internationally.

The Ethiopia E4A team is based in the MNCH department of the WHO Ethiopia country office. In addition to a Programme Director, E4A is supported by five regional Technical Advisors who have been supporting the four large agrarian regions (Amhara, Oromiya, SNNPR and Tigray) as well as Harari, Dire Dawa and Addis Ababa, and a Data Manager working in the EPHI Public Health Emergency Management (PHEM) directorate. The University of Aberdeen’s Immpact programme and Options serve as the E4A Technical Support Unit, providing strategic guidance and 2 advisors based in Ethiopia.

Read our two page summary of our experiences here>

Read our training materials and guidelines here>

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A Maternal Survival Action Network for Sierra Leone

This case study outlines how Sierra Leone introduced a Maternal Survival Action Network to support the implementation of Maternal Death Reviews across the country. This is an updated version of a case study originally published in our April 2013 issue of the MDSR Action Network newsletter.

In Sierra Leone, implementation of Maternal Death Surveillance and Response (MDSR) has been revitalised since the onset of the Ebola outbreak.

Sierra Leone’s national MDSR framework previously focussed on facility-based MDRs. There is widespread agreement by experts and activists that the use of findings from MDRs for service delivery improvements in the current model of implementing MDRs could be significantly strengthened and efforts to re-establish facility-based MDRs on a regular basis is being re-established. A review of processes and challenges identified opportunities to strengthen MDRs and make better use findings at facility level. The intention is to strengthen the system by identifying context-specific barriers and enablers to the use of MDR findings for quality of care improvements. Continue reading

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The Maternal Death Audit Monitoring Form: a tool for action

In March 2015 we shared the news that the Evidence for Action programme in Ghana was piloting the use of Maternal Death Audit Monitoring Forms. This case study presents some of the key findings from this pilot, key challenges and lessons learned.

Background:

Ghana is faced with high maternal mortality. In 2015, the maternal mortality ratio was an estimated 319 deaths per 100,000 live births [1].  Facility-based maternal death audits have been used in Ghana as an important strategy to improve maternal health care since 2000. These audits are a qualitative improvement process that seeks to improve pregnancy care and outcomes through the systematic review of the care received. The ultimate purpose of maternal death audits is to identify factors contributing to the deaths and to take remedial action [2]. Continue reading

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Malawi builds trust and accountability with a community MDSR system

This case study is an excerpt from a collection of 22 case studies by the Evidence for Action-MamaYe! programme based on their experiences. These case studies bring to light new learning about the specific ways in which evidence, advocacy and accountability must work together to bring about change.

Evidence for Action-MamaYe! was established in 2011 through funding from the UK Department of International Development. The programme’s goal is to save maternal and newborn lives in Ethiopia, Ghana, Malawi, Nigeria, Sierra Leone and Tanzania, through better resource allocation and improved quality of care.

When the Evidence for Action-MamaYe (E4A) programme first started operations in Malawi, we observed that while some facilities and districts were carrying out maternal death reviews, committees met only rarely and did not communicate systematically with other levels. Rudimentary action plans were sometimes developed, but there were no follow-up meetings to track change. Furthermore, the maternal death review process did not include the community level. Consequently, community factors that might have contributed to facility deaths and maternal deaths occurring within communities were not recorded, no explanation was fed back to families or communities on the reasons for facility-based deaths, and no actions were taken in response. This led to distrust between community members and facility staff, who themselves often blamed the families for bringing the woman to the facility too late. Continue reading

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Saving Mothers, Giving Life initiative: lessons learned from a maternal death surveillance and response system in Uganda

Uganda was selected for a pilot project — Saving Mothers, Giving Life – to rapidly reduce maternal deaths through community and facility-based interventions. The model employs a comprehensive approach that builds upon existing district health systems, including strengthening the evidence base for improving maternal and perinatal survival. Read how investing in village health teams has resulted in a 30% reduction in population-based maternal mortality as well as stimulating advocacy efforts and community mobilisation. 

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