Guidelines and training resources

Malawi’s MDSR guidelines

The Ministry of Health in Malawi released Maternal Death Surveillance and Response (MDSR) guidelines for health professionals in 2014. These guidelines aim to inform capacity building and implementation of a functional MDSR system in Malawi, incorporating it within the current Integrated Disease Surveillance and Response (IDSR) system.

Download Malawi’s MDSR guidelines here.

Sierra Leone’s MDSR guidelines

Sierra Leone has one of the highest levels of maternal mortality in the world, with an estimated 2,400 women dying during pregnancy or childbirth every year. In order to prevent maternal deaths and improve quality of care, the Government of Sierra Leone has adopted the Maternal Death Surveillance and Response (MDSR) system and released these guidelines.

These guidelines provide guidance on the implementation of MDSR in Sierra Leone, building on the Maternal Death Review system and “piggybacking” onto the Integrated Disease Surveillance and Response (IDSR) system.  Maternal deaths have now been integrated into the notifiable reporting system of the IDSR. The guidelines focus on the following implementation steps:

  1. Identification and notification of maternal deaths
  2. Maternal death review
  3. Analysis – data aggregation and interpretation
  4. Response to maternal deaths
  5. Dissemination of results, recommendations and responses
  6. Monitoring and Evaluation for MDSR system
  7. MDSR implementation plan

Download Sierra Leone’s MDSR guidelines here.

Ethiopia MDSR training package and guidelines

The Ethiopian National MDSR Training Package was developed by the Federal Ministry of Health MDSR Task Force, with technical support from Evidence for Action and WHO.


In Ethiopia, the MDSR system was officially launched in May 2013, and a national level Train-the-Trainers workshop was conducted at that time by a multi-sectoral team drawn from the Task Force membership, the Ethiopian Society of Obstetricians and Gynaecologists (ESOG), and the E4A technical assistance team. Following the national training workshop, a “training cascade” was introduced. Each Regional Health Bureau has been responsible for rolling-out the MDSR training to relevant participants in their regions.

Initially, Maternal and Child Health staff were trained using the MDSR Technical Guideline. In 2014, the MDSR system was integrated with the Public Health Emergency Management (PHEM) directorate in the Ethiopian Public Health Institute (EPHI). Since then, surveillance officers have been trained using the PHEM Implementation Manual for MDSR.

The training materials, including the Trainers’ Manual, are designed to support delivery of a comprehensive introduction to the Ethiopian MDSR system, including familiarisation with the data collection tools, and roles and responsibilities at each level of the health system.

The training package

The training package is available to download below. It consists of the following materials:

The training package has been designed to be interactive. The emphasis throughout the training should be on the use of MDSR as a basis for action. The importance of multi-professional team collaboration is also emphasised throughout the training, as this has been shown to benefit the MDSR system by strengthening communication between disciplinary groups (clinicians, midwives, data managers, community representatives, etc). Where possible, training at each level should be delivered by a multi-disciplinary training team.

Overall Goal of the Training Package

To deliver a practical introduction to the Ethiopian MDSR to support establishment of a functional, effective and action-oriented MDSR system across Ethiopia.

Specific Aims

  • Introduce MDSR concepts and rationale, with presentation of international evidence for its effectiveness and best practice
  • Provide a detailed overview of the Ethiopia MDSR model and vision for how it will operate at each level of the national health system
  • Ensure staff are equipped with the requisite knowledge and competence-based skills for each component of the MDSR process
  • Provide an opportunity for participants to become familiar with the use of the National Guidelines and tools for data collection and reporting.

Target Audience and Objectives

Twelve training modules have been developed, although not all of them are relevant to all participants. The sample training workshop agenda provided in this manual makes suggestions for which modules can be adapted, shortened or removed for specific groups.

Four different levels are envisioned for delivering the training, each with slightly different primary objectives, as follows:

  • National and Regional leads – political commitment, orientation of the system
  • Referral/District Hospitals – facility based data collection
  • Zones and Woreda – managing data flow, identifying actions and reporting upwards
  • Health centres – collecting and reporting data from both community and facilities

By the end of each training workshop, participants should:

  • Understand how MDSR can reduce maternal mortality
  • Know the structure of the Ethiopian MDSR, including roles and responsibilities
  • Recognise and know how to use the national Tools
  • Demonstrate ability to recommend appropriate actions
  • Appreciate the importance of MDSR processes, particularly the need for smooth bi-directional flow of information between different levels of the system
  • Understand the role of monitoring actions to ensure the “response cycle” is completed

Trainings should be completed prior to the initiation of MDSR in each region, and should ensure dissemination of PHEM Integration Manual and Tools to all relevant institutions and individuals who will be involved in implementing the MDSR.

FIGO LOGIC MDSR guidelines and training curriculum

These guidelines and training curriculum were developed by FIGO LOGIC to guide health professionals in their efforts to assess quality of care in their own service, and to help health staff conduct reviews of maternal death cases occurring in their health facility.

The FIGO LOGIC (Leadership in Obstetrics and Gynaecology for Impact and ChangeMaternal Death Review Guidelines and Maternal Death Review Training Curriculum were published in early September 2013. The practical guidelines aim to  support clinicians, health systems and facility administrators, MNCH programme managers, NGOs and policy makers in assessing quality of care in their own settings, and build their capacity to conduct maternal death reviews at facility-level. The training curriculum is designed to accompany these guidelines and support their implementation in practice.

Together, they are key tools to support local stakeholders to move forward with MDSR implementation in their own contexts. The tools were field tested in Cameroon with the support of the Society of Obstetricians and Gynaecologists of Cameroon.

To download the FIGO MDR guidelines, click here.

To download the FIGO MDR training curriculum for free, click here.

Latest WHO technical guidance on MDSR

This key document, published in October 2013, provides practical guidance to move from maternal death reviews to surveillance and response, emphasising the response component as well as focusing on quality of care improvements. 

This document introduces the critical concepts of MDSR, including goals, objectives, and specific instructions for implementing each surveillance component, as well as outlining how districts can set up MDSR processes to strengthen surveillance and response.

These guidelines have been developed by the MDSR Working Group which includes UN agencies, academics and professional organizations and other partners. It builds on the 2004 WHO publication “Beyond the Numbers: Reviewing maternal deaths and complications to make pregnancy safer” and previous work done in this area by WHO and other partners.

Health-care professionals, health care planners and managers, policy makers working in maternal health, and those who measure maternal mortality will find these guidelines useful as they set up, implement and strengthen MDSR systems in their own settings.

To download the guidance for free, click here!