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 MPDSR training package and guidelines

The Ethiopian National Maternal and Perinatal Death Surveillance and Response (MPDSR) Training Package was developed by the multi-sectoral national MPDSR Task Force, with technical support from Evidence for Action (E4A) and the World Health Organization (WHO).

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In Ethiopia, an MDSR system was 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), WHO 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 into the Public Health Emergency Management (PHEM) directorate in the Ethiopian Public Health Institute (EPHI). The PHEM Implementation Manual for MDSR was developed to help orientate surveillance officers around the country on collecting maternal death data.

In 2017, perinatal death surveillance and response started to be added to the existing MDSR platform. The MPDSR Technical Guidance document was produced and a new integrated training package developed (see below). Two Training of Trainers (ToT) sessions were held by the end of 2017. Training roll-out will begin in 2018.

The MPDSR and MDSR training packages are available to download below.

The MPDSR training package

Original MDSR training package

The MPDSR training package has been designed to be interactive. The emphasis throughout the training should be on the use of MPDSR 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.

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!