News and updates

Kenya | MPDSR committees across all levels jointly tackle referral systems challenges

In 2016, nearly half of maternal deaths (48%)1 and almost a third of perinatal deaths (31%)2 occurring in health facilities in Bungoma County were referred from another facility. The facility level maternal and perinatal death reviews in the County, supported by the Maternal and Newborn Initiative (MANI) project highlighted multiple problems with the referral system, including:

  • Delays in the decision to refer clients
  • Inappropriate treatment prior to referral or lack of efforts to try to stabilise clients before transit (e.g. Administering magnesium sulphate to clients experiencing pre-eclampsia)
  • Referring facilities not calling ahead to enable referral facilities to prepare for receiving emergency cases
  • Referring facilities not sending completed referral slips or client history
  • Lack of (or delays in organising) ambulances, drivers, and/or fuel, especially at night
  • Lack of a nurse or clinician to accompany clients in ambulance
  • Emergency clients being dropped off alone at facility entrances.

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Bangladesh scales up MPDSR

To prevent mothers and babies from dying, Bangladesh has taken steps to scale up its maternal and perinatal death surveillance and response (MPDSR) system nationally. The country first piloted maternal and perinatal death review (MPDR) in 2010. By 2015, MPDR was rolled out to 12 districts. In 2015, the estimated maternal mortality ratio was 176 per 100,000 live births and in 2016, the neonatal mortality rate was 20 per 1,000 live births. While Bangladesh has made important gains, more needs to be done to achieve the Sustainable Development Goal 3 targets for maternal and newborn mortality.

In 2016, the Ministry of Health and Family Welfare (MoH&FW) took action to roll out MPDR throughout the country. In line with the World Health Organization (WHO) Maternal Death Surveillance and Response (MDSR) Technical Guidance, the MPDR system was updated to ensure an increased focus on surveillance and response.national MPDSR guideline workshop

Photo caption: Workshop on “Sharing MPDSR Guidelines, Training Module and Strategic Implementation Plan” for Universal Health Coverage, 2 October 2016. Photo credit: Dr Animesh Biswas.

Both the Health Economic Unit of the MoH&FW and the Bangladeshi government financially supported this transition. To ensure integration and adoption across the health system, changes were carried out in collaboration with: The Directorate General of Health Services and their Management Information system, Directorate General of Family Planning, developmental partners (for example, UNICEF, UNFPA, WHO), professional bodies (such as, the Obstetrical and Gynaecological Society of Bangladesh), implementing partners (for example, non-governmental organisations), public health experts and research organisations (such as, the Centre for Injury Prevention and Research).

Twenty-two districts are currently implementing the new maternal and perinatal death surveillance and response (MPDSR) system with UNICEF supporting 13 districts, UNFPA five and Save the Children four. Scale-up activities took place at the policy and implementation levels to support the expansion of the system, including:

  • The adoption of national MPDSR guidance based on existing MPDR guidelines. New national guidelines were approved by the MoH&FW in October 2016.
  • The development of a national Training of Trainer’s (ToT) manual on MPDSR to use at various levels (approved in December 2016 by the MoH&FW).
  • The creation of a pocket handbook on MPDSR for on-the-ground health workers.
  • The development of six additional tools, also approved in December 2016 by the MoH&FW: The community death notification slip, the community maternal death review form, the community neonatal death review form, the facility death notification slip, the facility-based maternal death review form and the facility-based neonatal death review form.
  • A cascade training approach comprising of a:
    • National level three-day ToT for 78 health professionals from the 22 districts.
    • Training of health and family planning staff on the ground, and volunteers, doctors and nurses at the district and upazila (sub-district) levels across the 22 districts.
  • The identification of MPDSR focal persons at the upazila, district and national levels.
  • Establishment of MPDSR sub-committees in facilities at upazila and district levels. Facility death findings will be periodically discussed in hospital-based MPDSR sub-committees and necessary steps taken to improve facility services.
  • The newly created national MPDSR committee will sit twice a year to discuss progress towards achieving targets for maternal and neonatal mortality, and improvements in the health system.
  • Capacity development on the national level assignment of causes of death from community maternal and neonatal verbal autopsy forms – based on the International Classification of Diseases 10 (ICD-10) – were conducted for clinicians, including gynaecologists, obstetricians, neonatologists and paediatricians, from seven tertiary medical college hospitals.

A key element of the revised system is to improve the quantity and quality of the collection of data. To ensure the notification and reporting of every community- and facility-based maternal and neonatal deaths and stillbirths, notification is now mandatory. The review of every maternal and neonatal death will be conducted at the facility level and a verbal autopsy will be carried out for all maternal and neonatal deaths at the community level. Moreover, for community sensitisation and awareness building, social autopsies for maternal and neonatal deaths will be conducted in communities.

Data is now viewable via a dashboard linked to the online management information system database, the District Health Information Software (DHIS-2). In addition to being shared and discussed at MDPSR sub-committee meetings, review findings will be fed into Quality Improvement Committee (QIC) meetings at the upazila and district levels. The QICs will be tasked with monitoring follow-up actions. Additional system improvements to support collection, management and review of data included:

  • Trainings to support health-care providers in community clinics to report community deaths to the DHIS-2, the smallest health system unit covering approximately 6,000 persons.
  • Trainings to upload causes of death from verbal autopsies to the DHIS-2 at the divisional level.
  • Meetings with MPDSR facility-level sub-committees to discuss findings from facility death reviews to improve the quality of maternal and newborn care.

The DHIS-2 presents data on maternal and neonatal mortality by time period and geographic location. Improvements in data availability, accessibility and quality are supporting improved decision making by health managers, planners and policy makers at various levels of the health system. Another notable achievement has been the integration of MPDSR into the fourth Health Population Nutrition Sector Development Plan (2017-2021). The MoH&FW plans to achieve countrywide scale up of the MPDSR system by 2021.

This country update was written by Dr Animesh Biswas, PhD, Senior Scientist and Associate Director, Reproductive and Child Health Department at the Centre for Injury Prevention and Research (CIPRB) in Dhaka, Bangladesh.

To read some publications by Dr Biswas, please click the titles below:

Nigeria | Updates on MPDSR in Katsina, Yobe and Zamfara

The Maternal Neonatal and Child health programme (MNCH2) is a five year country led programme which aims to reduce maternal and child mortality in northern Nigeria.  The programme works across six states: Jigawa, Kaduna, Kano, Katsina, Yobe and Zamfara.

Image_Map of Nigeria_MNCH2Since 2014, MNCH2 has been supporting maternal and perinatal death surveillance and response (MPDSR) across its six states.  At secondary level facilities (which often have a high number of deliveries), maternal death review (MDR) committees have been set up to review the causes of maternal death and take action to prevent similar deaths in the future.  MNCH2 also supports State MDR Committees to mentor and monitor facility-level committees.

MNCH2’s support to MPDSR across northern Nigeria has resulted in a number of achievements. Following the country update from March 2017, which featured updates from Kaduna, Kano and Jigawa States, here are some further examples from Katsina, Yobe and Zamfara States:

Katsina State

Discussions in the State MDR Committee led to the development of a training in the use of non-pneumatic anti-shock garments for nurses and midwives working at maternity units in ten secondary health centres. Medical Directors, Medical Officers and Maternity personnel in charge of 18 secondary health facilities contributed to this development.

Twenty nurses and midwives were trained in October 2016 on the application of anti-shock garments. Within a month, these training participants trained other maternity staff from the same secondary health facilities to use anti-shock garments. To ensure that the training is cascaded to all general hospitals, the State is mentoring facility-MDR committees on a monthly basis.

Yobe State

A MPDSR Scorecard was developed in collaboration with the State-MPDSR Committee and the Yobe State Accountability Mechanism for MNCH (YoSAMM) with support from the MNCH2 programme. Data from April to December 2016 was collected from ten government general hospitals with MNCH services. The findings are available in box 1.

MNCH2 update_Text box

The State organised a meeting in January 2017 to review the evidence from the MPDSR scorecard. The meeting was chaired by the Honourable Commissioner of Health, Dr Mohammed Bello Kawuwa and attended by the Chief Medical Directors of the ten general hospitals, and other members of the State MPDSR Steering Committee. The key issues discussed during the meeting were:

  • Facility MDR Committees irregularly meet to review maternal deaths and take actions.
    • Proposed recommendation: YoSAMM, with support from the Advocacy sub-committee, is to visit health facilities where reviews of maternal deaths are not regularly conducted as planned. Progress in this area will be discussed at the next YoSAMM quarterly meeting in June 2017.
  • Completion of MPDSR tools not meeting national standards.
    • Proposed recommendation: Health-care providers should receive a refresher training in the completion of MPDSR forms. A training was conducted in February 2017.
  • Pregnant women are reluctant to deliver at a facility.
    • Proposed recommendation: Local government health promotion officers should conduct community mobilisation activities on the importance of antenatal care (ANC) visits and delivery by a skilled birth attendant.

MNCH2_May MDSR newsletter_image 1

Zamfara State

MDR findings from a secondary facility led to the identification of a number of medical equipment and infrastructure features that were lacking. In response to this, the facility MDR committee called on the local government to build an ultrasound centre and provide ultrasound machines. The facility received these provisions in June 2016. Community MPDSR findings led to further action from the local government in the provision of a renovated labour room, a newly built ANC waiting room with a capacity of 250, and ten beds for the maternity ward.

Acknowledgements: This update was prepared based on feedback from:

  • Mohammad Anka – Evidence and Advocacy coordinator, MNCH2 Zamfara state office
  • Garba Haruna Idris – Evidence and Advocacy coordinator,MNCH2 Katsina state office
  • Musa Mohammad- Evidence and Advocacy coordinator, MNCH2 Yobe state office.

Nigeria | MPDSR scorecard from Lagos State

In Nigeria, the Evidence for Action (E4A)-MamaYe programme has continued to provide extensive support to the iImage_Cover of scorecardmplementation of maternal and perinatal death surveillance and response (MPDSR) at sub-national levels from October to December 2016.

The programme assisted the Lagos State MPDSR Committee and the Lagos State Accountability Mechanism for maternal, newborn and child health (LASAM) to develop the State-level Facility MPDSR Scorecard. Data from May to July, 2016 from 17 general hospitals with MNCH services were submitted and presented in the scorecard (see excerpt, below). Continue reading

State-level updates in northern Nigeria

The Maternal Neonatal and Child health programme (MNCH2) is a five year country led programme which aims to reduce maternal and child mortality in northern Nigeria.  The programme works across six states: Jigawa, Kaduna, Kano, Katsina, Yobe and Zamfara.

Image_Map of Nigeria_MNCH2Since 2014, MNCH2 has been supporting maternal and perinatal death surveillance and response (MPDSR) across its six states.  At secondary level facilities (which often have a high number of deliveries), MDR committees have been set up to review the causes of maternal death and take action to prevent similar deaths in the future.  MNCH2 also supports State MDR Committees to mentor and monitor facility-level committees.  MNCH2’s support to MPDSR across northern Nigeria has resulted in a number of achievements. Here are some examples: Continue reading

Ethiopia MDSR Resource Hub

Image_Ethiopia Quarterly MDSR newsletters_Banner_PostVisit the new Ethiopia MDSR Resource Hub on the Action Network website!

Read what the Minister of Health thinks about the power of MDSR. Watch a short film of how MDSR is saving lives in Ethiopia. Browse the first National Report on MDSR data; download the policy briefs on quality of care and strengthening maternal death surveillance; and much more!

The Global Financing Facility: A Brief Overview

Are you familiar with the Global Financing Facility (GFF)? Do you live in one of the 63 countries receiving or eligible to receive GFF funding?

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The GFF was launched by the UN and the World Bank in July last year to improve the health of women, children and adolescents. It is a financing model that combines domestic funding with external resources.

While the GFF is still in its early days, we believe that it has the potential to improve MDSR systems, through investing in civil registration and vital statistics (CRVS) systems, for example. An important focus of the GFF is to improve CRVS systems – a key method for measuring improvements in maternal and newborn health – to capture information on births, deaths and causes of deaths. Continue reading

Seminar Series: 2017

Innovations in maternal and perinatal health in humanitarian settings: Exploring evidence and innovations to improve maternal and newborn survival among populations affected by humanitarian crises 

This new seminar series will take place at the London School of Hygiene and Tropical Medicine (LSHTM) in collaboration with the Global MDSR Action Network and LSHTM’s Health in Humanitarian Crises Centre and The Centre for Maternal, Adolescent, Reproductive, and Child Health (MARCH). Continue reading

Three new tools from the World Health Organization

On 16 August, 2016 the World Health Organization (WHO) launched three new tools to count and review stillbirths, and maternal and neonatal deaths!

Browse the standardised system to capture and classify stillbirths and neonatal deaths in the WHO Application of the International Classification of Disease-10 to deaths during the perinatal period (ICD-PM).

Read the guide and toolkit, Making every baby count: audit and review of stillbirths and neonatal deaths. This publication assists countries to conduct audits and reviews to recommend and put into action solutions to prevent future stillbirths and neonatal deaths.

Explore Time to respond: a report on the global implementation of maternal death surveillance and response to review the findings of the WHO & UNFPA global survey of national MDSR systems in 2015.

Also…

Browse the press release and WHO website to learn more about these three tools, including related papers by the BJOG.

Read this Lancet commentary about all three publications.

Explore this photo story to learn more about MDSR implementation in ten countries around the world.

View this infographic about improving data to learn about what the WHO is doing to help countries save mothers’ and babies’ lives.

Do you know how many women each day experience a stillbirth worldwide? Browse this infographic on the tragedy of stillbirths to find out how many, and more!

News updates: Global Financing Facility

Global Financing Facility (GFF): the Country Powered Investments report supporting Every Woman, Every Child, was launched 20 September. Four new countries – Guatemala, Guinea, Myanmar and Sierra Leone – have also recently become eligible to access GFF funding. For more information about the GFF, visit the website here.