The Maternal Death Surveillance and Response System is a globally recognised public health tool for reducing maternal mortality.
In Ethiopia, latest data suggests that up to 11,000 maternal deaths occur each year, the vast majority of which are preventable. MDSR ensures these deaths are recognised and reported up through the health system, and also reviewed by experts to consider all the factors that led to the woman’s death, including during her pregnancy, while she was in labour, and after delivery.
MDSR combines surveillance with more complex analysis in order to identify patterns and trends that can then be addressed through appropriate actions in the community, at health centres and hospitals, and more broadly by health policy at district (woreda), zonal and regional levels. MDSR is a combined effort by the Public Health Emergency Management (PHEM) Directorate at the Ethiopian Public Health Institute (EPHI) and the Maternal and Child Health (MCH) directorate within the Federal Ministry of Health (FMoH) that is supported by WHO and Evidence for Action.
How MDSR works: the basics
Ethiopia’s MDSR system was introduced in 2013 and was formally integrated into the PHEM system as the 21st reportable condition in 2014. Throughout the country, data are starting to flow into a central MDSR database. The system relies on identification of deaths occurring during pregnancy, delivery or up to 42 days after the end of a pregnancy (through delivery, miscarriage or abortion).
Community members, Health Extension Workers (HEW) and health care providers in health facilities are often the first to hear of a maternal death, although health facility surveillance staff are also responsible for initial notification.
All deaths are then reported on the weekly surveillance form and then a verbal autopsy (VA) or facility based investigation (FBI) is arranged for collecting detailed information about events leading to the woman’s death. Information for VA is collected from people who were present when the death occurred and could describe the circumstances surrounding the death. FBI collects information from health care providers involved in the management of the deceased mother, attendants of the deceased woman, patient’s chart and log book. The data from either VA or FBI is then discussed at dedicated maternal death review meetings, where local responses or remedial actions are also defined.
Finally, data are summarised in a case-based Maternal Death Reporting Form that is sent to EPHI for inclusion in the database, from which information can be extracted to highlight key findings. Through this data, for example, it has become clear that almost half (49%) of all maternal deaths are due to haemorrhage, the vast majority of which occur post-partum.
Focus on informed action from lessons learnt
MDSR review meetings within health centres, hospitals, and health bureaus provide opportunities to discuss issues and consider what could have been done better to prevent each maternal death – and steps to take to prevent a similar tragedy in future.
Issues addressed during such reviews have included the need for improved communication between health professionals and community members and enhancing awareness of pregnant women and their families of the warning of signs of maternal death.
Other issues addressed include the needs of pregnant women for assistance in accessing health facilities on time with the aim of ensuring receipt of skilled care during delivery – this is an issue that might require improved roads, more ambulances, or waiting homes at health centres so women from remote areas can come closer to the health centre well before onset of labour.
Another lesson from the MDSR review meetings is the need for health staff to sometimes update their knowledge and skills so that they can act immediately to provide the right care and treatment during an emergency as well as awareness of the indications for and timely action to refer very serious cases quickly to the next level of the health system.
Evidence for Action Support for Ethiopia’s MDSR
Evidence for Action (E4A) has worked across six countries in sub-Saharan Africa – Ethiopia, Ghana, Malawi, Nigeria, Sierra Leone and Tanzania – and regionally to improve maternal and newborn survival. Originally funded with UK Aid from the UK government, it is now funded by the Bill and Melinda Gates Foundation.
In Ethiopia, E4A provides support to the Federal Ministry of Health to implement a national MDSR system.
To read more about E4A Ethiopia, click here.
To read more about E4A-MamaYe in other countries, click here.
WHO Support for Ethiopia’s MDSR
The WHO Ethiopia Country Office has been instrumental in supporting the national MDSR system since its inception, particularly through hosting the Evidence for Action (E4A) programme of technical support.
Representatives from WHO are core members of the MDSR Task Force, and WHO staff based in FMoH in Addis Ababa, field offices and EPHI have integrated MDSR into regular supervision and management mechanisms, including adding indicators relevant for monitoring implementation of the system.
For more information, please contact:
Dr. Azmach Hadush, WHO MCH; Email: Gebregiorgisaz@who.int
Joanna Busza, Evidence for Action Ethiopia; Email: Joanna.Busza@lshtm.ac.uk
Dr Ruth Lawley, Evidence for Action Ethiopia; Email: firstname.lastname@example.org