- Doubling the number of maternal deaths identified.
- Accurate and cost-efficient method of measuring the maternal mortality ratio.
- Strengthened relationships and trust between health facilities and communities they serve.
- Community actions to prevent future deaths: establishing mobile antenatal care clinics, arranging community meetings to explore traditional beliefs and mobilising funds for bicycle ambulances.
These are some of the key results from a community-linked maternal death review (CLMDR) pilot that ran from 2011-2012 in Mchinji district, Malawi. Presented by Dr Tim Colbourn, Lecturer in Global Health Epidemiology and Evaluation at the University College London (UCL) Institute for Global Heath, the results of the study show the importance of involving communities in the process of identifying maternal death and acting on the recommendations of maternal death review and surveillance (MDSR) systems.
In many settings, it has proved challenging to get an accurate picture of the number of women dying due to pregnancy-related causes, especially when those deaths occur outside of health facilities. This may be because the deaths are not recognised as maternal deaths, are not reported for reasons including HIV or unsafe abortions or because health workers, traditional birth attendants and those involved in treating the woman feel they will be blamed.
The strength of the community MDSR, and the CLMDR pilot Dr Colbourn spoke of, is that it can help minimise the culture of blame by involving various members of the community and emphasising the need to address systemic issues rather than individual fault. Dr Colbourn explained that in the pilot in Malawi “communities and families were enthusiastic about the process because they wanted something done to prevent such deaths in the future.”
The results identified at the start of this blog point to the concrete and varied impact involving communities can have – from being an accurate way to measure the maternal mortality ratio to inspiring a community to work together to define recommendations to reduce the risk of other deaths happening from similar causes and help to achieve the recommendations.
In Malawi, the MamaYe-Evidence for Action (E4A) team has been continuing to work on establishing and supporting community MDSR committees. You can read more about this by clicking here.
You can learn more about how the CLMDR project was implemented and what the other achievements were by clicking here to watch Dr Colbourn’s presentation in full, to download the Power Point presentation and to read the paper about the study discussed including the five-stage CLMDR form (see supplementary materials).
To find out more about MDSR in Malawi, click on the links to read about:
- The Ministry of Health’s training manual for community focused maternal death review (June 2011) which provides more details of the process and how it has been implemented in Mchinji district.
- An article about the challenges of conducting MDRs in Malawi
- Other initiatives involving communities in the MDSR system.
Acknowledgements: This blog was written by Patricia Doherty, E4A-MamaYe Technical Advisor at Options and Sara Nam, Technical Specialist at Options and Manager of the MDSR Action Network.