The 2014 article ‘The role of advocacy in the national strategy for maternal death review in Nigeria’, by Fred F. Achem, Chris O. Agboghoroma, and Moses O. Adeoye, published in the International Journal of Gynecology and Obstetrics, describes the role of stakeholder advocacy in the development of a maternal death review programme in Nigeria in 2013. The authors note that MDRs are more sustainable when incorporated into already existing health services. Given that most health services in low-income countries are linked to the government, advocacy efforts by stakeholders to encourage ownership and commitment by governments are vital for the success of MDRs.
With regards to Nigeria’s experience, the authors explain that in 2012 advocacy and technical support to the Society of Gynaecology and Obstetrics in Nigeria was provided by FIGO-LOGIC (the International Federation of Gynecology and Obstetrics’s Leadership in Obstetrics and Gynecology for Impact and Change Initiative in Maternal and Newborn Health). Through the support of FIGO-LOGIC, a national assessment was undertaken to find out the key challenges that may face the implementation of an MDR programme. Some of these included lack of ownership and involvement by the ministries of health at both federal and state level, limited resources, and no policy for implementation.
In light of this information, visits were made to the Nigerian Government and its agencies to encourage their ownership of the MDR programme. With this buy-in from the government, training and technical workshops took place with a range of stakeholders including government officials, development partners, and health professionals. The result was the formal adoption of the national strategy, guidelines and tools for MDRs by the National Council on Health in August 2013.
Key features of the national MDR strategy included:
- A phased implementation of MDRs from the federal hospitals to the state and local health facilities.
- The review process will begin at the facility level and the later community based MDRs will be considered.
- The review process will involve recording maternal deaths according to the World Health Organization’s definition, conducting local MDR meetings to discuss the maternal death and recommendations, and an anonymous summary put together for the state or national level MDR committee to collate, analyse, report, and take action upon.