At national level, the Federal Ministry of Health (FMOH) is planning to institutionalise Maternal and Perinatal Death Surveillance and Response (MPDSR) in Nigeria. As part of this, the FMOH carried out four zonal orientation meetings of representatives of the 36 State Steering Committees and the FCT, on MPDSR in Lagos, Port Harcourt, Jos and Kaduna in early November, which covered in-country experiences of implementing MPDSR at the facility and community level. The meetings were attended by a variety of stakeholders, including representatives from the FMOH, the World Health Organization, Save the Children, Evidence for Action (E4A), UNICEF and the Society of Gynaecology and Obstetrics of Nigeria.
As a result of these four zonal orientation meetings, the FMOH established a virtual MDSR network on MPDSR titled ‘Maternal and Perinatal Death Surveillance and Response in Nigeria’ and is hosted on Facebook.
At sub-national level, in Ondo State, the first zonal facility MDR training has taken place for MDR agents, who included Chief Medical Directors, heads of the Obstetrics and Gynaecology departments, and the nurse/midwife or matron in charge of the hospital labour ward. In Kano, a two-day MDR review meeting has taken place for the State and Facility MDR Committees, which resulted in the development of a workplan for August 2015 to February 2016. In Bauchi State, the Technical Working Group on MDRs successfully trained 131 Facility MDR Committee members from 25 out of the 26 General Hospitals in the State. The committees have drawn up workplans to begin reviews in their facilities.
Update from Dr Tunde Segun, County Director E4A-Nigeria
At national level, the National Committee for Confidential Enquiries into Maternal Deaths (NCCEMD) quarterly update meeting took place at the end of August. The meeting focussed on revising the Terms of Reference of the NCCEMD members and how they should be reporting. MDSR tools have also been reviewed in Malawi in order to integrate duplications in data collection and lessen the burden on those reporting. Now the MDSR form in the DHIS II system will not be filled in, but instead all MDSR variables have been integrated into the Maternal and Newborn Health form in DHIS II. Another form has also been created to track recommendations at district level.
At sub-national level, in Kasunga, four more community MDSR (cMDSR) committees were trained in the area of Senior Chief Kaomba. The senior chief dedicated his time as one of the participants for the three day training.
Update from Lumbani Banda, Project Manager for Evidence for Action-Malawi
This article by Matthews Matthai and colleagues in the International Journal of Gynecology and Obstetric’s October supplement World Report on Women’s Health 2015 describes the MDSR system, explaining its role as a mechanism for strengthening accountability and ending preventable maternal deaths. The article also provides updates from around the world on how far the system is being implemented using findings from the WHO Global Maternal, Newborn, Child and Adolescent Health (MNCAH) policy survey 2013-2014. This information has since been updated with findings from the MDSR implementation monitoring survey (April-Sept 2015) presented in the WHO’s latest online report on the status of MDSR implementation globally.
The article highlights that around the world countries are adopting MDSR into policy. However, there is a gap between policy development and placing it into practice:
- Findings from the MNCAH policy survey found that three-quarters of high-priority countries surveyed had a policy stating that all maternal deaths must be reviewed and yet less than a third had a national MDR committee that meets on a quarterly basis.
- More recent findings from the MDSR implementation monitoring survey has found that 90 per cent of countries surveyed had a policy stating that all maternal deaths must be reviewed and yet 42 per cent had a national MDR committee that meets at least biannually.
The authors conclude that training more health workers, monitoring and evaluation, and building partnerships with technical experts are recommended to support greater up-take of MDSR.