Tag Archives: Community


Global experience with Maternal Death Surveillance and Response: building for the long-term

This briefing note written by Evidence for Action Ethiopia provides a review of the global experience of MDSR at April 2016. It covers the history and current state of national MDSR systems and provides six lessons learnt from countries’ experiences.

To read the briefing, click here.

Mother and baby_Malawi_MamaYe

Malawi builds trust and accountability with a community MDSR system

This case study is an excerpt from a collection of 22 case studies by the Evidence for Action-MamaYe! programme based on their experiences. These case studies bring to light new learning about the specific ways in which evidence, advocacy and accountability must work together to bring about change.

Evidence for Action-MamaYe! was established in 2011 through funding from the UK Department of International Development. The programme’s goal is to save maternal and newborn lives in Ethiopia, Ghana, Malawi, Nigeria, Sierra Leone and Tanzania, through better resource allocation and improved quality of care.

When the Evidence for Action-MamaYe (E4A) programme first started operations in Malawi, we observed that while some facilities and districts were carrying out maternal death reviews, committees met only rarely and did not communicate systematically with other levels. Rudimentary action plans were sometimes developed, but there were no follow-up meetings to track change. Furthermore, the maternal death review process did not include the community level. Consequently, community factors that might have contributed to facility deaths and maternal deaths occurring within communities were not recorded, no explanation was fed back to families or communities on the reasons for facility-based deaths, and no actions were taken in response. This led to distrust between community members and facility staff, who themselves often blamed the families for bringing the woman to the facility too late. Continue reading

Community-based surveillance of maternal deaths in rural Ghana

This article by Joseph Adomako and colleagues, published by the Bulletin of the World Health Organization in February 2016, presents the findings of a study examining the feasibility and effectiveness of community-based surveillance of maternal deaths in rural Ghana. Using a modified reproductive age mortality survey (RAMOS 4+2) and verbal autopsies in Bosomtwe district, the study found that community-based surveillance of deaths of women of reproductive age is feasible and can help to identify maternal deaths in rural communities where they can go unreported.

Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh

This article by Animesh Biswas and colleagues, published by Health in September 2014, presents findings from a mixed-method study examining the process, feasibility, and acceptance of community death notification in Thakurgaon district, Bangladesh. The study found that community death notification was achievable and acceptable at the district level.

Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi

This article by Olivia Bayley and colleagues, published by BMJ Open in April 2015, describes a pilot study in rural Malawi which assesses the value of involving communities in investigating and responding to local maternal deaths. The pilot developed and implemented a community-led maternal death review (CLMDR) system over a 1-year period in the Mchinji District of Malawi. The study found that engaging and empowering communities through the CLMDR system can help ensure effective review of maternal deaths, and can facilitate targeted response planning and accountability.

Verbal autopsy in Bangladesh

This case study by Helen Smith and colleagues, published by the World Health Organization in October 2015, describes the process in introducing verbal autopsy in four regions in Bangladesh in 2010. The authors describe the verbal autopsy model implemented, key findings from an analysis of verbal autopsies carried-out over two years,  and key implementation lessons.

Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

This article by Sunil Saksena Raj and colleagues, published by the International Journal of Health Policy and Management in January 2015, presents the findings of verbal autopsies carried out in Unnao District between 2009 and 2010. The findings point to the need to improve the inter-facility referral system.

Maternal and Perinatal Death Inquiry and Response (MAPEDIR): Empowering communities to avert maternal deaths in India

This document, produced by UNICEF in 2008, describes the Maternal and Perinatal Death Inquiry and Response (MAPEDIR) initiative implemented in 16 districts in India. The MAPEDIR tool is a detailed autopsy questionnaire, which aims to capture, from relatives or those close to the deceased woman, individual, familial, socio-cultural, economic and environmental factors missing from medical records. The document describes the development, implementation, key findings, obstacles and opportunities of the MAPEDIR initiative in India. The initiative found that the generation of data by the community highlighted areas where several deaths had occurred and stimulated responses by the community and health providers.

Nigeria: Implementing a community component and using evidence for action

At national level, the Federal Ministry of Health carried-out a meeting in February with key stakeholders (UNICEF, E4A, National Primary Healthcare Development Agency, WHO, UNFPA, National Population Commission, and the Centre for Disease Control)  on their Maternal and Perinatal Death Surveillance and Response (MPDSR) system. The purpose of the meeting was to share updates on progress in implementing MPDSR and discuss moving MPDSR forward. Reported progress in implementing MPDSR to date from the federal-level includes: 

  • Development of MPDSR national guidelines
  • Nation-wide orientation on MPDSR held at zonal level
  • Establishment of National and State Steering Committees
  • Development of national and state implementation plan

The central discussion of the meeting focussed on how to leverage existing structures to implement a community component of MPDSR.

At sub-national level, E4A-MamaYe has supported the training of Maternal Death Review (MDR) committees in all Secondary Health Facilities in the following States: Bauchi, Jigawa, Kano, and Ondo. These facilities are now conducting MDRs. MDR data is collected quarterly and used to develop scorecards that provide evidence for the Advocacy Sub-Committees of the State-Led Accountability Mechanisms. Please see examples of MDR scorecards from Bauchi, Kano, and Ondo.

MDR evidence is influencing policy, service delivery and community action in Nigeria. For example, as a result of MDR evidence, Kano State Government included three key activities in the 2016-2018 State Medium Term Sector Strategy (MTSS). These include:

  1. Conduct of MDRs in facilities and quarterly MDR review meetings at the State level
  2. Provision and maintenance of functional blood banks in all State hospitals
  3. Integrated demand creation activities to improve uptake of ANC and maternal survival.

In response to the finding that post-partum haemorrhage is a leading cause of maternal deaths in Gumel General Hospital of Jigawa State, the hospital management mobilised community members (around the catchment areas of the facility) to form blood donation groups who are now donating their blood voluntarily, and blood is now available in the facility.

Update from Oko Igado, National Technical Advisor for E4A-MamaYe, 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