Tag Archives: DHIS-2

Bangladesh scales up MPDSR

To prevent mothers and babies from dying, Bangladesh has taken steps to scale up its maternal and perinatal death surveillance and response (MPDSR) system nationally. The country first piloted maternal and perinatal death review (MPDR) in 2010. By 2015, MPDR was rolled out to 12 districts. In 2015, the estimated maternal mortality ratio was 176 per 100,000 live births and in 2016, the neonatal mortality rate was 20 per 1,000 live births. While Bangladesh has made important gains, more needs to be done to achieve the Sustainable Development Goal 3 targets for maternal and newborn mortality.

In 2016, the Ministry of Health and Family Welfare (MoH&FW) took action to roll out MPDR throughout the country. In line with the World Health Organization (WHO) Maternal Death Surveillance and Response (MDSR) Technical Guidance, the MPDR system was updated to ensure an increased focus on surveillance and response.national MPDSR guideline workshop

Photo caption: Workshop on “Sharing MPDSR Guidelines, Training Module and Strategic Implementation Plan” for Universal Health Coverage, 2 October 2016. Photo credit: Dr Animesh Biswas.

Both the Health Economic Unit of the MoH&FW and the Bangladeshi government financially supported this transition. To ensure integration and adoption across the health system, changes were carried out in collaboration with: The Directorate General of Health Services and their Management Information system, Directorate General of Family Planning, developmental partners (for example, UNICEF, UNFPA, WHO), professional bodies (such as, the Obstetrical and Gynaecological Society of Bangladesh), implementing partners (for example, non-governmental organisations), public health experts and research organisations (such as, the Centre for Injury Prevention and Research).

Twenty-two districts are currently implementing the new maternal and perinatal death surveillance and response (MPDSR) system with UNICEF supporting 13 districts, UNFPA five and Save the Children four. Scale-up activities took place at the policy and implementation levels to support the expansion of the system, including:

  • The adoption of national MPDSR guidance based on existing MPDR guidelines. New national guidelines were approved by the MoH&FW in October 2016.
  • The development of a national Training of Trainer’s (ToT) manual on MPDSR to use at various levels (approved in December 2016 by the MoH&FW).
  • The creation of a pocket handbook on MPDSR for on-the-ground health workers.
  • The development of six additional tools, also approved in December 2016 by the MoH&FW: The community death notification slip, the community maternal death review form, the community neonatal death review form, the facility death notification slip, the facility-based maternal death review form and the facility-based neonatal death review form.
  • A cascade training approach comprising of a:
    • National level three-day ToT for 78 health professionals from the 22 districts.
    • Training of health and family planning staff on the ground, and volunteers, doctors and nurses at the district and upazila (sub-district) levels across the 22 districts.
  • The identification of MPDSR focal persons at the upazila, district and national levels.
  • Establishment of MPDSR sub-committees in facilities at upazila and district levels. Facility death findings will be periodically discussed in hospital-based MPDSR sub-committees and necessary steps taken to improve facility services.
  • The newly created national MPDSR committee will sit twice a year to discuss progress towards achieving targets for maternal and neonatal mortality, and improvements in the health system.
  • Capacity development on the national level assignment of causes of death from community maternal and neonatal verbal autopsy forms – based on the International Classification of Diseases 10 (ICD-10) – were conducted for clinicians, including gynaecologists, obstetricians, neonatologists and paediatricians, from seven tertiary medical college hospitals.

A key element of the revised system is to improve the quantity and quality of the collection of data. To ensure the notification and reporting of every community- and facility-based maternal and neonatal deaths and stillbirths, notification is now mandatory. The review of every maternal and neonatal death will be conducted at the facility level and a verbal autopsy will be carried out for all maternal and neonatal deaths at the community level. Moreover, for community sensitisation and awareness building, social autopsies for maternal and neonatal deaths will be conducted in communities.

Data is now viewable via a dashboard linked to the online management information system database, the District Health Information Software (DHIS-2). In addition to being shared and discussed at MDPSR sub-committee meetings, review findings will be fed into Quality Improvement Committee (QIC) meetings at the upazila and district levels. The QICs will be tasked with monitoring follow-up actions. Additional system improvements to support collection, management and review of data included:

  • Trainings to support health-care providers in community clinics to report community deaths to the DHIS-2, the smallest health system unit covering approximately 6,000 persons.
  • Trainings to upload causes of death from verbal autopsies to the DHIS-2 at the divisional level.
  • Meetings with MPDSR facility-level sub-committees to discuss findings from facility death reviews to improve the quality of maternal and newborn care.

The DHIS-2 presents data on maternal and neonatal mortality by time period and geographic location. Improvements in data availability, accessibility and quality are supporting improved decision making by health managers, planners and policy makers at various levels of the health system. Another notable achievement has been the integration of MPDSR into the fourth Health Population Nutrition Sector Development Plan (2017-2021). The MoH&FW plans to achieve countrywide scale up of the MPDSR system by 2021.

This country update was written by Dr Animesh Biswas, PhD, Senior Scientist and Associate Director, Reproductive and Child Health Department at the Centre for Injury Prevention and Research (CIPRB) in Dhaka, Bangladesh.

To read some publications by Dr Biswas, please click the titles below:

Bangladesh | the roll out of MPDSR

Maternal and perinatal death surveillance and response in Bangladesh was initiated by the Ministry of Health and Family Welfare (MOH&FW) to monitor the overall improvement of maternal and neonatal health. Since its inception, the MoH&FW has been implementing MPDSR in 17 districts across Bangladesh following the pilot programme in Thakurgaon district in 2010. The approval of the national MPDSR guideline has paved the way to scale up MPDSR. From July to September 2016, a number of initiatives have taken place to further MPDSR implementation across the country.

RECENT ACTIVITIES

  • The national guidelines for MPDSR have been approved by the MOH&FW. Printing is underway and the dissemination workshop will take place in October 2016.
  • Plans to scale up MPDSR countrywide by 2021 have been drafted in the results framework of the Health, Population and Nutrition Sector Development Program 2011-2016
  • The MPDSR Training of Trainers manual is under development and will be implemented to train sub-national level facilitators who in-turn will train healthcare providers from multiple disciplines at the district and upazila levels. The upazila team will then train the field-level health care providers on death notification, verbal autopsy (VA), social autopsy and facility death review. Participants will also be trained in data collection and analysis
  • A booklet on MDPSR for health and family planning workers in the field is also being developed in the local Bengali language. A draft will be complete by September 2016. The booklet is expected to be distributed to field-level health workers (health assistants, family welfare assistants, health inspectors, assistant health inspectors, family planning inspectors and sanitary inspectors) by November 2016
  • Simplified tools of MPDSR to help facilitate death notification, VA and facility death reviews, to name a few, are being prepared for dissemination to all 17 districts. Selected variables of VA have been incorporated in the District Health Information System-2 (DHIS-2)
  • A national-level meeting – led by the Director, Primary Health Care and Line Director of Maternal, Neonatal, Child and Adolescent Health of the Directorate General of Health Services – was planned in September 2016 to share experiences in maternal and perinatal death review across 14 districts
  • The national MPDSR guidelines will be shared at six divisional workshops once finalised (expected date: December 2016).
  • The UNICEF South Asian Regional Office has organised a South-to-South exchange visit for the MOH&FW Obstetric and Gynaecological Society of Bangladesh to travel to China in November 2016 to share experiences about auditing maternal near misses

To learn more about Bangladesh’s implementation of MPDSR or components of it, please read the country update from July 2016.

Browse this case study to read about how social autopsy is used as an intervention tool to prevent maternal and neonatal deaths in communities in Bangladesh. The WHO has also published a case study about social autopsy in Bangladesh.

Acknowledgements: This country update was prepared and reviewed by Dr Riad Mahmud, Health Specialist (Maternal and Neonatal Health), Health Section, UNICEF Bangladesh and Dr Animesh Biswas, National Consultant (MPDSR), Health Section, UNICEF, Bangladesh.

Scaling-up Maternal and Perinatal Death Reviews in Bangladesh

The Maternal and Perinatal Death Review (MPDR) system is now being scaled-up in Bangladesh since it was piloted in Thakurgaon district in 2010. Read this case study about the pilot.  Recent developments include:

  • To date, MPDR is being implemented in 14 out of Bangladesh’s 64 districts.
  • In the later part of 2015, the Ministry of Health & Family Welfare revised the existing MPDR guidelines to reflect a countrywide scale-up, which was also highlighted in the Government’s fourth Health Sector Development Programme (2016-2021). As part of these revisions, a simpler version of community verbal autopsy and facility death review tools on maternal and newborn deaths were developed from existing MPDR tools.
  • The MPDR death notification system has been incorporated into the online District Health Information System (DHIS-2) by the Directorate General of Health Services (DGHS). As a consequence, the health system is gradually notifying each maternal and neonatal death from the community into the DHIS-2 database routinely. Read this case study about the transfer to DHIS-2.
  • In 2015, professional experts at the periphery medical college hospitals, including consultants of obstetricians/gynaecologists, paediatricians, and neonatologists,   undertook training to improve the analysis of causes of deaths taken during verbal autopsies at the district and sub-district level.

Update from Dr Animesh Biswas, PhD, Senior Scientist, Reproductive and Child health Unit at Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.

Malawi

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