Tag Archives: Ethiopia

An innovative approach to measuring maternal mortality at community level in low-resource settings using mid-level providers: a feasibility study in Tigray, Ethiopia

This paper proposes a community-based approach to measuring maternal mortality based on a feasibility study conducted in 2010-2011 in Tigray, Ethiopia, based on the concept of ‘task shifting’.

Priests, traditional birth attendants and community-based reproductive health agents were given responsibility for locating and reporting all births and deaths, and they assisted mid-level providers to locate key informants for verbal autopsy.

From there, nurses and nurse-midwives were trained to administer verbal autopsies and assign cause of death according to WHO ICD-10 classifications.

The study highlights the feasibility of using existing community and health structures to implement MDR.

Expert opinions from around the world: The role of the multi-disciplinary team in MDSR

We asked six experts from Malaysia, Ireland, Ethiopia and India about the importance of multi-disciplinary teams in maternal death surveillance and response (MDSR) systems. Here are the insights they shared with us.

Our contributors have all worked closely with MDSR (or maternal death review also known as MDR, which is a component of MDSR) in various guises, contexts and parts of the world. We have drawn together common themes from their insights to draw out lessons learned for the successful implementation of multi-disciplinary health actor involvement in MDSR.

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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.


MDSR in Ethiopia: three years on

E4A has been providing technical assistance for the introduction, implementation and scale-up of Ethiopia’s national Maternal Death Surveillance & Response (MDSR) system since 2012.

At national level, this has involved contributing to the development of the MDSR Guidance, data collection tools and database, and training curriculum, participating as active members of the MDSR task force, and representing the programme internationally.

The Ethiopia E4A team is based in the MNCH department of the WHO Ethiopia country office. In addition to a Programme Director, E4A is supported by five regional Technical Advisors who have been supporting the four large agrarian regions (Amhara, Oromiya, SNNPR and Tigray) as well as Harari, Dire Dawa and Addis Ababa, and a Data Manager working in the EPHI Public Health Emergency Management (PHEM) directorate. The University of Aberdeen’s Immpact programme and Options serve as the E4A Technical Support Unit, providing strategic guidance and 2 advisors based in Ethiopia.

Read our two page summary of our experiences here>

Read our training materials and guidelines here>

Ethiopia: Obstetricians plan for the future with CME module in MDSR

MDSR now has its own ESOG (Ethiopian Society of Obstetrics and Gynecologists) continuing  medical education (CME) module, which will be used across the country to educate obstetricians and other senior clinicians about  the process of  MDSR.

The module was launched at the ESOG Annual Conference with 68 participants. These  included senior gynaecologists,  who graduated well before the development of the MDSR system, alongside Obstetric and Gynecologist residents who will be leading the system in the future.

The seminar included the latest maternal death data from the national database, the global context of MDSR, an overview of the surveillance system, as well as practical exercises that guide SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) responses.

Ethiopia_CME training

Eighty-five per cent of  the delegates rated the workshop as excellent or above average and ninety-four per cent rated the module as relevant to their practice. Similar numbers said they would modify their practice as a result of the workshop with improvement in documentation being the most popular improvement.

There are plans to take the seminars to the Regions in the near future.

To read more, take a look at Ethiopia’s February 2016 MDSR Newsletter here. You’ll find updates on the role of the Ethiopian Public Health Institute in managing national MDSR data, inspiring stories of good practice, and two case studies: 1) the death of a pregnant adolescent girl from sepsis and 2) a near miss of a pregnant woman with a scarred uterus who received delayed management.

Please also read a presentation on strengthening the MDSR system in Ethiopia delivered at the Global Maternal Newborn Health Conference in Mexico in October 2015 by Professor Wendy Graham, University of Aberdeen, Scotland, and Dr Ephrem Teckle Lemango, Federal Ministry of Health, Ethiopia.

Update from Dr Ruth Lawley, Clinical Technical Adviser, E4A-Ethiopia

Ethiopia MDSR training package and guidelines

The Ethiopian National MDSR Training Package was developed by the Federal Ministry of Health MDSR Task Force, with technical support from Evidence for Action and WHO.


In Ethiopia, the MDSR system was officially launched in May 2013, and a national level Train-the-Trainers workshop was conducted at that time by a multi-sectoral team drawn from the Task Force membership, the Ethiopian Society of Obstetricians and Gynaecologists (ESOG), and the E4A technical assistance team. Following the national training workshop, a “training cascade” was introduced. Each Regional Health Bureau has been responsible for rolling-out the MDSR training to relevant participants in their regions.

Initially, Maternal and Child Health staff were trained using the MDSR Technical Guideline. In 2014, the MDSR system was integrated with the Public Health Emergency Management (PHEM) directorate in the Ethiopian Public Health Institute (EPHI). Since then, surveillance officers have been trained using the PHEM Implementation Manual for MDSR.

The training materials, including the Trainers’ Manual, are designed to support delivery of a comprehensive introduction to the Ethiopian MDSR system, including familiarisation with the data collection tools, and roles and responsibilities at each level of the health system.

The MPDSR and MDSR training packages are available to download below.

The MPDSR training package

  • An MPDSR Training Manual (2017) with power point slides, group activities and solutions for nine modules, including a sample training agenda, and pre- and post-tests.
  • An MPDSR Workbook (2017) intended for use with the three-day training programme,
  • Answer book (to be provided to participants at the end of the training workshop).

The MDSR training package

The MDSR training package has been designed to be interactive. The emphasis throughout the training should be on the use of MDSR as a basis for action. The importance of multi-professional team collaboration is also emphasised throughout the training, as this has been shown to benefit the MDSR system by strengthening communication between disciplinary groups (clinicians, midwives, data managers, community representatives, etc). Where possible, training at each level should be delivered by a multi-disciplinary training team.

Overall Goal of the Training Package

To deliver a practical introduction to the Ethiopian MDSR to support establishment of a functional, effective and action-oriented MDSR system across Ethiopia.

Specific Aims

  • Introduce MDSR concepts and rationale, with presentation of international evidence for its effectiveness and best practice
  • Provide a detailed overview of the Ethiopia MDSR model and vision for how it will operate at each level of the national health system
  • Ensure staff are equipped with the requisite knowledge and competence-based skills for each component of the MDSR process
  • Provide an opportunity for participants to become familiar with the use of the National Guidelines and tools for data collection and reporting.

Target Audience and Objectives

Twelve training modules have been developed, although not all of them are relevant to all participants. The sample training workshop agenda provided in this manual makes suggestions for which modules can be adapted, shortened or removed for specific groups.

Four different levels are envisioned for delivering the training, each with slightly different primary objectives, as follows:

  • National and Regional leads – political commitment, orientation of the system
  • Referral/District Hospitals – facility based data collection
  • Zones and Woreda – managing data flow, identifying actions and reporting upwards
  • Health centres – collecting and reporting data from both community and facilities

By the end of each training workshop, participants should:

  • Understand how MDSR can reduce maternal mortality
  • Know the structure of the Ethiopian MDSR, including roles and responsibilities
  • Recognise and know how to use the national Tools
  • Demonstrate ability to recommend appropriate actions
  • Appreciate the importance of MDSR processes, particularly the need for smooth bi-directional flow of information between different levels of the system
  • Understand the role of monitoring actions to ensure the “response cycle” is completed

Trainings should be completed prior to the initiation of MDSR in each region, and should ensure dissemination of PHEM Integration Manual and Tools to all relevant institutions and individuals who will be involved in implementing the MDSR.