Tag Archives: Guidelines

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

Sierra Leone: Introducing Maternal Death Surveillance and Response

The Ministry of Health and Sanitation (MoHS) have developed national MDSR guidelines (see here) in partnership with UNFPA, the World Bank, and the WHO. The Directorate of Reproductive and Child Health are now leading on the national roll-out of these guidelines. Also, the MoHS, in partnership with UNFPA and other health development partners, has developed a three year costed plan to be implemented over the next three years.

In February 2016, the national MDSR committee was inaugurated and an orientation meeting took place in the same month.  This month, an orientation meeting is planned for all MDSR focal point persons, including midwife investigators and other key staff from the districts. All districts will shortly have inaugural meetings for their MDSR committees (building on existing MDR committees).

Update from Bockarie Sesay, Monitoring & Evaluation Advisor for the Partnership Management, Evaluation and Learning (PMEL) programme, and Rosanna le Voir, Technical Assistant for PMEL

Sierra Leone’s MDSR guidelines

Sierra Leone has one of the highest levels of maternal mortality in the world, with an estimated 2,400 women dying during pregnancy or childbirth every year. In order to prevent maternal deaths and improve quality of care, the Government of Sierra Leone has adopted the Maternal Death Surveillance and Response (MDSR) system and released these guidelines.

These guidelines provide guidance on the implementation of MDSR in Sierra Leone, building on the Maternal Death Review system and “piggybacking” onto the Integrated Disease Surveillance and Response (IDSR) system.  Maternal deaths have now been integrated into the notifiable reporting system of the IDSR. The guidelines focus on the following implementation steps:

  1. Identification and notification of maternal deaths
  2. Maternal death review
  3. Analysis – data aggregation and interpretation
  4. Response to maternal deaths
  5. Dissemination of results, recommendations and responses
  6. Monitoring and Evaluation for MDSR system
  7. MDSR implementation plan

Download Sierra Leone’s MDSR guidelines here.

Tanzania

The Ministry of Health and Social Welfare (MOHSW), in collaboration with several stakeholders including the World Health Organization, UNFPA, UNICEF, Evidence for Action (E4A), national professional bodies, and Tanzanian and international research institutions, have updated the existing Maternal and Perinatal Death Review system to Maternal and Perinatal Death Surveillance and Response (MPDSR) in light of latest technical guidance.  The updated MPDSR guidelines were approved in November by the MOHSW and are now being rolled-out across Tanzania through a phased approach, starting in Mara region. To read more about Tanzania’s MPDSR guidelines, take a look at this case study by E4A.

Update from Dr Moke Magoma, Evidence Advisor for E4A-Tanzania

FIGO LOGIC MDSR guidelines and training curriculum

These guidelines and training curriculum were developed by FIGO LOGIC to guide health professionals in their efforts to assess quality of care in their own service, and to help health staff conduct reviews of maternal death cases occurring in their health facility.

The FIGO LOGIC (Leadership in Obstetrics and Gynaecology for Impact and ChangeMaternal Death Review Guidelines and Maternal Death Review Training Curriculum were published in early September 2013. The practical guidelines aim to  support clinicians, health systems and facility administrators, MNCH programme managers, NGOs and policy makers in assessing quality of care in their own settings, and build their capacity to conduct maternal death reviews at facility-level. The training curriculum is designed to accompany these guidelines and support their implementation in practice.

Together, they are key tools to support local stakeholders to move forward with MDSR implementation in their own contexts. The tools were field tested in Cameroon with the support of the Society of Obstetricians and Gynaecologists of Cameroon.

To download the FIGO MDR guidelines, click here.

To download the FIGO MDR training curriculum for free, click here.

Latest WHO technical guidance on MDSR

This key document, published in October 2013, provides practical guidance to move from maternal death reviews to surveillance and response, emphasising the response component as well as focusing on quality of care improvements. 

This document introduces the critical concepts of MDSR, including goals, objectives, and specific instructions for implementing each surveillance component, as well as outlining how districts can set up MDSR processes to strengthen surveillance and response.

These guidelines have been developed by the MDSR Working Group which includes UN agencies, academics and professional organizations and other partners. It builds on the 2004 WHO publication “Beyond the Numbers: Reviewing maternal deaths and complications to make pregnancy safer” and previous work done in this area by WHO and other partners.

Health-care professionals, health care planners and managers, policy makers working in maternal health, and those who measure maternal mortality will find these guidelines useful as they set up, implement and strengthen MDSR systems in their own settings.

To download the guidance for free, click here!