In Malawi, the Reproductive Health Directorate, National Committee for Confidential Enquiries into Maternal Death (NCCEMD) and UNFPA are taking a lead in the establishment of MDSR in three new districts (Mzimba, Nkhata Bay and Rumphi) in the northern zone. Over the last few years, MamaYe-E4A has worked in the central and southern regions to introduce components of MDSR into several districts, and this expertise is now being called upon in the expansion of the system to the new districts.
With support from MamaYe-E4A in Balaka, district stakeholders have established MDSRs where there had not been any maternal deaths investigated for a substantial period of time. MamaYe-E4A worked with district authorities to use Health Management Information System and MDSR data to compile a district data dashboard: a user-friendly visual display of graphs in an Excel spreadsheet allowing decision-makers to easily use data to inform their decisions. Based on the analysis of these data, annual MDSR reports were developed, and submitted by the Maternal Health Coordinator to the Director of Health for Balaka to the District Council. The reports highlighted issues with lack of blood and equipment, and the information prompted the District Commissioner for Health to work in collaboration with representatives of civil society and representatives of the community to start fundraising for resources for the health sector.
This type of support is now being extended through MamaYe-E4A to selected districts in the northern region (Rumphi, Nkhata Bay and Mzimba) through funding through the Gates Foundation, in collaboration with the RHD, NCCEMD and UNFPA through the process of establishing the MDSR systems. Through a series of intensive meetings in June, representatives of MamaYe-E4A have supported these organisations to take the lead on MDSR through:
- Developing an MDSR monitoring tool for national level monitoring of the districts’ work on MDSR
- Adapting a maternal death audit form to be used by the districts themselves to monitor their own progress
- Putting together a 2016 workplan, including a commitment to support districts to produce their own quarterly reports according to the guidelines in order for district level decision-makers to be able to take action without having to wait for feedback from the national level monitoring. The plan also includes a proposed meeting between the NCCEMD committee and the National Minister for Health in July to share the progress report on the status for MDSR in the country
- Developing terms of reference for MamaYe-E4A’ssupport of MDSR-focused supportive supervision visits in the three districts.
In addition, MamaYe-E4A has been asked by the CCEMD to finalise the MDSR reports from 2014 and 2015, where these reports have experienced delays related to missing or un-submitted data.
In the last quarter, priorities in the new districts include establishing quarterly supervision of the community-MDSR (cMDSR) committees by district teams and training new cMDSR committees in verbal autopsy. Where there are periods of an absence of maternal deaths at this level, the momentum of the cMDSR committees is being maintained through a broader involvement in the MamaYe campaign. Committee members are engaging in work as MamaYe activists and also as activists mobilising their communities to give blood during the National Blood Transfusion Services’ blood donation drives to help prevent maternal deaths from haemorrhage.
District health authorities in the northern districts have also been supported to replicate the district data dashboard model used in Balaka. Based on evidence arising from the dashboards and MDSR data, e evidence-based advocacy materials have been developed, which call upon different groups to act in support of improving the lives of mothers and babies. For example, in Nkhata Bay, the district data dashboard has revealed that 22 women died from pregnancy or childbirth-related causes between 2013 and 2015, and posters and leaflets were developed to call on healthcare workers, district leaders and traditional authorities to address this issue.
Finally, Malawi is also in the process of establishing nationwide best practice guides. The training of health workers in MDSR has so far been based on the national guidelines, but the Ministry of Health is in the process of standardising the training through establishing a training manual. A database is also being established to list all the health workers already trained in MDSR so that they can be called upon to help scale up the system.
Illustration of dashboard data from a district in Malawi
To view the posters and leaflets developed in Nkhata Bay to call for stakeholder action, please click here and read more about how this evidence on maternal health is used to drive accountability from this link.
Acknowledgements: This country update was developed based on feedback from Project Manager for MamaYe-E4A, Lumbani Banda, and Evidence Advisor for MamaYe-E4A, Hajj Daitoni, as well as updates from the programme reports.