Tag Archives: 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.

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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>

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A Maternal Survival Action Network for Sierra Leone

This case study outlines how Sierra Leone introduced a Maternal Survival Action Network to support the implementation of Maternal Death Reviews across the country. This is an updated version of a case study originally published in our April 2013 issue of the MDSR Action Network newsletter.

In Sierra Leone, implementation of Maternal Death Surveillance and Response (MDSR) has been revitalised since the onset of the Ebola outbreak.

Sierra Leone’s national MDSR framework previously focussed on facility-based MDRs. There is widespread agreement by experts and activists that the use of findings from MDRs for service delivery improvements in the current model of implementing MDRs could be significantly strengthened and efforts to re-establish facility-based MDRs on a regular basis is being re-established. A review of processes and challenges identified opportunities to strengthen MDRs and make better use findings at facility level. The intention is to strengthen the system by identifying context-specific barriers and enablers to the use of MDR findings for quality of care improvements. Continue reading

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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

Malawi’s MDSR guidelines

The Ministry of Health in Malawi released Maternal Death Surveillance and Response (MDSR) guidelines for health professionals in 2014. These guidelines aim to inform capacity building and implementation of a functional MDSR system in Malawi, incorporating it within the current Integrated Disease Surveillance and Response (IDSR) system.

Download Malawi’s MDSR guidelines here.

Maternal Death Surveillance and Response in East and Southern Africa

This article by Heather Scott and colleagues, published by the Journal of Obstetrics and Gynecology Canada in October 2015, provides an overview of the status of MDSR implementation in East and Southern Africa by presenting key findings from 1) a knowledge-sharing regional meeting in Johannesburg, South Africa in November 2014, and 2) an evaluation of the Confidential Enquiry into Maternal Deaths in South Africa by UNFPA. The authors found that MDSR is still not at an optimal level in many countries in sub-Saharan Africa. More work by national authorities, communities, and development organisations is needed, particularly in addressing key challenges.

Gender mainstreaming Maternal Death Surveillance and Response Systems in Africa

This report, published by the African Union Commission and UN Women in May 2015, examines how maternal death audits or MDSR systems are being used to track gender inequalities.   The researchers carried out in-depth interviews with key informants from five African countries, Chad, Ethiopia, Nigeria, South Africa and Tunisia, as well as a documentary analysis of key documents. On the basis of the findings from this research, the document provides recommendations on ways these systems can be used to monitor more effectively gender-related contributors and how to mainstream gender in MDSR systems in Africa.

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.

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.

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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