This analysis of the findings of the national confidential enquiry around maternal deaths conducted the Ministry of Health in Morocco shows that 54.3% of the deaths analysed in 2009 could have been avoided if appropriate action had been taken at health facilities.
This contradicted previous beliefs that the main causes of maternal death were due to women delaying seeking care. Lack of competence or motivation of staff were linked to the majority of cases of substandard care these women received.
The authors recommend that the managers of local health systems and practitioners themselves received the information and means to support them to implement the recommendations of the audits.
This study highlights the importance of involving hospitals and health providers in the audit process and particularly in supporting them to respond to findings.
The 2013 paper describes the development of the maternal death surveillance system (MDSS) in Morocco and discusses initial results.
When DHS surveys highlighted a high MMR in Morocco in 1997 and 2003 (227 and 228 per 100 000 respectively), the Ministry of Health established the National Commission on Maternal and Neonatal Mortality Reduction, in 2007 to strategise how the high levels of mortality can be reduced. One key aspect of the strategy was the systematic reporting and analysis of maternal deaths, by documenting the location, the cause and circumstances of each maternal death.
Although a routine reporting system for maternal deaths covering all public health facilities already existed it did not cover private facilities or all home deaths. The MDSS was designed to bridge this gap and the data collection includes:
- mandatory reporting by local authorities (rural moqadems and the urban Municipal Hygiene Bureaus) of all home deaths of women aged 15 – 49 to local health services
- reviews of discharge registers at all hospitals to record all hospital deaths of women of reproductive age in a special register
Maternal deaths are then identified and reviewed through confidential audit and verbal autopsy. Quarterly reports are submitted to the MDSS central team. After the first year of implementing the MDSS which relies on a Reproductive Age Mortality Study (RAMOS) approach covering the whole country, one of the weaknesses appeared to be the incompleteness of data. This helped to consider the shortcomings in the processes of reporting, particularly in the rural areas. However, over all, the system allowed for the identification of 12.3% more pregnancy-related deaths in health facilities than the routine information system. It enabled a better understanding of the causes and circumstances of maternal deaths, it also provided a basis for action.
Abouchadi, S., Belghiti Alaoui, A., Meski, F.Z., & De Brouwere, V. (2013). Implementing a maternal mortality surveillance system in Morocco – challenges and opportunities. Tropical Medicine and International Health, 18 (3) (open access)