Tag Archives: Nepal

Making the case for MDSR at Women Deliver

The MDSR Action Network was represented at the Women Deliver conference through an Options evening side event on ‘Accountability for Health Results’.

The event included talks and booths about Options’ work in Nigeria, Nepal, Tanzania and Malawi as well as Options’ regional network and platforms: MamaYe, Africa Health Budget Network, The Girl Generation, African Health Stats and the MDSR Action Network.

Photo credit: E4A

The MDSR booth at the event exhibited materials highlighting Options’ MDSR work worldwide, including copies of the MDSR Action Network newsletter and the MDSR scorecards from Sierra Leone and Nigeria. It provided a great opportunity to share resources and experiences of how different countries are using MDSR to strengthen accountability to improve the care of mothers and babies.

Dr Tunde Segun, Country Director of MamaYe-E4A Nigeria, manned the booth and engaged with a steady stream of visitors, talking them through the materials, answering questions, and inviting them to sign up for the MDSR Action Network newsletter. Almost all of those approaching the booth readily agreed to sign up to be kept in the loop on this important issue.

Dr Segun spoke to a crowded room about how the MamaYe-E4A programme in Nigeria has supported MDSR. For example, four states have now established MDSR scorecards, which measure the strength of the MDSR system and can act as powerful catalysts of action to improve quality of care. In Jigawa State, the MDSR data showed clearly that more maternal deaths were occurring at night, and action was taken to modify staff rotas to ensure senior midwives were on duty during the night shifts.

In Ondo State during the last quarter of 2015 and first quarter of 2016, the MDSR scorecard showed that sepsis had overtaken haemorrhage as the primary cause of maternal death. Health care providers, policy makers and stakeholders discussed these findings, looking at gains made in addressing haemorrhage by improving the functionality of blood banks in Ondo, but also in terms of the practical actions the state could take to confront sepsis. Actions such as lobbying to get the most effective antibiotics available under the state’s free maternity services are being considered.

Finally, Dr Segun celebrated Nigeria’s pioneering spirit on MDSR by sharing the fact that during the FIGO World Congress in Vancouver 2015, the World Health Organization had revealed that Nigeria was the only country at that time to have produced an MDSR scorecard at the sub-national level.


This case study was informed by feedback from Dr Tunde Segun, Country Director for Evidence for Action in Nigeria.

Malaysia | Strengthening MDSR at national and regional level

The MDSR system in Malaysia is often referred to as a model upon which other countries can learn about how success can be achieved with limited resources. To support other countries in taking forward MDSRs, the Government and Ministry of Health of Malaysia are actively supporting implementation in Lao PDR, Vietnam and Nepal with regular visits conducted by Dr Ravichandran Jeganathan, the National Head of Obstetrics and Gynaecological Services at the Ministry of Health in Malaysia. Dr Jeganathan summarised the focus of his advocacy during the Lao PDR meeting as a call for ensuring adequate skilled birth attendance for each community at village level by ensuring that each village to have at least one midwife.

During these visits, local teams are guided in how to adapt and develop tools to conduct the investigation process, and have been trained how to conduct maternal death reviews. Specific attention is given to clarify the concept of a non-punitive approach and how the response mechanism can be implemented and achieved with ease, even with minimal resources. Dr Jeganathan is a keen advocate for including medical and nursing students on the training to ensure their exposure to the concept of MDSRs early on in their career. 

In Malaysia, the sixth edition of the Report on the Confidential Enquiries into Maternal Deaths in Malaysia 2009 – 2011 that was in progress during the last newsletter is now available upon request.

In addition, a near miss registry is being finalised; parameters have been identified and tools drafted. This near miss approach will be piloted in one district hospital in September 2016 to ascertain its validity.


This country update was informed by feedback from Dr Ravichandran Jeganathan, the National Head of Obstetrics and Gynaecological Services at the Ministry of Health in Malaysia.

For previous country updates of Malaysia and a case study written by Dr Jeganathan, follow the links or visit the MDSR Action Network website.