This article by Animesh Biswas and colleagues in PLoS ONE presents findings of a qualitative study with healthcare providers involved in Facility Maternal and Newborn Death Reviews (FDRs) in two districts in Bangladesh: Thakurgaon and Jamalpur. The study aimed to explore healthcare providers’ experiences, acceptance, and effects of carrying out FDRs.
The study found that there was a high level of acceptance of FDRs by healthcare providers and there were examples of FDRs leading to improvements in quality of care at facilities, such as the use of FDR findings in Thakurgaon district hospital which ensured that adequate blood supplies were available, which saved the life of a mother who had severe post-partum bleeding. The article also identified gaps and challenges in carrying-out FDRs to consider for future efforts, including ensuring incomplete patient records and inadequately skilled human resources to carry out FDRs.
The authors conclude that FDRs are a simple and non-blaming mechanism to improving outcomes for mothers and newborns in health facilities.
To read more about maternal and newborn death reviews in Bangladesh, take a look at several case studies: two from the MDSR Action Network website: “Mapping for Action” and “eHealth to support MPDRs”; and another in the WHO’s global MDSR report here.
In May 2013, the Federal Ministry of Health launched Ethiopia’s MDSR system. By the end of 2014, the system had been introduced in 17 zones and has been integrated into the existing surveillance system. This case study presents the findings of a preliminary audit of responses to maternal death. The “response” arm of MDSR is recognized to be the most challenging part of MDSR with few centres managing to respond in an organised constructive manner to maternal death.
A preliminary audit of responses to maternal death from health facilities at different levels of the health system demonstrated an average of 3 responses to each maternal death.
The audit captured 211 responses to 71 maternal deaths at 33 health facilities/ communities. Of the 211 responses 39% were aimed at improving care within the hospital or health centre demonstrating a constructive approach to the MDSR process. In other words, health facility staff did not simply pass blame to the community or referring health facility for the woman’s death and say “she came too late”.
Actions improved feedback and training to staff, improving services available at the health facility, improving access to essential drugs and equipment and redistribution of staff to improve effectiveness. A further 35% of responses targeted community awareness of the need to access health care in pregnancy. This was done through a variety of methods including regular women’s groups, community meetings and pregnant women’s conference.
MDSR information is a powerful tool of communication between health professionals and communities. Fifteen per cent of actions involved communication with referring health facilities thereby strengthening referral pathways, whilst the remaining 10% targeted the regional or zonal offices to improve transport systems and obtain essential drugs.
It is noted that the majority of the responses taken were not expensive in terms of cash but contributed to staff professional development and raising community awareness of maternal health issues.
To read more, take a look at Ethiopia’s MDSR Newsletter here and a case study in the World Health Organization’s global MDSR report here.
Case study written by Evidence for Action in Ethiopia.
Photo credit: UNICEF Ethiopia/2010/Tuschman
The Evidence for Action programme has developed a structured literature review of how information communication technology (ICT)/mobile technology have been used in low and middle income countries for monitoring and improving the quality of maternal and newborn healthcare in general, as well as in the context of vital event registration and/or maternal death reviews.
The review identified a total of 24 projects covering four thematic areas:
- data management including collection, transmission, and analysis of information
- point of care support by assisting decision-making and diagnosis
- training and disseminating knowledge to healthcare workers (e.g. latest research and guidelines)
- improving communication and networking between healthcare workers and health facilities, patients or other healthcare workers
The review found that these technologies could have greater potential in improving and monitoring quality of maternal and newborn care if the following factors are considered:
- ensuring the deployment of technology that can be installed and maintained locally
- deploying devices and infrastructure that is low cost and can be integrated within the health system
- ensure the buy-in and commitment of key stakeholders
The paper concludes that the future of ICT to contributing to quality of care improvements is promising; however it must be complemented by other inputs such as adequate infrastructure and human resources to maximize its potential.
In October 2012, Evidence for Action hosted a half day practical and interactive “resource room” on Maternal Death Surveillance and Response (MDSR) at the International Federation of Gynecology and Obstetrics (FIGO) 2012 World Congress.
The interactive resource session aimed to:
1) Provide delegates with access to resources and expertise on MDSR
2) Identify training and guidance needs
3) Identify the range of global expertise on MDSR
Key themes covered during the interactive session included:
1) Creating a conducive enabling environment. Resources developed for this theme include:
- Legal briefing leaflet focused on overcoming legal challenges and creating an enabling environment on MDSRs
- Poster on legal considerations related MDSRs.
2) Maternal death identification, notification and reporting. Resources developed for this theme include:
- Poster on maternal death identification, notification and reporting
- Poster on maternal death identification, notification and reporting flowchart
3) Use of findings at multiple levels, including data management, to improve quality of care, prevent further deaths and influence the health system more broadly. Resources developed for this theme include:
- Poster on analysis and response within MDSR
- Poster on improvements in quality of care
- Literature review on the impact of Maternal Death Reviews on quality of care compiled by the Evidence for Action team, September 2012.
4) Components of MDSR. Resources developed for this theme include:
- Poster on MDSR and verbal autopsy
5) Training and support. Resources developed for this theme include:
For more information on MDSR or to join the MDSR Action Network, please:
An International Journal of Obstetrics and Gynaecology has published a special supplement International Reviews: Quality of Care, covering review articles, country studies, and commentaries on the provision and accurate assessment of quality of care for maternal and newborn health. In particular, the supplement highlights experiences in developing and implementing different types of audit to improve the quality of maternal and newborn health, including maternal and /or perinatal death reviews, confidential enquiries, near miss audits, and clinical audits.