Tag Archives: Tanzania

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.

Acknowledgements:

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

Tanzania | Rolling out MPDR to new regions

A maternal and perinatal death reviews (MPDR) system has been embedded in Mara Region in Tanzania with support from the Mama Ye-E4A programme. This programme worked with the Ministry of Health to establish accountability mechanisms at and council levels in line with the national MPDR guidelines which ensures timely reviews of the implementation progress. The evidence-based National MPDR Guidelines have been replaced by MPDSR guidelines.

Mara was chosen by the Ministry of Health to act as an initial roll-out region for the new MPDSR guidelines in Tanzania. A subsequent assessment suggests that health care providers and managers have the required skills to implement the national guidelines effectively across all levels of service delivery and administration. This brings optimism that for the first time in the national implementation of maternal and perinatal death audits, progress will be monitored and evaluated to inform subsequent responses in maternal and perinatal survival and well-being for transformative gains across the health sector and beyond.

In embedding a functioning action and response cycle through the MPDSR process, Mama Ye-E4A ensured that decision-makers have been supported to continue to deliver against their responsibilities and commitments such that a functioning action and response cycle is embedded and sustainable in Mara region. The last quarter saw the end of the Mama Ye-E4A programme in Tanzania, but the important progress and championing of the establishment and subsequent roll-out of MPDSR looks set to continue under the remit of the GIZ-supported Tanzania German Health Support Programme.

The MPDSR system has been rolled out by the Ministry of Health to two more regions of Kagera and Lindi. Already, training has been conducted for key personnel in all hospitals in the two regions, regional and council health management team members and to stakeholders’ staffs supporting the two regions in RMNCAH namely Jhpiego and GIZ respectively. MPDSRs are recognised as key accountability and quality of care improvement mechanisms and referred to in the National Health Sector Strategic Plan 2016-2020- an important health sector guiding document beyond RMNCAH to ensure they remain a priority in the years to come. They have also been incorporated in the final drafts of the One Plan II (National RMNCAH Strategy for 2016-2020).

At the national level, the WHO country office has released funds for rolling out MPDSR across all regions in the country using the same platform that was used to roll-out the Sharpened National Accelerated Plan for Reduction of Maternal, Newborn and Child Deaths. Thus, significant activities are expected countrywide with a focus to impact appropriate skills in MPDSR implementation across all regions.

This update was informed by feedback from Moke Magoma, former Evidence Advisor on Mama Ye-E4A Tanzania; a March 2016 policy study conducted by Dr Sarah Clark (University College London), Dr Stephanie Smith (University of New Mexico), and Dr Moritz Hunsmann (French National Centre for Scientific Research); country director reports; and Mama Ye-E4A quarterly reports.

Maternal death reviews at Bugando hospital north-western Tanzania: a 2008–2012 retrospective analysis

This article by Moke Magoma and colleagues, published by BMC Pregnancy and Childbirth in December 2015, presents the findings of a statistical analysis of data from maternal death reviews (MDR) in Bugando Medical Centre, north-western Tanzania between 2008 and 2012. The study presents the findings from the analysis, as well as describing the challenges of the analysis and how it provided a greater understanding of maternal deaths. The authors found that routine MDRs in this setting were not complete, with key documentation missing, such as actions to address weaknesses in the system.  The authors conclude that the roll-out of new national guidelines in Tanzania may help to build capacity for tertiary institutions to carry-out training of health professionals in maternal and perinatal death reviews.

Tanzania: Rolling-out Maternal and Perinatal Death Surveillance and Response

At national level, the Maternal and Perinatal Death Surveillance and Response (MPDSR) guidelines have been sent for printing ready for distribution across the regions. In Mara region, the maternal and perinatal death review report has been reviewed to include all deaths from 2015.

Update from Dr Moke Magoma, Evidence Advisor for E4A-Tanzania

Tanzania

The Ministry of Health and Social Welfare (MOHSW), in collaboration with several stakeholders including the World Health Organization, UNFPA, UNICEF, Evidence for Action (E4A), national professional bodies, and Tanzanian and international research institutions, have updated the existing Maternal and Perinatal Death Review system to Maternal and Perinatal Death Surveillance and Response (MPDSR) in light of latest technical guidance.  The updated MPDSR guidelines were approved in November by the MOHSW and are now being rolled-out across Tanzania through a phased approach, starting in Mara region. To read more about Tanzania’s MPDSR guidelines, take a look at this case study by E4A.

Update from Dr Moke Magoma, Evidence Advisor for E4A-Tanzania

Strengths and weaknesses in the implementation of maternal and perinatal death reviews in Tanzania; perceptions, processes and practice

A recent article, published in Tropical Medicine and International Health, by C. E. Armstrong, I. L. Lange, M. Magoma, C. Ferla, V. Filippi, and C. Ronsmans, analyses the implementation of MPDR in Tanzania at district and regional hospitals and how the staff have engaged with the system, and their perceptions of it.

This qualitative study using semi-structured interviews with thirty-seven key informants found that there was a great need to strengthen the capacities of staff to collect quality data.