Tag Archives: training


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>

Sierra Leone - mother

The 2012 MDSR Resource Room

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:

Email: l.hulton@evidence4action.net

Visit: www.mdsr-action.net


Ethiopia MDSR training package and guidelines

The Ethiopian National MDSR Training Package was developed by the Federal Ministry of Health MDSR Task Force, with technical support from Evidence for Action and WHO.


In Ethiopia, the MDSR system was officially launched in May 2013, and a national level Train-the-Trainers workshop was conducted at that time by a multi-sectoral team drawn from the Task Force membership, the Ethiopian Society of Obstetricians and Gynaecologists (ESOG), and the E4A technical assistance team. Following the national training workshop, a “training cascade” was introduced. Each Regional Health Bureau has been responsible for rolling-out the MDSR training to relevant participants in their regions.

Initially, Maternal and Child Health staff were trained using the MDSR Technical Guideline. In 2014, the MDSR system was integrated with the Public Health Emergency Management (PHEM) directorate in the Ethiopian Public Health Institute (EPHI). Since then, surveillance officers have been trained using the PHEM Implementation Manual for MDSR.

The training materials, including the Trainers’ Manual, are designed to support delivery of a comprehensive introduction to the Ethiopian MDSR system, including familiarisation with the data collection tools, and roles and responsibilities at each level of the health system.

The training package

The training package is available to download below. It consists of the following materials:

The training package has been designed to be interactive. The emphasis throughout the training should be on the use of MDSR as a basis for action. The importance of multi-professional team collaboration is also emphasised throughout the training, as this has been shown to benefit the MDSR system by strengthening communication between disciplinary groups (clinicians, midwives, data managers, community representatives, etc). Where possible, training at each level should be delivered by a multi-disciplinary training team.

Overall Goal of the Training Package

To deliver a practical introduction to the Ethiopian MDSR to support establishment of a functional, effective and action-oriented MDSR system across Ethiopia.

Specific Aims

  • Introduce MDSR concepts and rationale, with presentation of international evidence for its effectiveness and best practice
  • Provide a detailed overview of the Ethiopia MDSR model and vision for how it will operate at each level of the national health system
  • Ensure staff are equipped with the requisite knowledge and competence-based skills for each component of the MDSR process
  • Provide an opportunity for participants to become familiar with the use of the National Guidelines and tools for data collection and reporting.

Target Audience and Objectives

Twelve training modules have been developed, although not all of them are relevant to all participants. The sample training workshop agenda provided in this manual makes suggestions for which modules can be adapted, shortened or removed for specific groups.

Four different levels are envisioned for delivering the training, each with slightly different primary objectives, as follows:

  • National and Regional leads – political commitment, orientation of the system
  • Referral/District Hospitals – facility based data collection
  • Zones and Woreda – managing data flow, identifying actions and reporting upwards
  • Health centres – collecting and reporting data from both community and facilities

By the end of each training workshop, participants should:

  • Understand how MDSR can reduce maternal mortality
  • Know the structure of the Ethiopian MDSR, including roles and responsibilities
  • Recognise and know how to use the national Tools
  • Demonstrate ability to recommend appropriate actions
  • Appreciate the importance of MDSR processes, particularly the need for smooth bi-directional flow of information between different levels of the system
  • Understand the role of monitoring actions to ensure the “response cycle” is completed

Trainings should be completed prior to the initiation of MDSR in each region, and should ensure dissemination of PHEM Integration Manual and Tools to all relevant institutions and individuals who will be involved in implementing the MDSR.

FIGO LOGIC MDSR guidelines and training curriculum

These guidelines and training curriculum were developed by FIGO LOGIC to guide health professionals in their efforts to assess quality of care in their own service, and to help health staff conduct reviews of maternal death cases occurring in their health facility.

The FIGO LOGIC (Leadership in Obstetrics and Gynaecology for Impact and ChangeMaternal Death Review Guidelines and Maternal Death Review Training Curriculum were published in early September 2013. The practical guidelines aim to  support clinicians, health systems and facility administrators, MNCH programme managers, NGOs and policy makers in assessing quality of care in their own settings, and build their capacity to conduct maternal death reviews at facility-level. The training curriculum is designed to accompany these guidelines and support their implementation in practice.

Together, they are key tools to support local stakeholders to move forward with MDSR implementation in their own contexts. The tools were field tested in Cameroon with the support of the Society of Obstetricians and Gynaecologists of Cameroon.

To download the FIGO MDR guidelines, click here.

To download the FIGO MDR training curriculum for free, click here.