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. 2017 Mar 14;2(2):e000199.
doi: 10.1136/bmjgh-2016-000199. eCollection 2017.

'We identify, discuss, act and promise to prevent similar deaths': a qualitative study of Ethiopia's Maternal Death Surveillance and Response system

Berhanu Abebe  1 , Joanna Busza  2 , Azmach Hadush  1 , Abdurehman Usmael  1 , Amsalu Belew Zeleke  1 , Sahle Sita  1 , Solomon Hailu  1 , Wendy J Graham  3
Affiliations

'We identify, discuss, act and promise to prevent similar deaths': a qualitative study of Ethiopia's Maternal Death Surveillance and Response system

Berhanu Abebe et al. BMJ Glob Health. .

Abstract

Introduction: Ethiopia introduced national Maternal Death Surveillance and Response (MDSR) in 2013 and is among the first sub-Saharan African countries to capture data on facility-based and community-based maternal deaths. We interviewed frontline MDSR implementers about their experiences of the first 2 years of MDSR, including perceptions of its introduction and outcomes for health services.

Methods: We conducted a qualitative case study in 4 zones in the largest regions, interviewing 69 key informants from regional, zonal, district and facility levels.

Results: A defining feature of Ethiopia's MDSR system is its integration within existing disease surveillance, with both benefits and challenges. Facilitators of the system's introduction were strong political support, alignment with broader health strategies and strong links across health system departments. Barriers included confusion around new responsibilities, high staff turnover and fear of legal repercussions. Stakeholders believed MDSR increased confidence in using local data to improve maternal health services and enhanced communication across the health system.

Conclusions: MDSR systems take time to establish, encountering challenges in early implementation. Ensuring MDSR has a clear purpose, explicitly defined roles and responsibilities, and adequate supervisory support from the start will ensure it becomes embedded within the health system as routine practice rather than perceived as a stand-alone system. Countries planning to adopt or extend MDSR can learn from Ethiopia's experience, particularly the decision to make maternal mortality a weekly reportable condition within Public Health Emergency Management.

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Conflict of interest statement

Competing interests: All authors worked for the Evidence for Action (E4A) programme at the time of conducting the study and writing the paper, which was funded through the UK Department for International Development.

Figures

Figure 1
Figure 1
Ethiopia's MDSR system structure and data flow. EPHI, Ethiopian Public Health Institute; FMOH, Federal Ministry of Health; MCH, Maternal and Child Health; MDSR, Maternal Death Surveillance and Response; PHEM, Public Health Emergency Management.
See this image and copyright information in PMC

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