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Review
. 2017 Jul 17;17(1):233.
doi: 10.1186/s12884-017-1405-6.

Implementing maternal death surveillance and response: a review of lessons from country case studies

Helen Smith  1 , Charles Ameh  2 , Natalie Roos  3 , Matthews Mathai  2 , Nynke van den Broek  2
Affiliations
Review

Implementing maternal death surveillance and response: a review of lessons from country case studies

Helen Smith et al. BMC Pregnancy Childbirth. .

Abstract

Background: Maternal Death Surveillance and Response (MDSR) implementation is monitored globally, but not much is known about what works well, where and why in scaling up. We reviewed a series of country case studies in order to determine whether and to what extent these countries have implemented the four essential components of MDSR and identify lessons for improving implementation.

Methods: A secondary analysis of ten case studies from countries at different stages of MDSR implementation, using a policy analysis framework to draw out lessons learnt and opportunities for improvement. We identify the consistent drivers of success in countries with well-established systems for MDSR, and common barriers in countries were Maternal Death Review (MDR) systems have been less successful.

Results: MDR is accepted and ongoing at subnational level in many countries, but it is not adequately institutionalised and the shift from facility based MDR to continuous MDSR that informs the wider health system still needs to be made. Our secondary analysis of country experiences highlights the need for a) social and team processes at facility level, for example the existence of a 'no shame, no blame' culture, and the ability to reflect on practice and manage change as a team for recommendations to be acted upon, b) health system inputs including adequate funding and reliable health information systems to enable identification and analysis of cases c) national level coordination of dissemination, and monitoring implementation of recommendations at all levels and d) mandatory notification of maternal deaths (and enforcement of this) and a professional requirement to participate in MDRs.

Conclusions: Case studies from countries with established MDSR systems can provide valuable guidance on ways to set up the processes and overcome some of the barriers; but the challenge, as with many health system interventions, is to find a way to provide catalytic assistance and strengthen capacity for MDSR such that this becomes embedded in the health system.

Keywords: Case studies; Implementation; MDSR; Maternal death surveillance and response.

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Conflict of interest statement

Ethics approval and consent to participate

In this paper, we report findings of a secondary analysis of ten case studies. The case studies were summarised from a series of original articles for the WHO Global MDSR Implementation Survey. The original articles were published in BJOG: An international Journal of Obstetrics & Gynaecology: http://obgyn.onlinelibrary.wiley.com/hub/issue/10.1111/bjo.2014.121.issue-s4/. Because we analysed already published and available research findings, we did not require ethical approval.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Maternal Death Surveillance and Response (MDSR) system: a continuous-action cycle (adapted from WHO 2014 [3])
See this image and copyright information in PMC

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