Table 1 TOWS Matrix of the process of maternal death review in Malawi

Strengths

Having a task force (staff in maternity and female ward);

Having standards to guide the Maternal Death Review Committee;

Availability of data;

Support from District Health Management Team;

Availability of tools for maternal death review (review forms);

Having financial resources for implementation;

Having technical expertise;

Knowing the evidence.

Weaknesses

Fear of repercussions (blame);

Other competing commitments;

Some health care providers lack knowledge and skills;

Inadequate resources (human and finances);

Missing documentation (poor record keeping);

Lack of transport to follow up at community level;

Shortage of staff especially; senior staff such as Obstetricians & Gynaecologists;

Shortages of drugs, supplies, blood etc.;

Patients come from across the border or other districts.

Opportunities

Technical assistance from international organisations;

Support from the Ministry of Health;

Having national safe motherhood protocols;

Exchange visits to share ideas;

Sharing experiences at workshops;

Current high maternal mortality which provides the rationale to conduct maternal death reviews;

Political will;

Community support/involvement;

Working with women's group.

SO Strategy

Use standards and protocols to identify gaps in practice during maternal death reviews;

Promote information documentation through the use of checklists and supportive supervision;

Promote any forum of sharing experiences such as workshops and exchange visits;

Involve senior management in maternal death reviews;

Promote community involvement/support by working closely with women's group.

WO Strategy

Use technical assistance from international organisations to improve knowledge and skills to conduct maternal death reviews;

Promote forums for sharing experiences such as workshops and exchange visits;

Use women's groups to advocate for more resources in maternal and neonatal health.

Threats

Lack of openness on cultural practices;

Threatening potential court case,

Demotivation by the high maternal mortality;

Political differences (parties);

Communication problems and poor planning (district level reviews);

Lack of political will;

Shortages of supplies, drugs and blood;

Shortages of human resources.

ST Strategy

Promote community involvement by involving men and community leaders on maternity issues;

Emphasize the principle of "no name, no blame" during maternal death reviews;

Encourage the District Health Management Team to allocate resources for Maternal Death Reviews;

Ensure proper stock inventory to prevent the frequent out-stocking of drugs, supplies and blood.

WT Strategy

Promote community involvement by working with community leaders and women's group;

Emphasize anonymity and confidentiality during maternal death reviews;

Lobby for more staff from the Ministry of Health;

Encourage districts to allocate resources for maternal and neonatal health when drawing their annual implementation plan.