From: Implementing maternal death surveillance and response: a review of lessons from country case studies
Drivers and conditions of success | Relevant case study examples | Aspects of implementation that need strengthening as countries transition from MDR to MDSR | Relevant case study examples |
---|---|---|---|
Policy level | Policy level | ||
Strong government commitment and involvement in commissioning or providing administrative support to the CEMD process | Malaysia, RSA, UK | Less reliance on external funds and/or the goodwill of national professional organisations to support administration, training and implementation of the MDR process | Cameroon, India, Kenya, Malawi, Nigeria |
Enforcement of MDR policies by professional organisations/colleges | UK | Political commitment and government funds to scale-up, supervise and monitor MDR activities | Bangladesh, Cameroon, India, Nigeria |
Adequate legal frameworks to prevent punitive action | UK, Malaysia | ||
Use of review data to target MoH budget allocation and revise key performance indicators | Malaysia | ||
District level | District level | ||
Accurate data on number of live births and maternal deaths collected via reliable district health information systems or routine death registration | Malaysia, RSA, UK | Knowledge among health professionals and administrators of the MDSR reporting process | India, Nigeria, Malawi |
Electronic systems that allow for rapid assessment and analysis | Malawi, RSA, UK | Available reporting forms or forms to collect information pertaining to maternal deaths that are fit for purpose | Kenya, Malawi |
Systematic identification and dissemination of remedial actions and recommendations targeted at different levels of the health system | Malaysia, UK | Strategy for monitoring implementation of recommendations | Cameroon, Kenya |
Obtaining accurate patient records or information on circumstance and management of women at all levels | Bangladesh, India, Malawi, Moldova, RSA | ||
Underreporting and misclassification of maternal deaths | Bangladesh, India, Kenya, RSA | ||
Facility level | Facility level | ||
Commitment of unpaid health professionals who participate as part of professional development | Malaysia, RSA, UK | Familiarity and confidence in the reporting process for MDR | India, Kenya, Nigeria |
Knowledge and understanding among healthcare providers of how to assign cause of death and contributing factors and/or apply ICD-MM | Kenya, Malawi | ||
Need to reassure health professionals involved in MDR of the principles of confidentiality and anonymity, and take action to avert or overcome a blame culture | India, Kenya, Malaysia, Moldova, RSA | ||
Culture among assessors and/or healthcare workers of quality improvement through reflection on practice | Cameroon, India, Moldova, Nigeria | ||
Mechanism to support health facilities or health professionals to act on review recommendations to improve quality of care at different levels | Cameroon, India, Kenya. Moldova, RSA |