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Table 2 Key drivers of success and aspects that need strengthening to implement MDSR

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


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



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