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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 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