Overcoming blame culture: Key strategies to catalyze Maternal and Perinatal Death Surveillance and Response

Maternal deaths remain a major public health concern in low- and middle-income countries. Implementation of maternal and perinatal deaths surveillance and response (MPDSR) is vital to reduce preventable deaths. The study aimed to assess implementation of MPDSR in Rwanda. We applied mixed methods following the six-step audit cycle for MPDSR to determine the level of implementation at 10 hospitals and three health centers. Results showed various stages of implementation of MPDSR across facilities. Maternal death audits were conducted regularly, and facilities had action plans to address modifiable factors. However, perinatal death audits were not formally done. Implementation was challenged by lack of enough motivated staff, heavy workload, lack of community engagement, no linkages with existing quality improvement efforts, no guidelines for review of stillbirths, incomplete medical records, poor classification of cause of death, and no sharing of feedback among others. Implementation of MPDSR varied from facility to facility indicating varying capacity gaps. There is need to integrate perinatal death audits with maternal death audits and ensure the process is part of other quality improvement initiatives at the facility level. More efforts are needed to support health facilities to improve implementation of MPDSR and contribute to achieving sustainable development goal (SDG) 3.

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Causes and contributory factors of maternal mortality: evidence from maternal and perinatal death surveillance and response in Ogun state, Southwest Nigeria

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2202-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 8

Author(s):

Rabiatu Sageer ◽

Eugene Kongnyuy ◽

Wasiu Olalekan Adebimpe ◽

Omolaso Omosehin ◽

Elijah Ayowole Ogunsola ◽

...

Keyword(s):

Maternal Mortality ◽

Perinatal Death ◽

Contributory Factors ◽

Ogun State ◽

Surveillance And Response ◽

Southwest Nigeria

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Implementation of maternal and perinatal death reviews: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2019-031328 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031328

Author(s):

Mary V Kinney ◽

David Roger Walugembe ◽

Phillip Wanduru ◽

Peter Waiswa ◽

Asha S George

Keyword(s):

Conceptual Framework ◽

Scoping Review ◽

Perinatal Death ◽

Grey Literature ◽

Third Party ◽

Related Form ◽

Factors Influencing ◽

Surveillance And Response ◽

Low Middle Income Countries ◽

Review Protocol

IntroductionMaternal and perinatal death surveillance and response (MPDSR), or any related form of audit, is a systematic process used to prevent future maternal and perinatal deaths. While the existence of MPDSR policies is routinely measured, measurement and understanding of policy implementation has lagged behind. In this paper, we present a theory-based conceptual framework for understanding MPDSR implementation as well as a scoping review protocol to understand factors influencing MPDSR implementation in low/ middle-income countries (LMIC).Methods and analysisThe Consolidated Framework for Implementation Research will inform the development of a theory-based conceptual framework for MPDSR implementation. The methodology for the scoping review will be guided by an adapted Arksey and O’Malley approach. Documents will include published and grey literature sourced from electronic databases (PubMed, CINAHL, SCOPUS, Web of Science, JSTOR, LILACS), the WHO Library, Maternal Death Surveillance and Response Action Network, Google, the reference lists of key studies and key experts. Two reviewers will independently screen titles, abstracts and full studies for inclusion. All discrepancies will be resolved by an independent third party. We will include studies published in English from 2004 to July 2018 that present results on factors influencing implementation of MPDSR, or any related form. Qualitative content and thematic analysis will be applied to extracted data according to the theory-based conceptual framework. Stakeholders will be consulted at various stages of the process.Ethics and disseminationThe scoping review will synthesise implementation factors relating to MPDSR in LMIC as described in the literature. This review will contribute to the work of the Countdown to 2030 Drivers Group, which seeks to explore key contextual drivers for equitable and effective coverage of maternal and child health interventions. Ethics approval is not required. The results will be disseminated through various channels, including a peer-reviewed publication.

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Juridification of maternal deaths in Ethiopia: a study of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system

Health Policy and Planning ◽

10.1093/heapol/czaa043 ◽

2020 ◽

Vol 35 (8) ◽

pp. 900-905

Author(s):

Andrea Melberg ◽

Lidiya Teklemariam ◽

Karen Marie Moland ◽

Henriette Sinding Aasen ◽

Mitike Molla Sisay

Keyword(s):

Health System ◽

Health Workers ◽

Perinatal Death ◽

Legal Protection ◽

Sub Saharan Africa ◽

Legal Responsibility ◽

Maternal Deaths ◽

Reporting Practices ◽

Surveillance And Response ◽

Sub Saharan

Abstract Juridification of maternal health care is on the rise globally, but little is known about its manifestations in resource constrained settings in sub-Saharan Africa. The Maternal and Perinatal Death Surveillance and Response (MPDSR) system is implemented in Ethiopia to record and review all maternal and perinatal deaths, but underreporting of deaths remains a major implementation challenge. Fear of blame and malpractice litigation among health workers are important factors in underreporting, suggestive of an increased juridification of birth care. By taking MPDSR implementation as an entry point, this article aims to explore the manifestations of juridification of birth care in Ethiopia. Based on multi-sited fieldwork involving interviews, document analysis and observations at different levels of the Ethiopian health system, we explore responses to maternal deaths at various levels of the health system. We found an increasing public notion of maternal deaths being caused by malpractice, and a tendency to perceive the juridical system as the only channel to claim accountability for maternal deaths. Conflicts over legal responsibility for deaths influenced birth care provision. Both health workers and health bureaucrats strived to balance conflicting concerns related to the MPDSR system: reporting all deaths vs revealing failures in service provision. This dilemma encouraged the development of strategies to avoid personalized accountability for deaths. In this context, increased juridification impacted both care and reporting practices. Our study demonstrates the need to create a system that secures legal protection of health professionals reporting maternal deaths as prescribed and provides the public with mechanisms to claim accountability and high-quality birth care services.

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Strengthening the “P” in Maternal and Perinatal Death Surveillance and Response in Bungoma county, Kenya: implications for scale-up

BMC Health Services Research ◽

10.1186/s12913-019-4431-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Sarah Bandali ◽

Camille Thomas ◽

Phidelis Wamalwa ◽

Shanti Mahendra ◽

Peter Kaimenyi ◽

...

Keyword(s):

Perinatal Death ◽

Scale Up ◽

Surveillance And Response

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“It might be a statistic to me, but every death matters.”: An assessment of facility-level maternal and perinatal death surveillance and response systems in four sub-Saharan African countries

PLoS ONE ◽

10.1371/journal.pone.0243722 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243722

Author(s):

Mary V. Kinney ◽

Gbaike Ajayi ◽

Joseph de Graft-Johnson ◽

Kathleen Hill ◽

Neena Khadka ◽

...

Keyword(s):

Mixed Methods Research ◽

Perinatal Death ◽

Child Survival ◽

Future Research ◽

African Countries ◽

Cross Sectional ◽

Surveillance And Response ◽

Sub Saharan ◽

Facility Level ◽

Implementation Progress

Background Maternal and perinatal death surveillance and response (MPDSR) systems aim to understand and address key contributors to maternal and perinatal deaths to prevent future deaths. From 2016–2017, the US Agency for International Development’s Maternal and Child Survival Program conducted an assessment of MPDSR implementation in Nigeria, Rwanda, Tanzania, and Zimbabwe. Methods A cross-sectional, mixed-methods research design was used to assess MPDSR implementation. The study included a desk review, policy mapping, semistructured interviews with 41 subnational stakeholders, observations, and interviews with key informants at 55 purposefully selected facilities. Using a standardised tool with progress markers defined for six stages of implementation, each facility was assigned a score from 0–30. Quantitative and qualitative data were analysed from the 47 facilities with a score above 10 (‘evidence of MPDSR practice’). Results The mean calculated MPDSR implementation progress score across 47 facilities was 18.98 out of 30 (range: 11.75–27.38). The team observed variation across the national MPDSR guidelines and tools, and inconsistent implementation of MPDSR at subnational and facility levels. Nearly all facilities had a designated MPDSR coordinator, but varied in their availability and use of standardised forms and the frequency of mortality audit meetings. Few facilities (9%) had mechanisms in place to promote a no-blame environment. Some facilities (44%) could demonstrate evidence that a change occurred due to MPDSR. Factors enabling implementation included clear support from leadership, commitment from staff, and regular occurrence of meetings. Barriers included lack of health worker capacity, limited staff time, and limited staff motivation. Conclusion This study was the first to apply a standardised scoring methodology to assess subnational- and facility-level MPDSR implementation progress. Structures and processes for implementing MPDSR existed in all four countries. Many implementation gaps were identified that can inform priorities and future research for strengthening MPDSR in low-capacity settings.

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Implementation of maternal and perinatal death surveillance and response system among health facilities in Morogoro Region: a descriptive cross-sectional study

BMC Health Services Research ◽

10.1186/s12913-021-07268-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Christina Jacob Kashililika ◽

Fabiola Vincent Moshi

Keyword(s):

Perinatal Death ◽

Cross Sectional Study ◽

Health Facilities ◽

Cross Sectional ◽

Implementation Phase ◽

Surveillance And Response ◽

The Status ◽

The Government ◽

Implementation Status ◽

Document Review

Abstract Background When used effectively, the Maternal and Perinatal Death Surveillance and Response (MPDSR) system can bring into reality a revolutionary victory in the fight against maternal and perinatal mortality from avoidable causes. This study aimed at determining the status of implementation of the system among health facilities in the Morogoro Region. Method This study was conducted among 38 health facilities from three districts of the Morogoro region, Tanzania, from April 27, 2020, to May 29, 2020. Quantitative data were collected through document review for MPDSR implementation status. The outcome was determined by using a unique scoring sheet with a total of 30 points. Facilities that scored less than 11 points were considered to be in the pre-implementation phase, those scored 11 to 17 were considered in the implementation phase, and those scored 18 to 30 were considered to be in the institutionalization phase. Results The majority 20(53 %) of health facilities were in the pre-implementation phase, only 15(40 %) of assessed health facilities were in the implementation phase, and few 3(8 %) of health facilities were in institutionalization phase. There was a strong evidence that MPDSR implementation was more advanced in urban compared to rural health facilities (Fisher’s test = 6.158, p = 0.049), hospitals compared to health centers (Fisher’s test =14.609, p <0.001) and private and faith-based organization than public facilities (Fisher’s test, 15.897 = p = 0.002). Conclusions The study revealed that health facilities in Morogoro Region have not adequately implemented the MPDSR system. The majority of health facilities in rural settings and owned by the government showed poor MPDSR implementation and hence called for immediate action to rectify the situation. Strengthen MPDSR implementation, health facilities should be encouraged to adhere to the available MPDSR guidelines in the process of death reviews. Transparent systems should also be established to ensure thorough tracking and follow-up of recommendations evolving from MPDSR reviews. Health facilities should also consider integrating MPDSR to other quality improvement teams to maximize its efficiency.

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