Presentation on theme: "The global movement for Maternal Death Surveillance and Response"— Presentation transcript:
1The global movement for Maternal Death Surveillance and Response (MDSR)Prepared by Professor Wendy J Graham
2Confidential Enquiries into Maternal Deaths: United Kingdom, Malaysia, Sri Lanka, South Africa, EgyptWHO, 2004Maternal death reviews (MDR) have been shown to be effective in improving team work, management and quality of care.
346 AFRO countries (2011):15% have established required policies & are conducting MDR at facility and community levels.68% of countries are conducting facility-based MDR in selected districts. 17% of countries had no information available.
4Why is there renewed interest in maternal death reviews Why is there renewed interest in maternal death reviews? Why a global movement?
6Progress on maternal and child survival : 75 highest-burden countries (2012) On track for MDGs 4 and 5a (8)Bangladesh, Cambodia, China, Egypt, Eritrea, Lao PDR, Nepal and VietnamOn Track for MDG 5(a) only (1)Equatorial GuineaOn track for MDG 4 only (15)Bolivia, Brazil, Guatemala, Indonesia, Iraq, Korea DPR, Kyrgyz Republic, Liberia, Madagascar, Malawi, Mexico, Morocco, Peru, Philippines, Solomon Islands
7Do all women, newborns and children have access to the essential continuum of care? The Continuum of Care
10“Maternal mortality is much more than a medical issue” Ban Ki-moonUnited Nations Secretary GeneralUN General Assembly 2009
11Secretary-General Ban Ki-moon launches the Global Strategy for Women’s and Children’s Health (Sept 2010)1111
12Commission’s 10 recommendations have been translated into a common strategic work plan, with priority areas including:birth and death registrationmonitoring of resultsmaternal death surveillance and responsestrengthening use of ICTresource trackingnational mechanisms for review and accountabilityadvocacy for action
13Maternal Death Surveillance & Response: a continuous action cycle at community, facility, regional & national levelsSurveillanceRespond &monitor responseAnalyse & makerecommendationsIdentify & notify deathsReview deathsResponse
14Maternal Death Surveillance & Response May 2013“A maternal death surveillance and response system that includes maternal death identification, reporting, review and response can provide the essential information to stimulate and guide actions to prevent future maternal deaths and improve the measurement of maternal mortality.”(Bull World Health Organ Nov 2011;89:779–779A)
15What lessons were learnt from existing death review systems? Action-focusedFacility & community deathsDeaths are notifiable eventsMulti-professionalMulti-sectoral responsibilityCulture of no-blame & legal framework addressedSystematic capture & useLessons learnt at all levelsMDSRReview-process focusedFacility deaths onlyDeaths not notifiablePhysician-drivenHealth sector onlyCulture of blame & legal issues ignoredAd hoc capture of dataLimited lessons for action at national level
16Why is MDSR important? What opportunities does MDSR provide? Provides information for actionConnects actions to resultsMakes maternal death visible at local & national levelsSensitizes communities & facility health workersBoosts country ownership of dataProvides data in real timeEnables progress towards capturing all deaths
17What are the challenges faced in implementing MDSR? Engaging communitiesWeak data availability & qualityHuman resource requirementsNeed for continuous commitment at all levelsBuilding enabling environment of “no blame” & legal framework (protection, anonymity, confidentiality)
18Common concerns with death reviews Patients: concern that illegal behaviour will be punished (e.g. abortion, under-age marriage)Families: concern for repercussions (not seeking care, being involved in illegal behaviour)Health workers: concern for prosecution or job lossFacilities: concern for lost reputation & legal costsCommittee members: concern for adverse reactions from colleagues or management
19Some consequences of concerns Under-reportingMisreportingDefensive behaviourDiverts attention from actions to save lives of mothers & newborns
20Fostering the essential culture of “no blame” Acknowledgment throughout system that mistakes do happenConstructive approach to learning from every deathIdentifying preventive measures for the future as over-riding priorityUse of multi-professional committee to build team solidarityParticipation of community representatives to explain value & results to wider audience
21“The presence of a legal framework is a driving force behind MDSR systems ,and is critical to mitigating legal challenges on numerous levels including for the patient, family, health professional and facility”Pearson, L. et al (2009). Maternal death reviews in Africa. International Journal of Gynecology and Obstetrics, 106,
22International Example: United Kingdom “No name, no blame” is a fundamental principleBoth women who have died AND the health providers remain anonymous during reviewsTwo government acts guarantee confidentialityReviews cannot be used in litigation, management sanctions or personal blame
23International experience: India Motherhood is the top priority of India’s Rural Health MissionConfidential, non-threatening environment created to allow documentation and analysis of factors leading to adverse maternal outcomesInformed consent and confidentiality ensuredConfidentiality protected when sharing findingsResult has been openness in reporting, trust across the system and better data
24Why is Ethiopia at the forefront of the global movement for MDSR? RMNCH is a top national priorityFMoH’s strong ownership of MDSRAction-focused MDSR from outsetStrong championsExisting expertise & experienceCommunity link enabled by HDAHigh level commitment to maintaining momentum started todayEnabling environment being built, including legal framework