1. The Legal Framework for MDSR in Ethiopia’s Health System

2. Overview Importance of the legal framework in guiding MDSR
International examples of successful models
Common concerns
Protections within an MDSR system
Confidentiality
Anonymity
Establishing a “No blame” culture

3. International Examples Malaysia & Sri Lanka
Both countries experienced dramatic improvements in maternal & newborn health
Formal MDR and confidential enquiry systems established
MDR processes adopted ‘no blame’ approach
Emphasised to all that purpose of MDSR to learn from each death and prevent others

4. International experience: India
‘Maternal & Perinatal Death Inquiry and Response’ (MAPEDIR)
Verbal autopsies to address family, community, health services and policy level determinants
Motherhood is a top priority of India’s Rural Health Mission
Confidential, non-threatening environment to allow documentation and analysis of factors leading to adverse maternal outcomes
Informed consent and confidentiality ensured
Confidentiality protected when sharing findings
Result has been openness in reporting, trust across the system and better data

5. Fundamental principles to protect an MDSR:
Confidentiality strictly maintained
Anonymity of all concerned
“No name, no blame” institutionalised
Community liaison at every level

6. Confidentiality: a Code of conduct
Local data collectors and involved health care workers are the only staff who see the names of deceased
Knowledge contained within review committees
All individuals (including committee members) who access identifying data sign a non-disclosure confidentiality agreement (kept on record)

7. Draft Disclaimer (Non-disclosure confidentiality agreement)
We, the members of the ---- review committee, agree to maintain anonymity and confidentiality for all the cases discussed at this meeting, held on [DATE]. We pledge not to talk to anyone outside this meeting about details of the events analysed here, and will not disclose the names of any individuals involved, including family members or health care providers.

8. Anonymity
Notes and reports protect the patient, friends, family and staff members involved
Names obscured on case notes used in review
No names recorded on abstraction forms
Family informed of the purpose of the investigation and how data will be used

9. Essentials of no blame
Acknowledgment throughout system that mistakes do happen
Constructive approach to learning from every death
Identifying preventive measures for the future remains the priority
Use of multi-professional committee to build team solidarity and understanding that each role valuable to the MDSR process
Participation of community representatives to explain value & results to wider audience