1. Maternal Deaths & Maternal Death Surveillance and Response (MDSR): Definitions, the National Guidelines and Action Plan Midwife in Sudan. UNFPA www.evidence4action.net/wp-content/uploads/2011/09/en_SOWMR_ExecSum.pdf

2. Learning objectives By the end of this session, participants will be able to: Define and classify maternal deaths Describe global patterns of maternal mortality Describe the structure of the Ethiopian MDSR Identify the review committees and their composition at each level Explain how data will flow through the system

3. Definitions (1) A Maternal death is the death of a woman  while pregnant or within 42 days of the end of pregnancy (irrespective of duration and site of pregnancy)  from any cause related to or aggravated by the pregnancy or its management  but not from accidental or incidental causes (Source: ICD-10)

4. Definitions (2) Direct obstetric deaths are maternal deaths resulting from complications in pregnancy, labour or postpartum or from omissions or incorrect treatment. Indirect obstetric deaths are maternal deaths resulting from previously existing or newly developed medical conditions aggravated by the physiologic effects of pregnancy. Late maternal deaths are deaths from direct or indirect causes that occur from 42 to 365 days after the end of pregnancy (Source: ICD-10)

5. Definitions (3) A Pregnancy related death is all deaths of women during or within 42 days of the end of pregnancy regardless of cause. Useful in settings where it is difficult to determine cause, and in many low resource contexts, the cause of death is highly likely to be related to pregnancy

6. Definitions (4) A maternal near-miss is defined as “a woman who nearly died but survived a complication during pregnancy, childbirth or within 42 days of end of the pregnancy”  “Near misses” occur when women survive life- threatening conditions (i.e. organ dysfunction)  Use of Near Misses provides a positive approach (analysing survivals rather than deaths)  Appropriate for review when there are too few deaths to support regular review meetings

8. Review of Classifications Direct Causes (75%) Obstetric causes during pregnancy, childbirth and the post-partum period, such as: Haemorrhage Hypertensive disorders Infection Obstructed labour Abortion Indirect Causes (25%) Medical conditions that can be aggravated through pregnancy, such as: HIV (including TB and pneumonia) Malaria Anaemia Heart conditions Social, cultural & environmental factors across a woman’s life course affect risk for direct & indirect causes of death

9. Purpose of the MDSR Guidelines To provide guidance for the set-up and sustained functioning of Ethiopia’s MDSR for: o health professionals o health care planners and managers o policy makers who take action based on MDSR findings To ensure use of emerging information in improving maternal health outcomes

10. Goal and Objectives of Guidelines Goal : To guide effective implementation and scale up of MDSR in a systematic, standardized and integrated manner

11. Objectives o Strengthen capacity of program managers & providers in analysis & interpretation of maternal death data o Facilitate standardization & harmonization of the MDSR process at community, facility, district & regional levels o Guide program managers in timely implementation, monitoring and supervision of MDSR at different levels o Serve as a basic tool to guide service providers in MDSR o Improve use of information to produce local solutions to the root causes of maternal death

12. Committee Structure National Task Force RHB Review Committee Zonal Level Reporting Woreda Level Reporting Health Centre Committee: Reviews Verbal Autopsies for community & HC deaths Hospital Committee: Reviews deaths occurring within the premises Referral Hospitals

13. Committee Membership Chair, MSD, HPDP, FMHACA, HRNI, Midwives Assoc., Anaethetists, ESOG, H4, partners Zonal Level Reporting Woreda Level Reporting HC Director, HEW Supervisor, Midwives, Nurses, 2 Comm reps, Pharmacists, Woreda MNH Lead OB/GYN, IESO, Snr. Midwives, Anaethetists, CEO, Med Dir, Quality of Care Lead RHB Deputy Head, MNH focal person, Senior Midwife, ESOG, Partner representative OB/GYN, IESO, Snr. Midwives, Anaethetists, CEO, Med Dir, Quality of Care Lead

15. Culture of no blame The man in the boat needs help managing his appetite, a reminder of good nutrition, and assistance to stop sinking, but NOT a lecture on his poor eating habits! Healthcare providers are vulnerable to self blame, which does not improve care Support and training are better solutions for preventing future deaths “No blame” is NOT “no accountability”

16. National MDSR Action Plan May: National training & dissemination of guidelines June – September : Regional Committees established June - September: Phase I implementation (committees established at Facilities & Health Centres, with woreda support) September : Orientation for Health Facilities, Health Centres and HEW October ‘13 – March ‘14: Phase II April – September ‘14: Phase III Monthly monitoring throughout