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Implementing maternal death surveillance and response: a review of lessons from country case studies.

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Smith, Helen ORCID: https://orcid.org/0000-0002-6252-3793, Ameh, Charles ORCID: https://orcid.org/0000-0002-2341-7605, Roos, Natalie, Mathai, Matthews ORCID: https://orcid.org/0000-0002-7352-9330 and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2017) 'Implementing maternal death surveillance and response: a review of lessons from country case studies.'. BMC Pregnancy and Childbirth, Vol 17, Issue 1, e233.

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Abstract

Maternal Death Surveillance and Response (MDSR) implementation is monitored globally, but not much is known about what works well, where and why in scaling up. We reviewed a series of country case studies in order to determine whether and to what extent these countries have implemented the four essential components of MDSR and identify lessons for improving implementation. A secondary analysis of ten case studies from countries at different stages of MDSR implementation, using a policy analysis framework to draw out lessons learnt and opportunities for improvement. We identify the consistent drivers of success in countries with well-established systems for MDSR, and common barriers in countries were Maternal Death Review (MDR) systems have been less successful. MDR is accepted and ongoing at subnational level in many countries, but it is not adequately institutionalised and the shift from facility based MDR to continuous MDSR that informs the wider health system still needs to be made. Our secondary analysis of country experiences highlights the need for a) social and team processes at facility level, for example the existence of a 'no shame, no blame' culture, and the ability to reflect on practice and manage change as a team for recommendations to be acted upon, b) health system inputs including adequate funding and reliable health information systems to enable identification and analysis of cases c) national level coordination of dissemination, and monitoring implementation of recommendations at all levels and d) mandatory notification of maternal deaths (and enforcement of this) and a professional requirement to participate in MDRs. Case studies from countries with established MDSR systems can provide valuable guidance on ways to set up the processes and overcome some of the barriers; but the challenge, as with many health system interventions, is to find a way to provide catalytic assistance and strengthen capacity for MDSR such that this becomes embedded in the health system.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WB Practice of Medicine > Diagnosis > General Diagnosis > WB 293 Collections of clinical case reports
WP Gynecology > WP 100 General works
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12884-017-1405-6
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 04 Aug 2017 10:03
Last Modified: 25 May 2018 14:30
URI: https://archive.lstmed.ac.uk/id/eprint/7419

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