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Maternal Death Surveillance and Response Systems in Driving Accountability and Influencing Change

This is the fifth article in Evidence for Action-MamaYe’s third series published in the International Journal of Gynaecology and Obstetrics. This paper presents key findings from the 2015 WHO and UNFPA Global Implementation Survey on Maternal Death Surveillance and Response (MDSR) systems.   


From 1990-2015, there was good progress in reducing maternal deaths.  However more progress is needed meet the Sustainable Development Targets (SDG) and to end preventable maternal deaths.  MDSR systems contribute to improved, actionable information on maternal deaths and can prevent similar deaths in the future. 

This paper analyses key findings from the 2015 WHO and UNFPA Global MDSR Implementation Survey to look at how far MDSR systems are strengthening response and accountability for better health outcome.  It also looks at two case-studies from Nigeria and Ethiopia to understand how findings have influenced systematic changes in policy or practice.

Analysis Approach

  • A total of 67 countries responded to the survey.  62 countries with WHO country profiles prior to a cut-off point of April 2016 were included in this analysis
  • The analysis focuses on the reporting and response components of the MDSR cycle
  • Summary statistics provide a status update on MDSR implementation
  • Thematic analysis was used for open-ended responses by comparing countries’ responses and identifying recurring patterns and themes.  Categories were developed from these themes, which were used to benchmark countries against recommendations in the MDSR Technical Guidance where possible
  • Countries were stratified according to the Strategies toward Ending Preventable Maternal Mortality categories, which are based on maternal mortality ratios (MMR) in 2010: low burden MMR 70 (n=13), medium burden MMR 420 (n=25), and high burden MMR N420 (n=24)

Key findings

  • Most countries have policies in place for maternal death notification and review.  However, there remains a gap at the steps beyond this
  • Minimal progress has been made in dissemination of findings and involving stakeholders outside the health system, including civil society and communities
  • Only 26 of 62 countries made annual MDSR reports available to any stakeholders at national, sub-national, community, or facility level
  • Less than half of countries assessed have a system to monitor how MDSR findings and recommendations have been implemented and to track actions and outcomes
  • Compared with low and medium burden countries, fewer high burden countries are making reports available to stakeholders, disseminating at multiple levels, and have monitoring systems in place to track recommendations

Conclusion and recommendations

The MDSR Technical Guidance is relatively new and some countries have already made progress in implementing recommendations, particularly by putting in place policies for maternal death notification and review.  However, there remains a gap in the steps beyond this.  The paper proposes several factors to increase the effectiveness and sustainability, including:

  • A supportive institutional culture, that fosters a learning environment
  • Multidisciplinary teams at different levels of the health system to review, communicate, and act on findings
  • leadership and commitment of government and healthcare staff
  • Aggregate data from facility and community to higher levels to provide a deeper understanding of quality of care gaps and system-wide challenges
  • Recognition that local and less resource-intensive solutions can save lives

To read the WHO report on the global implementation of maternal death surveillance and response (MDSR), click here.

To visit the MDSR Action Network, click here

To download the full article for free, click here and to read other articles in the series click here.

Bandali, S., Thomas, C., Hukin, E., Matthews, Z., Mathai, M., Thandassery, T.R. & Hulton, L. (2016). Maternal Death Surveillance and Response Systems in driving accountability and influencing change. International Journal of Gynecology and Obstetrics, 135(3): 365-371.
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