"It might be a statistic to me, but every death matters.": An assessment of facility-level maternal and perinatal death surveillance and response systems in four sub-Saharan African countries

PLoS One. 2020 Dec 18;15(12):e0243722. doi: 10.1371/journal.pone.0243722. eCollection 2020.

Abstract

Background: Maternal and perinatal death surveillance and response (MPDSR) systems aim to understand and address key contributors to maternal and perinatal deaths to prevent future deaths. From 2016-2017, the US Agency for International Development's Maternal and Child Survival Program conducted an assessment of MPDSR implementation in Nigeria, Rwanda, Tanzania, and Zimbabwe.

Methods: A cross-sectional, mixed-methods research design was used to assess MPDSR implementation. The study included a desk review, policy mapping, semistructured interviews with 41 subnational stakeholders, observations, and interviews with key informants at 55 purposefully selected facilities. Using a standardised tool with progress markers defined for six stages of implementation, each facility was assigned a score from 0-30. Quantitative and qualitative data were analysed from the 47 facilities with a score above 10 ('evidence of MPDSR practice').

Results: The mean calculated MPDSR implementation progress score across 47 facilities was 18.98 out of 30 (range: 11.75-27.38). The team observed variation across the national MPDSR guidelines and tools, and inconsistent implementation of MPDSR at subnational and facility levels. Nearly all facilities had a designated MPDSR coordinator, but varied in their availability and use of standardised forms and the frequency of mortality audit meetings. Few facilities (9%) had mechanisms in place to promote a no-blame environment. Some facilities (44%) could demonstrate evidence that a change occurred due to MPDSR. Factors enabling implementation included clear support from leadership, commitment from staff, and regular occurrence of meetings. Barriers included lack of health worker capacity, limited staff time, and limited staff motivation.

Conclusion: This study was the first to apply a standardised scoring methodology to assess subnational- and facility-level MPDSR implementation progress. Structures and processes for implementing MPDSR existed in all four countries. Many implementation gaps were identified that can inform priorities and future research for strengthening MPDSR in low-capacity settings.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Cross-Sectional Studies
  • Epidemiological Monitoring*
  • Female
  • Health Plan Implementation / statistics & numerical data*
  • Humans
  • Infant, Newborn
  • Maternal Death / prevention & control*
  • Maternal Death / statistics & numerical data
  • Maternal Mortality
  • Perinatal Care / organization & administration*
  • Perinatal Care / statistics & numerical data
  • Perinatal Death / prevention & control*
  • Perinatal Mortality
  • Pregnancy
  • Professional Practice Gaps / statistics & numerical data
  • Qualitative Research

Grants and funding

This study was made possible by the generous support of the American people through the US Agency for International Development (USAID) under the terms of the Cooperative Agreement AID-OAA-A-14-00028 (www.usaid.gov). The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government. AG is supported by the South African Research Chair’s Initiative of the Department of Science and Technology and National Research Foundation of South Africa (Grant No. 82769) (www.nrf.ac.za/tags/dst), and the South African Medical Research Council (www.mrc.ac.za). Any opinion, finding, and conclusion or recommendation expressed in this material is that of the author, and the National Research Foundation of South Africa does not accept any liability in this regard.