Maternal and neonatal death surveillance and response is implemented in Burundi but needs improvement

Abstract

Objective To analyze implementation of the maternal and neonatal death surveillance and response (MNDSR) strategy in Burundi. Methods Secondary data analysis using a qualitative approach and document review. The qualitative approach consisted of semistructured interviews with decision‐makers at central, regional, and district levels, health providers, and technical and financial partners using four interview guides and a data extraction tool. Document review utilized maternal death review reports and policy documents. Interviews and hospital visits took place from July 16–26, 2017, in Bujumbura and Gitega, Burundi. Results Notification of maternal deaths is incorporated into the Integrated Disease Surveillance and Response (IDSR) system. Maternal death review committees existed in the five visited hospitals (Prince Regent Charles Hospital and Kamenge University Hospital in Bujumbura, Gitega Regional Hospital, Kibimba District Hospital, and Kibuye District Hospital) but not at subnational level (provincial or district levels). Since the beginning of 2017, maternal death review has been effective and regular in some district and regional hospitals due to integration of quality‐of‐care criteria for the performance‐based financing strategy; review has been less effective at national hospital level. Implementation of review recommendations is heterogeneous and varies from one health facility to another. No formal follow‐up mechanism on review recommendations was identified. Notification and review of neonatal deaths does not occur, nor does notification of maternal or neonatal deaths at community level. Conclusion Despite integration of notification of maternal deaths into IDSR, efforts must be undertaken to scale up MNDSR to include neonatal deaths and maternal and neonatal deaths at community level.

Determinants of behaviors influencing implementation of maternal and perinatal death surveillance and response in low‐ and middle‐income countries: A systematic review of qualitative studies

“…56 Inclusion of MPDSR as an indicator for performance-based financing may be a more sustainable incentive but was only reported in one study. 66 Members became demotivated when no positive changes were observed, 9,49,52 the same recommendations were often repeated, 21,22,41 there was no support, 48 no feedback of recommendations, 18 and no incentives. 22,52 Automatic motivation to engage in MPDSR resulted from institutionalization of the process, such that it became part of the professional role and routine activities of health workers.…”

“…27,53 Although financial compensation for participation in meetings has been offered by some projects, this often depended on donor funding and so was unsustainable, 52 causing demotivation and even collapse of the process when incentives were withdrawn. 72 Other more sustainable incentives include performance-based financing, 66 providing refreshments during meetings, 39 and celebration of achievements. 9…”

Implementing maternal death surveillance and response in Sub‐Saharan Africa: The way forward

“…14 However, most of the countries continue to underreport maternal and neonatal deaths 12 and many countries do not include neonatal deaths in the notification system. 15 Community deaths also go unreported. This is a huge gap that needs to be addressed urgently.…”

“…Review of maternal death is a key part of MDSR. Maternal death reviews were not carried out routinely and were irregular in most countries [7][8][9][10][11][13][14][15][16] or stopped completely. 12 One healthcare provider noted that financial resources were not available to conduct reviews, which prevented them from happening.…”

“…Notification of maternal death is incorporated into routine health management information systems via integrated disease surveillance and response systems in Benin, 7 Burkina Faso, 8,9 Cameroon, 10 Central African Republic, 11 Chad, 12 Ghana, 13 and Liberia 14 . However, most of the countries continue to underreport maternal and neonatal deaths 12 and many countries do not include neonatal deaths in the notification system 15 . Community deaths also go unreported.…”