Shifting paradigm of maternal and perinatal death review system in Bangladesh: A real time approach to address sustainable developmental goal 3 by 2030

Abstract

Recently, Bangladesh has made remarkable progress in reducing maternal and neonatal morality, even though the millennium developmental goal to reduce maternal and neonatal mortality was not achieved. Sustainable Developmental Goal (SDG) 3 has already been set for a new target to reduce maternal and neonatal deaths by 2030. The country takes this timely initiative to introduce a maternal and perinatal death review system. This review will discuss the shifting paradigm of the maternal and perinatal death review system in Bangladesh and its challenges in reaching the SDG on time. This review uses existing literature on the maternal and perinatal death review system in Bangladesh, and other systems in similar settings, as well as reports, case studies, news, government letters and meeting minutes. Bangladesh introduced the maternal and perinatal death review system in 2010. Prior to this there was no such comprehensive death review system practiced in Bangladesh. The system was established within the government health system and has brought about positive effects and outcomes. Therefore, the Ministry of Health and Family Welfare of Bangladesh gradually scaled up the maternal and perinatal death review system nationwide in 2016 within the government health system. The present death review system highlighted real-time data use, using the district health information software(DHIS-2). Health mangers are able to take remedial action plans and implement strategies based on findings in DHIS-2. Therefore, effective utilization of data can play a pivotal role in the reduction of maternal and perinatal deaths in Bangladesh. Overall, the maternal and perinatal death review system provides a great opportunity to achieve the SDG 3 on time. However, the system needs continuous monitoring at different levels to ensure its quality and validity of information, as well as effective utilization of findings for planning and implementation under a measureable accountability framework.

The development of a new accountability measurement framework and tool for global health initiatives

“…Most of the mechanisms described in the literature stopped short of institutionalization, and many of the reviewed papers acknowledged this as a shortcoming. However, a few papers described how accountability mechanisms had brought about sustained changes to norms, perceptions and/or practices at the outcome level that in some cases were assumed to have caused changes at the impact level ( Rhoda et al , 2014 ; Bayley et al , 2015 ; Biswas, 2017 ). These papers indicated that there should be a distinction between institutionalization (which occurs when there are sustained, country-driven changes to embedded ‘processes’, such as quality improvement activities, staff shift patterns or systems for maintaining stocks of essential medicines) and transformation (which occurs when there are changes to ‘norms and/or policies’).…”

Uncovering the stories behind the numbers : a case study of maternal death surveillance and response in Goma, Democratic Republic of Congo.

“…Within a two-year period, the DWT initiative identified and reviewed 124 maternal deaths through community members, trained grassroots activists, and field staff (Subha Sri & Khanna, 2014). In Bangladesh, social autopsy has also been beneficial in identifying maternal deaths in the most remote communities, producing reliable MMR measures, and exploring socio-cultural barriers and solutions (Biswas, 2017). The CLMDR in Malawi engages community members as active participants in a process that combines community and FBMDRs (Bayley et al, 2015).…”

“…Additionally, the integration of MDSR with existing technology and information systems enables more efficient and rapid MDSR processes (Moodley et al, 2014;Om'Iniabohs et al, 2017;WHO, 2016b (Biswas, 2017;Moodley et al, 2014;Smith, Ameh, Roos, et al, 2017). In Senegal, equipping CHWs with mobile health applications to support verbal and social autopsy enhanced the timeliness of data collection and analysis in community settings (Moshabela et al, 2015).…”

“…First, the limited community engagement coupled with inadequate active surveillance in community settings affect the systematic and timely identification, notification, and review of maternal deaths in the community, consistent with reports from other countries such as Morocco, Nigeria, and Zimbabwe (Abouchadi et al, 2013;Om'Iniabohs et al, 2017;Scott & Dairo, 2015;Williams et al, 2017). Experiences from India (Subha Sri & Khanna, 2014), Bangladesh (Biswas, 2017), and Malawi (Bayley et al, 2015) have demonstrated that active community engagement in MDSR increases the number of maternal deaths identified, reported, and reviewed. Second, this study revealed a narrow focus on identifying and addressing medical causes and health system contributing factors and less attention to community-level factors and social determinants, which previous studies have attributed to the lack of community representation in MDSR (African Union Commission & UN Women, 2015).…”

“…Second, this study revealed a narrow focus on identifying and addressing medical causes and health system contributing factors and less attention to community-level factors and social determinants, which previous studies have attributed to the lack of community representation in MDSR (African Union Commission & UN Women, 2015). Conversely, the inclusion of community members and civil society in MDSR enables the exploration and solutions to previously ignored socio-cultural, health system, and individual factors (Bayley et al, 2015;Biswas, 2017;Kalter, Salgado, et al, 2011;Subha Sri & Khanna, 2014). Building strong community partnerships is therefore crucial in strengthening and scaling-up MDSR in Goma HZ.…”