‘We identify, discuss, act and promise to prevent similar deaths’: a qualitative study of Ethiopia's Maternal Death Surveillance and Response system

Abstract

IntroductionEthiopia introduced national Maternal Death Surveillance and Response (MDSR) in 2013 and is among the first sub-Saharan African countries to capture data on facility-based and community-based maternal deaths. We interviewed frontline MDSR implementers about their experiences of the first 2 years of MDSR, including perceptions of its introduction and outcomes for health services.MethodsWe conducted a qualitative case study in 4 zones in the largest regions, interviewing 69 key informants from regional, zonal, district and facility levels.ResultsA defining feature of Ethiopia's MDSR system is its integration within existing disease surveillance, with both benefits and challenges. Facilitators of the system's introduction were strong political support, alignment with broader health strategies and strong links across health system departments. Barriers included confusion around new responsibilities, high staff turnover and fear of legal repercussions. Stakeholders believed MDSR increased confidence in using local data to improve maternal health services and enhanced communication across the health system.ConclusionsMDSR systems take time to establish, encountering challenges in early implementation. Ensuring MDSR has a clear purpose, explicitly defined roles and responsibilities, and adequate supervisory support from the start will ensure it becomes embedded within the health system as routine practice rather than perceived as a stand-alone system. Countries planning to adopt or extend MDSR can learn from Ethiopia's experience, particularly the decision to make maternal mortality a weekly reportable condition within Public Health Emergency Management.

Triangulating data sources for further learning from and about the MDSR in Ethiopia: a cross-sectional review of facility based maternal death data from EmONC assessment and MDSR system

“…Furthermore, the number of facilities whose reports were captured at national level was less than half of the number of facilities reporting to the next level. Other studies revealed that poor data flow from the facility to the central level was a challenge in both MDR and MDSR systems, and stemmed from a lack of knowledge and confusion among facility staff on the reporting process, high staff turnover and fear of legal repercussions [6,7,24].…”

“…Multiple factors can affect the implementation of MDSR. Lack of awareness of the purpose and principles of MDSR among stakeholders, the existence of a blame culture, insufficient number of trained staff to implement MDSR, the unavailability of guidelines and tools, lack of commitment and financial resources all contribute to the implementation of MDSR [4][5][6][7][8][9][10][11][12][13]. These barriers may prevent compliance with national and global targets for MDSR and delay the establishment of functioning MDSR committees at all health facilities [14].…”

​Analysis of the Iranian maternal mortality surveillance system and providing system improvement strategies: Study protocol for strategy formulation

“…Many studies have emphasized the necessity of following maternal mortality surveillance system to reduce maternal deaths. According to these studies, decrease in the maternal mortality ratio during the recent years, compared to 1990s, has been related to the use of this system [12][13][14][15][16]. Moreover, examining the viewpoint of health workers about the maternal mortality system, other studies have had a positive attitude towards this system, and considered its exibility, acceptability and sensitivity to be valuable [17,18].…”

Associations between increased intervention coverage for mothers and newborns and the number and quality of contacts between families and health workers: An analysis of cluster level repeat cross sectional survey data in Ethiopia

“…However immediate newborn interventions and the coverage and quality of postnatal care checks lagged behind Over a decade ago the government committed to increase demand for and availability of health services everywhere and, through a comprehensive mix of multi-sectoral strategies, made remarkable progress to this end [ 15 ]. A large number of external partners played a role in supporting the government, testing for example quality improvement initiatives [ 16 ], improving access to emergency transport [ 17 ] strengthening community linkages [ 18 ], and institutionalising maternal death surveillance and response systems [ 19 ]. Current government priorities, as described in the Health Sector Transformation Plan, clearly define targets to improve the quality, not only the quantity, of health care provided.…”