Who Counts? What Counts? Place and the Limits of Perinatal Mortality Measures

Wendland, Claire

doi:10.1001/journalofethics.2018.20.3.pfor2-1803

Cited by 11 publications

(4 citation statements)

References 15 publications

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“…Finally, donors sidestepped opportunities to assist the Tanzanian government in strengthening the public sector (see also Maluka et al, 2018), including supporting policies that would have made their interventions more effective and alleviate some of the pressures on HCWs themselves. In the overburdened labor wards in Dar's largest hospitals, as Dynes et al (2018) explained, providing more equitable pay, decreasing workloads, increasing mentoring opportunities, and encouraging larger institutional commitments to providing resources and staff are needed, particularly as women are increasingly encouraged to deliver in facilities that are already severely underresourced (Wendland, 2018).…”

Section: Discussionmentioning

confidence: 99%

The “Sustainability Doctrine” in Donor-Driven Maternal Health Programs in Tanzania

Marten

2022

Global Maternal and Child Health

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Strengthening health systems to provide equitable, sustainable health care has been identified as essential for improving maternal and reproductive health. Many donors and non-governmental organizations (NGOs) have contributed to undermining health system strengthening, however, through adhering to what Swidler and Watkins call the “sustainability doctrine,” policies that prioritize time-limited, targeted interventions best suited for short-term funding streams, rather than the long-term needs of local populations. This chapter presents ethnographic data from semi-structured and key informant interviews with 16 policymakers and NGO directors in Dar es Salaam, Tanzania from 2011 to 2012. I illustrate how sustainability doctrine policies were put into practice, and how they have persisted, despite their shortcomings, using examples of donor-prioritized maternal healthcare initiatives in Tanzania rolled-out several years apart: prevention of mother-to-child transmission of HIV (PMTCT) and basic emergency obstetric and newborn care (BEmONC) programs in the late 2000s, and more recent efforts to implement respectful maternity care (RMC) programs. I focus on several issues informants identified as crippling efforts to build strong health systems, particularly the internal brain drain of healthcare workers from the public sector to higher-paying NGO jobs, and the prioritization of types of programs donors believed could be sustained after the funding period ended, specifically trainings and workshops. I describe how despite these issues, international organizations still design and implement less effective programs that often fail to account for local circumstances in their efforts to solve some of the more intractable health issues facing Tanzania today, in particular, the country’s stagnating maternal mortality rate. In this chapter, I argue that practices promoted and implemented under the guise of “sustainability” in policy papers and reports generated by donors paradoxically contribute to health system precarity in Tanzania.

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Section: Discussionmentioning

confidence: 99%

The “Sustainability Doctrine” in Donor-Driven Maternal Health Programs in Tanzania

Marten

2022

Global Maternal and Child Health

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“…By identifying and reviewing all maternal deaths, health workers and bureaucrats produce knowledge about policy implementation through the categorization of complex realities into countable events and indicators ( Merry, 2011 ). Data on maternal deaths are therefore not neutral ( Adams, 2016 ; Wendland, 2018 ). Maternal mortality metrics are also closely tied to accountability and governance, as they influence the allocation of resources, the nature of political decisions and the assessment of which countries prioritize maternal health ( Merry, 2011 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, maternal deaths figures in Ethiopia, like in many other settings, are highly uncertain. This is associated with the technical difficulties in producing maternal mortality data and their politicized nature ( Wendland, 2018 ). Maternal deaths are classified as a public health emergency in Ethiopia, and the government proclaims that ‘No mother should die while giving birth’.…”

Section: Introductionmentioning

confidence: 99%

Juridification of maternal deaths in Ethiopia: a study of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system

Melberg

Teklemariam

Moland

et al. 2020

Health Policy and Planning

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Juridification of maternal health care is on the rise globally, but little is known about its manifestations in resource constrained settings in sub-Saharan Africa. The Maternal and Perinatal Death Surveillance and Response (MPDSR) system is implemented in Ethiopia to record and review all maternal and perinatal deaths, but underreporting of deaths remains a major implementation challenge. Fear of blame and malpractice litigation among health workers are important factors in underreporting, suggestive of an increased juridification of birth care. By taking MPDSR implementation as an entry point, this article aims to explore the manifestations of juridification of birth care in Ethiopia. Based on multi-sited fieldwork involving interviews, document analysis and observations at different levels of the Ethiopian health system, we explore responses to maternal deaths at various levels of the health system. We found an increasing public notion of maternal deaths being caused by malpractice, and a tendency to perceive the juridical system as the only channel to claim accountability for maternal deaths. Conflicts over legal responsibility for deaths influenced birth care provision. Both health workers and health bureaucrats strived to balance conflicting concerns related to the MPDSR system: reporting all deaths vs revealing failures in service provision. This dilemma encouraged the development of strategies to avoid personalized accountability for deaths. In this context, increased juridification impacted both care and reporting practices. Our study demonstrates the need to create a system that secures legal protection of health professionals reporting maternal deaths as prescribed and provides the public with mechanisms to claim accountability and high-quality birth care services.

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“…Más allá del componente técnico, las desigualdades observadas son ante todo un asunto ético. Como plantea Wendland27 "what counts is what you count". Los departamentos con menor calidad de los datos se ubican mayoritariamente en la región del Caribe, Pacífico, Orinoquia y Amazonía, zonas históricamente excluidas del desarrollo social, con mayores índices de pobreza multidimensional y donde se ubican comunidades indígenas y afrodescendientes, quienes han sido históricamente excluidas producto del racismo estructural; por esta vía se están reproduciendo desigualdades estructurales.…”

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Evaluación de la calidad de las estadísticas vitales de niños menores de cinco años. Colombia, 2000-2018

Rojas-Botero

Borrero-Ramírez

Fernández-Niño

2022

revsal

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Introducción: las estadísticas vitales son fundamentales para conocer las condiciones de salud de la población y diseñar intervenciones. De su calidad depende la precisión y validez de las métricas derivadas y la relevancia de las decisiones de política pública. Objetivo: evaluar la calidad de las estadísticas vitales de niños menores de cinco años en Colombia, entre 2000 y 2018. Métodos: estudio descriptivo y exploratorio. Se analizó la calidad de los registros de nacidos vivos y defunciones publicados por el DANE, utilizando los criterios recomendados por las Naciones Unidas: exactitud (precisión), cobertura (compleción) y oportunidad. Resultados: se encontraron registros de nacimientos y defunciones con datos perdidos en categorías que indican gradiente social. El 8,2 % de los registros de defunción tenían como causa básica de muerte códigos poco útiles para la toma de decisiones en salud pública. El 97,8 % de los nacidos vivos fueron registrados durante el mismo año de ocurrencia. El subregistro de la mortalidad infantil se estimó en un 28,9 %, con diferencias entre territorios. Conclusiones: la calidad de las estadísticas vitales en niños menores de cinco años de Colombia mejoró en los 19 años evaluados, en particular en exactitud y oportunidad. Sin embargo, persisten problemas en la asignación de la causa básica de muerte y en el subregistro, con diferencias importantes entre territorios. Mejorar la calidad del sistema de estadísticas vitales debe ser un imperativo ético, en especial para comprender las poblaciones de áreas geográficas históricamente invisibilizadas en el país.

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Who Counts? What Counts? Place and the Limits of Perinatal Mortality Measures

Cited by 11 publications

References 15 publications

The “Sustainability Doctrine” in Donor-Driven Maternal Health Programs in Tanzania

The “Sustainability Doctrine” in Donor-Driven Maternal Health Programs in Tanzania

Juridification of maternal deaths in Ethiopia: a study of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system

Evaluación de la calidad de las estadísticas vitales de niños menores de cinco años. Colombia, 2000-2018

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