Meeting objectives
- Review results from MPDSR workplan 2020-2022
- To set new priorities and activities drafting the new MPDSR workplan 2023-2025
- To exchange lessons learned from different Sub-working groups and decide the future organization of the MPDSR TWG.
Expected outcomes
- All members of the Global MPDSR TWG are aware of the results from the current MPDSR workplan 2020-2022
- Adoption of a new MPDSR workplan 2023-2025
- All members of the Global MPDSR TWG are agreeing on the priority areas and implementation approach
Background
The Maternal and Perinatal Death Surveillance and Response (MPDSR) system is an essential quality of care intervention[1] for improving maternal, perinatal and neonatal survival, and it is a key in understanding the number and causes of deaths. MPDSR is a continuous cycle – identify and report deaths, review, develop and implement the response, and monitor outcomes – involving local data collection and review of preventable factors that led to the death of the woman and/or her baby and allowing the development of defined recommendations and response to improve the healthcare quality received by women and their newborns. Implementing MPDSR involves establishing an entire system to link surveillance and review of maternal and perinatal deaths at facility and community levels in order to inform national scale in-depth confidential enquiry of maternal and perinatal deaths[2]. A complex intervention including maternal death audit and review, as well as the development of local leadership and training, led to a 35% reduction in inpatient maternal mortality in district hospitals of low‐income countries, and probably slightly improved quality of care. More research is needed in community-based death reviews as a strong basis for collective action to reduce mortality and particularly about the effectiveness of perinatal death review in low‐income settings, including perinatal mortality.[3]
The majority of countries around the world have adopted national policies in support of implementing MPDSR. According to the WHO Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health (SRMNCAH) Policy Survey conducted in 2018 and 2019, almost all countries have adapted national policies, guidelines, laws requiring notification of all maternal deaths within 24 hours and to review all maternal deaths (more than 80%), with regional variation. Almost 70% of countries have a national policy/guideline law requiring review of newborns, but less than half have a national policy/guideline law requiring review of stillbirths. However, implementation of MPDSR varies greatly at national and sub-national levels, with a variety of challenges including:
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- Limitations around quality of reviews and appropriate coding causes of death
- Varied documentation and implementation of MPDSR recommendations
- Poor linkages between MPDSR audits and quality improvement processes at facility level
- Lack of linkages between health information and civil registration and vital statistics
- Issues on programme implementation and data analysis
- Lack of supportive legal frameworks for health care workers, as well as the need to strengthen local leadership and training
Moreover, there is a lot of stigma associated with notifying, reporting, and reviewing deaths. Successful implementation of MPDSR requires “No name, No Blame, No shame” environment and issues around blame remain a barrier to effective implementation in many settings. For example, clear support from leadership is highlighted to be one of the ten strategies to minimize the Blame culture in MPDSR[4] within all participating professional groups at all levels and ensure engagement with the MPDSR focal point on how to facilitate meetings and mentor others.
The MPDSR TWG
The MDSR Technical Working Group (TWG), led by WHO since 2013, was re-launched in November 2017 as the MPDSR TWG to provide global guidance, develop tools, and facilitate country level coordination of MPDSR, coordinating with other monitoring platforms and initiatives. During the November 2017 meeting, the TWG developed a workplan and priority activities.
WHO convenes a global MPDSR (TWG) to provide global guidance, develop tools, and facilitate country level implementation of MPDSR, coordinating with other monitoring platforms and initiatives. The TWG has five sub working groups: 1) Blame culture and community engagement; 2) Humanitarian and fragile settings; 3) Capacity building and mentorship; 4) Reporting and monitoring; and 5) Communication.
The MPDSR TWG meetings happen on a quarterly basis, while the sub working group meeting monthly. Each of them has clear priorities and results to present to the Global MPDSR TWG members. WHO Geneva coordinates all the sub working groups and connects each product in the overall MAH strategy. Moreover, it serves as a link between the different subgroups.
As a result, we have more than 50 members connecting quarterly, each of them strongly engaged within the work of the sub working groups to reach their goals. This enabled us also to pull together resources and technical expertise while obtaining concrete results in the international arena and country support.
During the period 2020-2022 each sub-working group has implemented a list of activities and results need to be presented during the next Global MPDSR TWG meeting in October 2022. Moreover, the TWG needs to reflect on how to continue its organization and if the sub-working groups is still convenient moving forward.
One of the results of this collaboration is the document WHO and partners developed, MPDSR: materials to support implementation developed by WHO and partners to address these challenges and strengthen the quality of MPDSR implementation and to promote a standardized documentation and implementation of MPDSR. This document published in November 2021, includes resources, tools and materials to strengthen MPDSR at country level, including in humanitarian and fragile settings.
Finally, during the meeting of the MPDSR TWG in October 2022, the new Workplan 2023-2025 will be drafted.
[1] WHO, Knowledge Brief 'Implementation of Maternal and Perinatal Death Surveillance and Response as part of Quality of Care efforts for Maternal and Newborn Health: Considerations for synergy and alignment', Geneva: WHO, 2021
[2] Smith H., Ameh C., et al. Implementing Maternal Death Surveillance and Response in Kenya: Incremental Progress and Lessons Learned, Glob Health Sci Pract.2017 Sep 27; 5(3): 345–354.
[3] Merlin L Willcox et al. Death audits and reviews for reducing maternal, perinatal and child mortality. Cochrane Library. March 2020
[4] Kinney M, et al. Overcoming blame culture: Key strategies to catalyze Maternal and Perinatal Death Surveillance and Response, BJOG: An International Journal of Obstetrics & Gynaecology, 2021.
