MPDSR is a system that ensures that deaths of mothers or babies during pregnancy, childbirth and post-natal period are notified, information is collected, causes reviewed and responses identified to prevent unnecessary deaths in future. In 2013, WHO released guidance on MPDSR with an emphasis on response and taking actions instead of just focusing on maternal death reporting and audits. Kenya adopted the MPDSR system in 2016, domesticated the guidelines and linked it to the Kenya Health Information System.
Building on the recently established good rapport between the MNH Coalition and the County Health Management Team, I was able to represent the MNH Coalition in a two-day MPDSR champions’ sensitisation forum. The forum was convened by Kamukunji sub-County Health Management team under the stewardship of Medical officer of Health, Dr. Miriam Etole and brought together representatives from ten private and public maternity hospitals. Among them is Pumwani Maternity Hospital, which is the biggest of its kind in East & Central Africa, handling about two to three thousand deliveries a month in Nairobi city. Pumwani is special to me as it is located a few kilometres from where I live. I know many women and girls who have used this facility.
The aim of this forum was to build knowledge and skills of facility MPDSR focal persons at private facilities on how to track MPDSR actions set during facility level death reviews. Kamukunji sub-County has a total of 17 maternity facilities out of which 15 are private while 2 are public. This forum was important to ensure implementation of MPDSR in the sub-County was extended beyond public facilities.
Role & structure of MPDSR committees
In her opening remarks, the sub-County Public Health Nurse Reginalda Khafafa mentioned that the current national maternal mortality rate stood at 362 per 100,000 live births. The Sustainable Development Goal 3 on health for all has targets to achieve a maternal mortality rate of less than 70 per 100,000 live births. This target underscores the importance of MPDSR. Nurse Khafafa emphasised that the purpose of MPDSR was not to incriminate healthcare workers rather it aimed at identifying, analysing and reviewing the cause of each maternal or perinatal death to come up with appropriate actions to ensure that we save more lives in future. She reiterated the importance of tracking actions set during reviews.
A key learning for me was how MPDSR captures information on root causes of women and perinatal deaths across health system levels. I realised that MPDSR involves not only health workers, but engages stakeholders across community, facility, sub-County, County and national levels.
Sometimes, the root causes of death cannot be found at the health facility but at the community level. Communities often hold the answers to the issues that lead to the death of a woman or baby. At the forum, I was able to get an in-depth understanding of community-based maternal and perinatal death reviews which include verbal autopsies. I learned that most of the maternal death cases that occur within the community remain unreported. This could be due to knowledge gaps in reporting or a communities cultural and religious beliefs. Kamukunji sub-County a while back had established community-level MPDSR structures, but they are now no longer active. Nairobi City County has also had challenges in strengthening community units in its health system and recently new ones were established in response to the population needs of the County. The sub-County MPDSR health team have agreed to sensitise new community units on MPDSR and build capacity of their membership so that they can perform their roles.
Committee using the MPDSR Action Tracker
During the forum, MPDSR case files from selected maternity facilities were presented and reviewed. After ensuring data accuracy, the representatives of the maternity facilities went through the MPDSR action tracker tool which they used to track whether actions in response to MPDSR data were taken. The actions are categorised into three; immediate, short, and long term. The Action Tracker is a simple tool that helps the sub-County MPDSR Committee to follow up and ensure that recommendations are acted upon, including those requiring more resources.
Already, the Naiorbi City County is reporting positive results from the MPDSR process. The Nairobi Metropolitan Services (NMS) set up a Blood Transfusion Centre at Mama Lucy Kibaki Hospital in the last two months. This follows MPDSR data revealing that excessive bleeding during pregnancy or childbirth was a leading cause of death for women and their babies in Nairobi. This new Blood Tranfusion Center will assist pregnant mothers who experience emergencies during pregnancy and childbirth. The MNH Coalition, will work closley with sub-County teams across Nairobi to pick up issues for advocacy to ensure resources are made available.
What’s next? Actions in response to data on root causes
One of the actions identified by the MPDSR committee, in response to the data, focused on ways in which community units can be engaged in the MPDSR process. This stood out for me because most times at community level deaths of women or babies go unreported and hence not captured in the government reporting platform (DHIS2). Therefore, community health workers can play a role in capturing these data.
The committee agreed to engage the County Community Health Coordinator and the sub-County Community focal person to strengthen community MPDSR in Kamukunji. Through the Community Health focal points, all community units in the sub-County can be reached and resources mobilised for sensitisation and skills building around performing verbal autopsies.
As a Coalition, evidence from MPDSR strengthens our case for investment in saving lives of mothers and babies. My coalition will work with government to strengthen community MPDSR as a key approach to making sure that reasons for deaths of mothers and babies are recorded and prevented, whether these happen at homes or in health facilities.