Moving forward with mortality reviews and reporting in Tanzania
The World Health Organization (WHO) recently released the new guidelines for maternal death surveillance and Response titled “Maternal Death Surveillance and Response. Technical Guidance. Information for Action to Prevent Maternal Deaths".
The focus has changed from the previous maternal death review (MDR) and reporting to the surveillance and Response (MDSR) that emphasises on the response or actions taken from the recommendations coming out of the reviews. More importantly are the suggestions on how maternal death reviews can be reported better. The Inclusion of maternal deaths as notifiable conditions within the existing national infectious diseases surveillance and response (IDSR) system and encouraging the use of innovative electronic technologies such as mobile phones are other options.
As noted in the 2003 WHO document titled “beyond the numbers”, most maternal deaths can be avoided even in resource-limited settings such as Tanzania, provided that actions are based on the right evidence. Maternal deaths reviews are envisaged to provide this evidence as they allow understanding of every maternal death in order to prevent similar deaths. Even few well reviewed maternal deaths to provide information that most women die from haemorrhage due to inadequate management of the third stage of labour followed by remedies to improve providers’ skills and availability and use of appropriate drugs such oxytocin and misoprostol can reduce maternal deaths significantly.
In most sub-Saharan countries however, the reviews are weak, fragmented and often not conducted systematically and regularly; most deaths are not reported and recommendations not acted on at all appropriate levels of the health system: health facilities, districts, regions and national. Furthermore, the fact that a significant proportion of maternal deaths still occur outside the health facilities (in communities or on way to facilities) means that facility based MDSR may not be adequate to provide the broader understanding of why women die, especially in countries where a significant proportion of maternal deliveries and deaths still occur at home.
Thus facility review could precede community review in a phased approach that can eventually ensure that all deaths are reviewed. This is not only important to understand the causes of maternal mortality, where women die, why and actions to take to address the problem, but also to get the number of women who die at various administrative and geographical locations: district, regional, zonal and national.
In Tanzania, Maternal and Perinatal Death Review guidelines were rolled-out in 2006 and are supposed to be part of the routine health care. But community deaths were not included although facilities were encouraged to understand factors beyond the health care system contributing to the deaths. Often, perinatal death review are rarely systematically conducted and reported. For the MDRs, except for limited geographic evidence on the potential of the review, reporting and responses, regional, zonal or countrywide evidence lack. The process of MDR implementation is also poorly understood as are facilitators and bottlenecks for effective implementation.
As a result, the Reproductive Health (RCH) section of the Ministry of Health and Social Welfare (MOHSW) is in the process of revising the guidelines to accommodate stakeholders’ suggestions and recommendations from the recent WHO MDSR guidance. The previous two forms (for review and reporting) will be merged based on the ICD 10 reporting and included into the electronic District Health Information System to improve reporting.
Till every maternal death counts, our path to significant reduction of maternal deaths and indeed perinatal deaths will remain unsatisfactory. Our mothers’ survival depends on our actions. It is the right time to act.
