Driving accountability and influencing change through MDSR

This paper looks at how maternal death surveillance and response (MDSR) systems are strengthening response and accountability for better health outcomes. This is the fifth paper in the MamaYe - Evidence for Action (E4A) series on accountability.

This paper, published in the International Journal of Gynaecology and Obstetrics, analyses key findings from the 2015 WHO and UNFPA Global MDSR Implementation Survey to look at how far MDSR systems are strengthening response and accountability for better maternal health outcomes. Two case-studies from Nigeria and Ethiopia are presented to illustrate how findings have influenced systematic changes in policy or practice.

Key findings

  • Most countries have policies in place for maternal death notification and review.
  • However, minimal progress has been made in dissemination of findings and involving stakeholders outside the health system, including civil society and communities.
  • Only 26 of 62 countries made annual MDSR reports available to any stakeholders at national, sub-national, community, or facility level.
  • Less than half of countries assessed have a system to monitor how MDSR findings and recommendations have been implemented and to track actions and outcomes.
  • Compared with low and medium burden countries, fewer high burden countries are making reports available to stakeholders, disseminating at multiple levels, and have monitoring systems in place to track recommendations.


 The authors propose several factors to increase the effectiveness and sustainability of MDSRs, including:

  • A supportive institutional culture, that fosters a learning environment
  • Multidisciplinary teams at different levels of the health system to review, communicate, and act on findings
  • leadership and commitment of government and healthcare staff
  • Aggregate data from facility and community to higher levels to provide a deeper understanding of quality of care gaps and system-wide challenges
  • Recognition that local and less resource-intensive solutions can save lives
Bandali, S., Thomas, C., Hukin, E., Matthews, Z., Mathai, M., Thandassery, T.R. & Hulton, L. (2016). Maternal Death Surveillance and Response Systems in driving accountability and influencing change. International Journal of Gynecology and Obstetrics, 135(3): 365-371.
Accountability maternal death surveillance and response case study MDSR