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| World Health Organization Maternal Death Surveillance and Response | |
|---|---|
| Name | Maternal Death Surveillance and Response |
| Established | 2012 |
| Founder | World Health Organization |
| Jurisdiction | United Nations |
World Health Organization Maternal Death Surveillance and Response
The World Health Organization Maternal Death Surveillance and Response (MDSR) is a country-level public health system designed to identify, notify, review, and respond to maternal deaths to prevent future fatalities. Originating from global initiatives and technical guidance promulgated by the World Health Organization and partners such as the United Nations Population Fund, United Nations Children's Fund, and World Bank, MDSR links surveillance, clinical audit, and health systems action across national programs like Ministry of Health (United Kingdom), Ministry of Health and Family Welfare (India), and regional bodies such as the African Union. MDSR interrelates with global frameworks including the Sustainable Development Goals, the Millennium Development Goals, and the Global Strategy for Women's, Children's and Adolescents' Health.
MDSR is structured as a continuous cycle comprising detection, notification, review, analysis, and response, integrating tools from the World Health Organization toolkit alongside guidance from FIGO, ICM, and partners like Centers for Disease Control and Prevention and Médecins Sans Frontières. The approach draws on methods from surveillance systems such as those used by the International Classification of Diseases and leverages national platforms seen in countries like Rwanda, Ethiopia, India, Brazil, and South Africa. MDSR seeks to situate maternal death review within broader initiatives such as the Every Woman Every Child movement and aligns with indicators monitored by the United Nations Statistics Division and WHO Global Health Observatory.
MDSR's rationale is grounded in evidence from maternal mortality trends reported by the Institute for Health Metrics and Evaluation, the World Bank Group, and research in journals associated with institutions like Harvard School of Public Health and London School of Hygiene & Tropical Medicine. Objectives include reducing preventable maternal mortality, improving quality of care in facilities tied to organizations such as Partners In Health and Jhpiego, strengthening health information systems exemplified by initiatives from United Nations Development Programme, and informing policy for national actors like Ministry of Health (Kenya), Ministry of Health (Nigeria), and multilateral mechanisms like the Global Financing Facility.
MDSR methodology combines case identification using the ICD-10 definition of maternal death, immediate notification protocols modeled on systems used by the European Centre for Disease Prevention and Control, confidential case review panels resembling procedures from National Institute for Health and Care Excellence, and health systems response planning influenced by frameworks from the World Bank and WHO Patient Safety. Core components include legal and policy frameworks involving ministries such as Ministry of Health (Zambia), standardized review forms adapted from WHO tools, multidisciplinary review committees similar to those in United States Department of Health and Human Services programs, and linkages to emergency obstetric care networks exemplified by referral systems in Mozambique and Bangladesh.
Adoption pathways vary: some nations integrate MDSR into national maternal death review systems as seen in Peru and Sri Lanka, while others pilot regionally through partnerships with Gavi, the Vaccine Alliance and bilateral cooperations with agencies like USAID and DFID. Implementation includes policy enactment in parliaments akin to processes in South Africa and capacity-building via training from centers associated with WHO Collaborating Centres, universities like University of Cape Town, and NGOs such as Save the Children. Regional bodies like the Pan American Health Organization and the European Commission have supported scale-up through technical cooperation and funding mechanisms linked to development banks like the African Development Bank.
Data flows in MDSR link facility-based reporting systems, civil registration and vital statistics (CRVS) systems championed by the United Nations Statistics Division, and national health information systems such as the District Health Information System 2 used in Tanzania and Uganda. Reporting standards align with guidance from the International Health Regulations and use classification tools from the World Health Organization. Data use for policy is guided by analytics and modelling from institutions like the Institute for Health Metrics and Evaluation and informs accountability mechanisms involving actors such as Parliamentary Committees and donor entities including the Global Fund.
Evaluations of MDSR cite reductions in facility-based maternal mortality in settings like Rwanda and Sri Lanka, improved clinical practice documented by partners such as Jhpiego and Averting Maternal Death and Disability (AMDD), and stronger linkages between surveillance and quality improvement observed in countries that partnered with WHO and UNFPA. Independent assessments by bodies like the Independent Evaluation Group and academic analyses from Johns Hopkins Bloomberg School of Public Health measure process indicators (notification timeliness, review completeness) and outcome metrics (maternal mortality ratio, case fatality rates), while comparative studies reference historical campaigns such as the Safe Motherhood Initiative.
Challenges include underreporting and misclassification tied to weak CRVS systems noted by the World Bank and UNICEF, legal and confidentiality concerns raised in analyses from Human Rights Watch, resource constraints highlighted by Global Health 50/50 and capacity gaps documented by WHO Regional Office for Africa. Critics point to variability in implementation between contexts like Haiti and Japan, potential for punitive use of review findings criticized by Amnesty International, and difficulties in attributing mortality declines solely to MDSR amid concurrent interventions by organizations such as MSF and national reforms driven by entities like the Bill & Melinda Gates Foundation.
Category:World Health Organization programs