Implementation of maternal and neonatal death surveillance and response in Cameroon.

OBJECTIVE: To analyze implementation of maternal and neonatal death surveillance and response (MNDSR) in Cameroon to determine to what extent monitoring objectives are being met and highlight the main obstacles and facilitating factors. METHODS: Secondary analysis of a cross-sectional study using a qualitative method and routine data on maternal health. Semistructured interviews were conducted with participants involved in MNDSR at the central, regional, and district levels. RESULTS: Notification of maternal deaths has been incorporated into the Integrated Disease Surveillance and Response (IDSR) system since January 2014. However, maternal deaths are underreported in most hospitals and neonatal and community deaths are not recorded. Comprehensive review of maternal deaths does not occur in all hospitals despite training of providers in 2013 on how to conduct reviews. CONCLUSION: Implementation of MNDSR in Cameroon is insufficient. More commitment from the Ministry of Health is needed to develop an action plan and secure funding.

Discontinuation of the maternal death surveillance and response system in the post-conflict context of the Central African Republic.

In the post-conflict context of the Central African Republic, underreporting of maternal deaths in health facilities has occurred. There are no guidelines in place for operational or intermediate levels. There are no review or audit committees within the health facilities, districts, or regions, or at the national level. Only three hospitals have an informal review committee. Implementing the MDSR system is not an easy task, especially in Africa, which has surveillance systems that remain fragile and inefficient. Conflict situations have affected the system, and the lack of optimal funding does not enable ideal implementation of these intervention strategies.

Analysis of the implementation of maternal death surveillance and response in Chad.

OBJECTIVE: To analyze implementation of the maternal death surveillance and response (MDSR) strategy in Chad. METHODS: Secondary data analysis of results from a cross-sectional study involving semistructured interviews with decision-makers at central, regional, and district levels, health providers, and technical and financial partners, and a document review. Data collection took place from June-July 2017. RESULTS: Maternal death reporting was incorporated into the Integrated Disease Surveillance and Response system but did not include neonatal deaths nor maternal and neonatal deaths in communities. Underreporting of maternal deaths owing to fear of repercussions was evident, likely associated with maternal deaths reported at monthly meetings held by the country's President with stakeholders in the health sector. Maternal death reviews were only undertaken between 2015 and 2016 in four regions of Chad and ceased in mid-August 2016. Reasons include the departure of foreign obstetricians, lack of motivation among health workers, weak accountability at all levels of the health system, organizational issues, and nonimplementation of review recommendations. CONCLUSION: Strong action is needed by the Ministry of Health to revive implementation of the MDSR system.

Maternal and neonatal death surveillance and response is implemented in Burundi but needs improvement.

OBJECTIVE: To analyze implementation of the maternal and neonatal death surveillance and response (MNDSR) strategy in Burundi. METHODS: Secondary data analysis using a qualitative approach and document review. The qualitative approach consisted of semistructured interviews with decision-makers at central, regional, and district levels, health providers, and technical and financial partners using four interview guides and a data extraction tool. Document review utilized maternal death review reports and policy documents. Interviews and hospital visits took place from July 16-26, 2017, in Bujumbura and Gitega, Burundi. RESULTS: Notification of maternal deaths is incorporated into the Integrated Disease Surveillance and Response (IDSR) system. Maternal death review committees existed in the five visited hospitals (Prince Regent Charles Hospital and Kamenge University Hospital in Bujumbura, Gitega Regional Hospital, Kibimba District Hospital, and Kibuye District Hospital) but not at subnational level (provincial or district levels). Since the beginning of 2017, maternal death review has been effective and regular in some district and regional hospitals due to integration of quality-of-care criteria for the performance-based financing strategy; review has been less effective at national hospital level. Implementation of review recommendations is heterogeneous and varies from one health facility to another. No formal follow-up mechanism on review recommendations was identified. Notification and review of neonatal deaths does not occur, nor does notification of maternal or neonatal deaths at community level. CONCLUSION: Despite integration of notification of maternal deaths into IDSR, efforts must be undertaken to scale up MNDSR to include neonatal deaths and maternal and neonatal deaths at community level.