Maternal Death Surveillance and Response in Tanzania : Challenges to successful implementation

Sammanfattning: Tanzania has one of the highest maternal mortality ratios (MMR) in the world. Tanzania introduced the Maternal Death Surveillance and Response (MDSR) system to facilitate deaths notification and learning from death reviews inorder to prevent future deaths. The aim was to describe the strengths, challenges and impact of implementing the MDSR system in Tanzania. A mixed methods study was conducted in the Lindi and Mtwara regions in Southern Tanzania. The system’s adequacy was assessed in terms of notification of deaths, categorization of causes of deaths and identification of three delays. The notification of deaths in the MDSR system was compared to other standard estimates. The causes of deaths and delays identified by the MDSR system were compared to an expert panel`s review using Cohen`s K statistic. Community members` perceptions and experiences of events leading to death were explored. The availability and documentation of narrative summaries used in death review meetings and action plans created by the MDSR committees were also assessed. A checklist was used to assess the summaries while the SMART criterion was used for assessing the action plans. Health providers and managers were interviewed through focus group discussions and key informant interviews on their perceptions and experiences in implementing the MDSR systemThe MDSR system performed well in categorizing the causes of maternal deaths (K statistic 0.76). Notification of deaths in the MDSR system was incomplete (MMR 137/100,000 live birth) and there was inadequate identification of all three delays (K statistics < 0.2). Caregivers failed to account for pregnancy complications during birth preparations. They also described challenges in interactions with health providers in health facilities and were excluded from the care of the deceased woman. Families suffered social, psychological and economic consequences from maternal deaths. Most narrative summaries used in death review meetings were not comprehensively written. Less than half of action plans met the SMART criteria. Health providers and managers expressed high ambitions in implementing the system with notable policy, attitude and quality of care changes. They further described many organizational, contextual and individual challenges facing the system.Addressing the above challenges will enable the MDSR system to effectively improve quality of care and reduce maternal deaths.