Ephrem Tekle Lemango | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Ethiopia’s National Maternal Death Surveillance and Response (MDSR) system was introduced in 2013 and aims to create an ongoing cycle of data collection, analysis, and action to improve the quality of MNCH services across the country. To further accelerate efforts to reduce preventable maternal deaths, MDSR has been integrated into national public health emergency management, with mandatory weekly notification by frontline surveillance officers, followed by collection, analysis, and reporting of verbal autopsy data upwards through each level of the health system.

Methodology: To explore facilitators and barriers to the establishment of a fully functioning MDSR in different contexts, six case studies were conducted in four agrarian and two urban zones where the MDSR system was first implemented. Semi-structured interviews and focus group discussions were conducted with over 50 key stakeholders at national, regional, zonal and district level to document MDSR introduction and development, with a focus on stories of change to assess effects on the health system beyond the generation of data on maternal deaths.

Results: Several pathways through which the process of MDSR has contributed to health system strengthening were identified, including raising awareness of maternal deaths at district level leading to improved infrastructure; increasing communication between hospitals and their catchment health centres resulting in more efficient referral mechanisms; strengthening relationships between health institutions and the communities they serve; and enhancing skills within facilities to recognise and act on obstetric emergencies.

Conclusion: The national MDSR in Ethiopia is catalysing positive changes at different levels of the health system as it gains strength and coverage, even before full implementation is achieved. Lessons learned from the Ethiopian experience could help galvanise nascent efforts to establish MDSR in other settings, particularly those experiencing significant challenges in the early phases, by demonstrating the immediate and medium term benefits.