Project overview
Globally, there are high rates of death among pregnant women and newborn babies due to poor quality of care. Reviewing deaths of mothers and babies helps health workers, governments and community members identify and solve issues in access and quality of care. This process, known as Maternal and Perinatal Death Surveillance and Response (MPDSR), can reduce deaths by a third.
However, in many countries MPDSR has not had the expected impact due to weak health systems with poor leadership, exclusion of communities from the process, insufficient resources, and lack of training. Fear of blame and punishment discourages people from reporting deaths or providing complete information, so discussions do not address the main issues, and the necessary actions are not taken. Lack of change demotivates health workers and communities. More evidence is needed on how to build a cost-efficient, acceptable MPDSR process, adapted and integrated within local country health systems.
The project aims to improve reporting, review and response to deaths of mothers and babies in Ethiopia, Ghana and Uganda, and to evaluate the effect of doing this on death rates of babies.
This four-year project will work with community members and stakeholders in Uganda, Ghana, and Ethiopia to study how deaths of mothers and babies are currently identified, reported and reviewed, and what changes are made in response. This project is led by the University of Southampton in collaboration with the University of Ghana School of Public Health, Haramaya University (Ethiopia), Mbarara University of Science and Technology (Uganda), University of Cape Town (South Africa), the World Health Organisation, Liverpool School of Tropical Medicine, and Leiden University (the Netherlands).
During phase 1 and 2 of the research (2024-2025), we will conduct in-depth research on current MPDSR practices and develop tools to address the main barriers to MPDSR implementation. In phase 3 (2026-2028), each country will introduce an intervention package of the tools developed in phase 2 into 3 districts, starting at different times. We will count deaths of women and babies before and during implementation. We estimate that the number of babies dying can be reduced by 30%. If this approach reduces deaths, and is cost-effective, countries will be supported to scale it up. Our materials will be made available online. This will help to reduce preventable deaths and improve quality of care for women and their babies.
Study objectives, activities and outputs.
This project has 8 workpackages (WPs) with the following objectives:
WP1: to build strong relationships between researchers and community members.
Outcomes:
- community advisory boards (CABs) established in each country.
- Research plans incorporate feedback from CABs to ensure they are relevant and meaningful to the community.
- Improved understanding of motivations and influence of different stakeholders in the MPDSR process
WP 2: To reduce fear of blame amongst for health workers, by improving laws and regulations.
Outcomes:
- Recommendations on changes to laws / regulations, so that information in MPDSR cannot be used as evidence against health workers
- Developing a complaints system that is separate from the MPDSR process.
WP 3: to develop standardized tools for reporting and collecting information on deaths of pregnant women and babies.
Outcomes:
- Standard tools for reporting maternal and perinatal deaths, and for collecting information about them.
- system for tracking implementation of recommendations
- Improved quality of data from health facilities.
WP 4: to improve skills of health workers in conducting MPDSR.
Outcomes:
- Updated training packages that equip health workers, and nursing / midwifery / medical students, with the knowledge and skills needed to effectively implement MPDSR.
WP 5: to monitor how well MPDSR is being carried out, what the process costs, and develop sustainable ways of financing it
Outcomes:
- standardised form to monitor the implementation of MPDSR
- Estimate of cost of implementing MPDSR
- Novel mechanism to fund recommendations from MPDSR
WP6: to empower communities to prevent the deaths of pregnant women and babies.
Outcomes:
- Community death reporting system, providing comprehensive data on deaths in communities.
- Standard simplified questionnaires on deaths for community health workers
- Community system for discussing deaths and making recommendations
- Training package for community health workers on bereavement counselling
WP7: to develop a customised “toolbox” in each country
Activities:
- Consultation with stakeholders on each of the tools developed in WP2-6.
Outcome: a customised “toolbox” in each country to improve implementation of MPDSR.
WP 8: to test the effectiveness of the “toolbox”
Activity: Clinical trial in three districts in each country, with staggered start dates to allow for comparison.
Outcome:
- High-quality evidence on cost-effectiveness of the “toolbox” to improve implementation of MPDSR.
However, in many countries MPDSR has not had the expected impact due to weak health systems with poor leadership, exclusion of communities from the process, insufficient resources, and lack of training. Fear of blame and punishment discourages people from reporting deaths or providing complete information, so discussions do not address the main issues, and the necessary actions are not taken. Lack of change demotivates health workers and communities. More evidence is needed on how to build a cost-efficient, acceptable MPDSR process, adapted and integrated within local country health systems.
The project aims to improve reporting, review and response to deaths of mothers and babies in Ethiopia, Ghana and Uganda, and to evaluate the effect of doing this on death rates of babies.
This four-year project will work with community members and stakeholders in Uganda, Ghana, and Ethiopia to study how deaths of mothers and babies are currently identified, reported and reviewed, and what changes are made in response. This project is led by the University of Southampton in collaboration with the University of Ghana School of Public Health, Haramaya University (Ethiopia), Mbarara University of Science and Technology (Uganda), University of Cape Town (South Africa), the World Health Organisation, Liverpool School of Tropical Medicine, and Leiden University (the Netherlands).
During phase 1 and 2 of the research (2024-2025), we will conduct in-depth research on current MPDSR practices and develop tools to address the main barriers to MPDSR implementation. In phase 3 (2026-2028), each country will introduce an intervention package of the tools developed in phase 2 into 3 districts, starting at different times. We will count deaths of women and babies before and during implementation. We estimate that the number of babies dying can be reduced by 30%. If this approach reduces deaths, and is cost-effective, countries will be supported to scale it up. Our materials will be made available online. This will help to reduce preventable deaths and improve quality of care for women and their babies.
Study objectives, activities and outputs.
This project has 8 workpackages (WPs) with the following objectives:
WP1: to build strong relationships between researchers and community members.
Outcomes:
- community advisory boards (CABs) established in each country.
- Research plans incorporate feedback from CABs to ensure they are relevant and meaningful to the community.
- Improved understanding of motivations and influence of different stakeholders in the MPDSR process
WP 2: To reduce fear of blame amongst for health workers, by improving laws and regulations.
Outcomes:
- Recommendations on changes to laws / regulations, so that information in MPDSR cannot be used as evidence against health workers
- Developing a complaints system that is separate from the MPDSR process.
WP 3: to develop standardized tools for reporting and collecting information on deaths of pregnant women and babies.
Outcomes:
- Standard tools for reporting maternal and perinatal deaths, and for collecting information about them.
- system for tracking implementation of recommendations
- Improved quality of data from health facilities.
WP 4: to improve skills of health workers in conducting MPDSR.
Outcomes:
- Updated training packages that equip health workers, and nursing / midwifery / medical students, with the knowledge and skills needed to effectively implement MPDSR.
WP 5: to monitor how well MPDSR is being carried out, what the process costs, and develop sustainable ways of financing it
Outcomes:
- standardised form to monitor the implementation of MPDSR
- Estimate of cost of implementing MPDSR
- Novel mechanism to fund recommendations from MPDSR
WP6: to empower communities to prevent the deaths of pregnant women and babies.
Outcomes:
- Community death reporting system, providing comprehensive data on deaths in communities.
- Standard simplified questionnaires on deaths for community health workers
- Community system for discussing deaths and making recommendations
- Training package for community health workers on bereavement counselling
WP7: to develop a customised “toolbox” in each country
Activities:
- Consultation with stakeholders on each of the tools developed in WP2-6.
Outcome: a customised “toolbox” in each country to improve implementation of MPDSR.
WP 8: to test the effectiveness of the “toolbox”
Activity: Clinical trial in three districts in each country, with staggered start dates to allow for comparison.
Outcome:
- High-quality evidence on cost-effectiveness of the “toolbox” to improve implementation of MPDSR.
