“So hard not to feel blamed!”: Assessment of implementation of Benin’s Maternal and Perinatal Death Surveillance and Response strategy from 2016–2018

Abstract

Objective To assess the implementation of the Maternal and Perinatal Death Surveillance and Response (MPDSR) strategy institutionalized in Benin in 2013 to address the alarmingly high maternal and neonatal death rates. Methods A retrospective, mixed‐methods study was performed. We used all maternal and neonatal death notifications and reviews from 2016 to 2018, reviewed the reports of 63 MPDSR working groups, and held two online group discussions. Descriptive quantitative analysis was performed, and content analysis was applied to qualitative data. Results Deaths were under‐notified, with estimated notification rates at 46%–48% for maternal and 16%–21% for neonatal deaths over the 3 years. Review completion rates were low, corresponding to 50%–56% of maternal and 8%–17% of neonatal deaths. Causes of undernotification included very low notification of community‐based and private health facility deaths, and fear of blame. Low review completion rates were due to heavy workload, staffing shortages, fear of blame, and weak leadership. Moreover, reviews were of poor quality and the response was weak. Conclusion Maternal and Perinatal Death Surveillance and Response is operational in Benin. However, this assessment highlights the need to strengthen the notification strategy, continuously build MPDSR committee members’ capacities, engage decision‐makers for an effective response, and create a better blame‐free, accountable, and learning culture.

Barriers to and enablers of quality improvement in primary health care in low- and middle-income countries: A systematic review

“…Using pre-post designs with interviews and focus groups, the role of leadership in facilitating QI was reported by Limato and colleagues [ 70 ] in Indonesia and Nahimana and colleagues [ 84 ] in Rwanda where leaders owned and steered interventions. In contrast, Hounsou and colleagues [ 89 ] using mixed methods reported that a lack of interest by managers constrained MPDSR in Benin. Senior leaders, especially, need to actively embrace and publicly show support for QI for it to succeed as health workers do not wish to second guess their bosses’ allegiances [ 43 , 56 , 64 , 69 , 77 , 82 ].…”

“…Researchers overwhelmingly focused on topics related to improvements in maternal and child health (MCH) with twenty-nine studies, including some two conducted in Kenya [ 46 , 79 ] and some five that focused on maternal and perinatal deaths: in Ethiopia [ 63 ]; in Benin [ 89 ]; in South Africa [ 65 ]; in Rwanda [ 64 ] and in Rwanda, Tanzania, Zimbabwe and Nigeria [ 62 ]. A summary of studies by topic of focus is contained in supplementary files ( S3 Table ).…”

“…Availability of resources to support QI was the focus of studies in Kenya [ 46 ], Uganda [ 52 , 57 ], Democratic Republic of the Congo [ 51 ], Zimbabwe [ 53 ], Ethiopia [ 54 , 72 , 82 ], Malawi [ 55 , 73 ], Haiti [ 56 ], India [ 59 ], Benin [ 58 , 89 ], South Africa [ 60 , 65 , 69 , 75 ], Tanzania [ 42 , 61 , 90 ], Zimbabwe [ 62 ], Rwanda [ 64 ], Namibia [ 66 ], Indonesia [ 70 ], Mozambique and Burkina Faso [ 79 ], Tajikistan [ 80 ], Mali [ 81 ], and Nigeria [ 44 , 45 , 86 ], underscoring its importance to impede QI and shared concerns across many LMIC contexts.…”

Implementing maternal death surveillance and response in Sub‐Saharan Africa: The way forward

“…Review of maternal death is a key part of MDSR. Maternal death reviews were not carried out routinely and were irregular in most countries [7][8][9][10][11][13][14][15][16] or stopped completely. 12 One healthcare provider noted that financial resources were not available to conduct reviews, which prevented them from happening.…”

“…Notification of maternal death is incorporated into routine health management information systems via integrated disease surveillance and response systems in Benin, 7 Burkina Faso, 8,9 Cameroon, 10 Central African Republic, 11 Chad, 12 Ghana, 13 and Liberia 14 . However, most of the countries continue to underreport maternal and neonatal deaths 12 and many countries do not include neonatal deaths in the notification system 15 .…”