Abstract
BACKGROUND
Maternal and perinatal death surveillance and response (MPDSR) is a system of identifying, analyzing and learning lessons from such deaths in order to respond to and prevent future deaths, and has been recommended by WHO and implemented in many low-and-middle-income settings in recent years. However, there is limited documentation of experience with MPDSR in humanitarian settings. A meeting on MPDSR in humanitarian settings was convened by WHO, UNICEF, CDC and Save the Children, UNFPA, and UNHCR on 17th–18th October 2019, informed by semi-structured interviews with a range of professionals, including experts attendees.
CONSULTATION FINDINGS
Interviewees revealed significant obstacles to the full implementation of the MPDSR process in humanitarian settings. Many obstacles were familiar to low resource settings in general but were amplified in the context of a humanitarian crisis, such as overburdened services, disincentives to reporting, accountability gaps, a blame approach, and politicization of mortality. Factors more unique to humanitarian contexts included concerns about health worker security and moral distress. There are varying levels of institutionalization and implementation capacity for MPDSR within humanitarian organizations. It is suggested that if poorly implemented, particularly with a punitive or blame approach, MPDSR may be counterproductive. Nevertheless, successes in MPDSR were described whereby the process led to concrete actions to prevent deaths, and where death reviews have led to an improved understanding of complex and rectifiable contextual factors leading to deaths in humanitarian settings.
CONCLUSIONS
Despite the challenges, examples exist where the lessons learned from MPDSR processes have led to improved access and quality of care in humanitarian contexts, including successful advocacy. An adapted approach is required to ensure feasibility, with varying implementation being possible in different phases of crises. There is a need for guidance on MPDSR in humanitarian contexts, and for greater documentation and learning from experiences.
