TANZANIA: Health workers face hurdles in performing effective maternal death reviews

July 2014 LSHTMBlog; The system of Maternal and Perinatal Death Review in Tanzania focuses too much on reporting mechanisms, and undermines opportunities to improve quality of care at hospital level, according to new research published in Tropical Medicine & International Health. Researchers found evidence suggesting a dysfunction in the established system, with poor quality reviews and limited action taken.

A Maternal Death Review is an audit process undertaken by hospital staff when a woman dies during pregnancy or childbirth, and it seeks to uncover problems and solutions that can be implemented at hospital level. This mandatory process has been institutionalised for many years in Tanzania. Researchers from the London School of Hygiene & Tropical Medicine and Evidence for Action Tanzania, conducted a qualitative study of a wide range of Tanzanian health system staff at facilities in Mara region, and throughout the health system administration, in June 2013.

They found that health workers in general were dedicated to the process, with routine documentation and reporting, but lacked skills or training in analysing the challenges of each case review. Staff held different understandings of the purpose of Maternal Death Reviews, some wrongly perceiving it as a data collection exercise, or to discover the person at fault. Action plans were of poor quality, as the review teams failed to identify appropriate challenges and solutions within the facility, often finding fault to lie with the community or individual.

Study author, Corinne Armstrong, epidemiologist at the London School of Hygiene & Tropical Medicine, said: “We found much evidence to show that the current system isn’t working very effectively – the reviews are taking place, but the lessons learned are not well-articulated or properly implemented.

“The current guidelines lack the appropriate level of detail and staff have not had any training. The Tanzanian Maternal Death Review system needs strengthening in order to establish a culture of continuous quality of care improvement, and improve accountability at all levels”.

International pressure for countries to expand existing systems of Maternal Death Review into the more advanced Maternal Death Surveillance and Response may be premature, given the researchers’ findings in Tanzania.

The researchers conclude that governments who wish to collect better data for public health decision-making, must build capacity among facility staff so that they can successfully collect and generate good quality evidence from the front line. A well-functioning Maternal Death Review System can provide data for action at other levels, but it relies on quality analysis in the facility review in order for appropriate and responsive action to be possible.

 

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The system of Maternal and Perinatal Death Review in Tanzania focuses too much on reporting mechanisms, and undermines opportunities to improve quality of care at hospital level, according to new research published in Tropical Medicine & International Health. Researchers found evidence suggesting a dysfunction in the established system, with poor quality reviews and limited action taken.

A Maternal Death Review is an audit process undertaken by hospital staff when a woman dies during pregnancy or childbirth, and it seeks to uncover problems and solutions that can be implemented at hospital level. This mandatory process has been institutionalised for many years in Tanzania. Researchers from the London School of Hygiene & Tropical Medicine and Evidence for Action Tanzania, conducted a qualitative study of a wide range of Tanzanian health system staff at facilities in Mara region, and throughout the health system administration, in June 2013.

They found that health workers in general were dedicated to the process, with routine documentation and reporting, but lacked skills or training in analysing the challenges of each case review. Staff held different understandings of the purpose of Maternal Death Reviews, some wrongly perceiving it as a data collection exercise, or to discover the person at fault. Action plans were of poor quality, as the review teams failed to identify appropriate challenges and solutions within the facility, often finding fault to lie with the community or individual.

Study author, Corinne Armstrong, epidemiologist at the London School of Hygiene & Tropical Medicine, said: “We found much evidence to show that the current system isn’t working very effectively – the reviews are taking place, but the lessons learned are not well-articulated or properly implemented.

“The current guidelines lack the appropriate level of detail and staff have not had any training. The Tanzanian Maternal Death Review system needs strengthening in order to establish a culture of continuous quality of care improvement, and improve accountability at all levels”.

International pressure for countries to expand existing systems of Maternal Death Review into the more advanced Maternal Death Surveillance and Response may be premature, given the researchers’ findings in Tanzania.

The researchers conclude that governments who wish to collect better data for public health decision-making, must build capacity among facility staff so that they can successfully collect and generate good quality evidence from the front line. A well-functioning Maternal Death Review System can provide data for action at other levels, but it relies on quality analysis in the facility review in order for appropriate and responsive action to be possible.

– See more at: http://blogs.lshtm.ac.uk/news/2014/07/11/health-workers-tanzania-face-hurdles-performing-effective-maternal-death-reviews/#sthash.sskIIVTL.dpuf

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