This article describes a pilot study in rural Malawi which assesses the value of involving communities in investigating and responding to local maternal deaths. The study team and authors include MamaYe Evidence for Action team members.
The existing system in place to investigate maternal deaths in Malawi is a facility-based maternal death review. Several weaknesses exist within this system:
- Inability to identify maternal deaths occurring outside of a hospital
- Limited reviews taking place of identified deaths
- Poor quality data to facilitate reviews
- Lack of involvement of relevant stakeholders beyond a limited number of clinical hospital staff
- Failure to involve communities in the process
- Weak accountability mechanisms for monitoring identified actions
In order to address these weaknesses, a community-led maternal death review (CLMDR) system was developed and piloted over a 1 year period, in the Mchinji District of Malawi.
The process for CLMDRs had several stages:
- A structured interview, with the family’s consent, whenever the community CLMDR team identified a local death.
- A meeting of the local community team, who recorded all relevant information about the cause of the death and suggestions for preventing future recurrences.
- A meeting at the facility nearest to where the death occurred, including a wide range of facility and community healthcare workers. Agreement of the clinical cause of death and any contributing health facility factors, and development of an action plan with individual responsibilities to prevent future deaths.
- An open forum to share this action plan with the community. Any community factors contributing to the death would be agreed, with corresponding action points.
- Bimonthly meetings attended by representatives from the community and the health facility to discuss and monitor progress against all actions, in order to hold the individuals responsible to account, and to share successes and challenges.
- Quarterly meetings of traditional leaders to share learnings across the district.
The results of the pilot CLMDR system addressed the weaknesses of the existing system listed above:
- Improved identification of maternal deaths:
- 52 maternal deaths identified during the pilot year, only 25 of which were picked up by the existing system.
- Significantly, as well as identifying deaths which took place outside the hospital, the CLMDR system identified 4 hospital deaths which has been missed.
- Twice as many identified deaths were reviewed under the CLMDR system - 86%
- Improved quality and range of information available to gain a full understanding of the factors contributing to each maternal death
- Increased number and range of stakeholders involved in MDRs
- Development of community action plans targeted to address issues raised during the MDR process, such as setting up a mobile clinic for antenatal care. 82% of actions were completed.
- Enhanced community accountability structures for commitments made by health workers. 65% of health centre actions and 67% of district hospital actions were completed.
Overall, the article concludes that engaging and empowering communities through the CLMDR system can help ensure effective review of maternal deaths, and can facilitate targeted response planning and accountability.
The Malawi Ministry of Health has recognised this opportunity, and has begun to roll out CLMDR across the country.
To read this article, click here.
|Bayley, O., Chapota, H., Kainja, E., Phiri, T., Gondwe, C., King, C., Nambiar, B., Mwansambo, C., Kazembe, P., Costello, A., Rosato, M., & Colbourn, T. (2015). Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi. BMJ Open, 5(4), e007753.|