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Time to respond: a report on the global implementation of maternal death surveillance and response (MDSR)

Maternal death surveillance and response (MDSR) is a continuous cycle of notification, review, analysis and response.  It builds on the concept of maternal death reviews (MDRs) by focusing on the response and follow-up to ensure recommendations are acted on. 

MDSR is a relatively new concept and there is limited systematic data on its implementation.  Therefore, in 2015, the World Health Organization (WHO), in collaboration with the United Nations Population Fund (UNFPA) conducted a global survey of national MDSR systems to provide baseline data on the status of implementation. 

This report presents the findings of this survey, including additional information from the WHO-MNCAH policy indicator database.  It details key aspects of the MDSR system, and discusses the importance of MDSR and its role in reducing preventable maternal death by 2030. 

Survey methods

  • A 46 question survey questionnaire was developed based on the indicators of MDSR implementation
  • The questionnaire was circulated through WHO and UNFPA regional offices in April 2015 and responses were received between May-September 2015
  • 67 countries responded, 64 of which were low- and middle-income countries (LMIC)
  • Information from the WHO-MNCAH policy indicator database was used to supplement survey responses  and build of picture of the current status of MDSR implementation in LMICs 

Implementation insights

  • There has been widespread adoption of the important elements of the MDSR system globally, yet, there remains a gap between policy and practice and there is a lack of progress towards full implementation in many countries
  • Most countries have national policies to notify all maternal deaths (86%) and review all maternal deaths (85%)
  • Only a small proportion of countries have a national MDR committee that meets at least biannually (46%)
  • Only 60% of countries have both a national and subnational MDR committee
  • Frequent review meetings at all levels are important for successful surveillance and response.  Therefore the functioning of the MDSR system may be sub-optimal in countries whose committees meet less than biannually

Case study insights

Member states were also invited to share case studies describing successful implementation.  18 countries contributed at least one case-study, describing how barriers were overcome and highlighting innovative approaches.  Some of the challenges and barriers to implementation include:

  • Limited political buy-in and long-term vision
  • Under reporting of suspected maternal deaths due to inefficient/incomplete notification systems
  • Blame culture
  • Incomplete/inadequate legal frameworks
  • Inadequate staff, resources, and budget
  • Cultural norms and practices that limit MDSR operation
  • Problems of geography and infrastructure that inhibit MDSR operation 

Conclusions and next steps

  • There is a gap between MDSR policy and practice in many countries, with the “response” component lagging the furthest behind
  • Countries should be supported to focus on improving levels of maternal death notification and on strengthening mechanisms for response at all levels
  • To support countries in their implementation effort, the MDSR Working Group will work with partners to develop flexible MDSR training packages that can be adapted to countries priorities
  • The next global MDSR implementation survey is scheduled for 2017 and will be repeated every two years thereafter 

To read the WHO’s MDSR technical guidance, which describes the measures required to establish an effective MDSR system, click here

To visit the MDSR Action Network, click here

To download for report for free, click here

World Health Organization. (2016). Time to respond: a report on the global implementation of maternal death surveillance and response. Geneva: WHO.

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