E4A Research Report: Institutionalisation of maternal death reviews. A study on progress in Kano State, Nigeria

Maternal death reviews (MDRs) capture information on maternal deaths, examine underlying factors, and aim to create change needed to improve quality of health services and avert future deaths. Evidence for Action MamaYe is working closely with partners in Nigeria to roll out the implementation of MDRs in Jigawa and Kano States and to ensure that findings are acted upon at local, state and national levels. This study examined the extent to which MDRs (or equivalent) are implemented and the use of findings in Kano State in Nigeria. It also aimed to gather information about challenges and constraints, and understand various stakeholders and their level of engagement. Methods

• 7 Key informant interviews were conducted to gain insight on midwives and health planners’ perspectives of MDRs in Kano state
• A two-day focus meeting on issues of MDR and the midwife service scheme was convened by E4A in collaboration with the National Primary Health Care Development Agency 
• Data were collected from January – March 2013 

Key findings

• The national MDR strategy included a phased implementation, starting at federal facilities, and moving to state, then local facilities.
• The initial focus was on facility-based MDRs.
• MDR committees were established at both facility and state levels to review maternal deaths and develop action plans for all maternal deaths. 
• The State Ministry of Health was a key stakeholder in MDR implementation and had a critical role managing other stakeholders.
• As of December 2014, no significant progress in MDR implementation was achieved in Kano State.  This was associated with a lack of government commitment.
• Challenges in implementing MDRs in Kano State included a lack of a strong team, inadequate planning, incomplete data, lack of community sensitization and a lack of cooperation from the ward development committees and health facility staff.
• Stakeholder management and involvement was identified as a potential barrier to successful MDR implementation.

Recommendations and conclusionThis study concludes that the approval of national MDR guidelines is a significant opportunity, highlighting national level commitment and political will to improving maternal health.  Based on the findings, this study proposes the following recommendations:

• Advocacy efforts to hold decision makers to account
• Adequate coordination between facility and state level MDR teams to ensure that MDRs are action-oriented and improve the quality of care
• Workforce and organisations capable of supporting implementation of MDRs in Kano state, particularly advocacy and accountability activities
• Follow-up tools to help monitor and ensure that actions and interventions are carried out

To download the report, click here. To become part of the Maternal Death Surveillance and Response Network and help save mothers’ lives, click here. Evidence for Action. (2015). E4A Research Report: Institutionalisation of maternal death reviews. A study on progress in Kano State, Nigeria, January–March 2013. London & Abuja: Evidence for Action.