Health system readiness to manage maternal death data and avail evidence for decision-making through the Maternal Death Surveillance System in Ethiopia, 2020

Endris and Tilahun BMC Health Services Research (2023) 23:318 https://doi.org/10.1186/s12913-023-09321-x BMC Health Services Research Open Access RESEARCH Health system readiness to manage maternal death data and avail evidence for decision‑making through the Maternal Death Surveillance System in Ethiopia, 2020 Abduilhafiz A. Endris1* and Tizita Tilahun2 Abstract Background Maternal mortality remains a major health problem in Ethiopia. To generate contextual evidence on the burden and distribution of existing causes and contributing factors for programmatic and individual-level decisionmaking, the Maternal Death Surveillance and Response System was introduced in 2013. This assessment describes the Ethiopian health system’s readiness to avail evidence for decision-making through the MDSR system. Method A cross-sectional study designed using the WHO framework for evaluating surveillance systems was used. By employing a multistage sampling, 631 health facilities and 539 health posts were included. ODK collect data entry software was used to collect data from September 2019 to April 2020. Findings are presented in text descriptions, graphs, maps, and tables. Findings Four hundred (77.1%) health facilities (332 (74.6%) health centers and 68 (91.9%) hospitals) and 264 (71.5%) health posts reported implementing the MDSR system. Of the implementing health facilities, 349 (87.3%) had a death review committee, and only 42 (12.4%) were functional. About 89.4% of health centers and 79.4% of hospitals had suboptimal maternal death identification and notification readiness. Only 23 (6.96%) and 18 (26.47%) MDSR-implementing health centers and hospitals had optimal readiness to investigate and review maternal deaths, respectively. Moreover, only 39 (14.0%) health posts had locally translated case definitions and 28 (10.6%) had verbal autopsy format to investigate maternal deaths. Six (1.5%) facility officers and 24 (9.1%) health extension workers were engaged in data analysis and evidence generation at least once during 2019/20. Regional variation is observed in system implementation. Conclusions and recommendations Sub-optimal MDSR system implementation is recorded. Revitalizing the system by addressing all system components is critical. Having a national-level roadmap for MDSR system implementation and mobilizing all available resources and stakeholders to facilitate this is vital. Establishing a system for routine data quality monitoring and assurance by integrating with the existing PHEM structure, having a system for routine capacity building, advocacy, and monitoring and evaluating the availability and functionality of MDSR committees at health facilities are all critical. Digitalization, designing a system to fit emerging regions’ health service delivery, and availing required resources for the system is key. Keywords Health system readiness, MDSR, System evaluation, Ethiopia *Correspondence: Abduilhafiz A. Endris Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Endris and Tilahun BMC Health Services Research (2023) 23:318 Background Introduction Globally, maternal mortality continues to be a significant public health concern. In 2017, maternal mortality ranged from 462 per 100 000 live births in the least-developed countries to 11 per 100 000 in highincome countries. The report also indicated that low and middle-income countries in Sub-Saharan Africa and Southern Asia make up 86% of global maternal deaths [1, 2]. Based on the Sustainable Development Goals (SDGs) goal for 2030, all countries should reduce MMR by twothirds of their 2010 baseline level. The average global target is an MMR of less than 70/100 000 live births by 2030. However, accurate information on how many women died, where they died, and why they died is essential yet currently inadequate [3]. Ethiopia has one of the highest Maternal Mortality Rates (MMR) globally, with an estimated maternal mortality ratio of 412 maternal deaths per 100,000 live births [4]. On the path to ending preventable maternal mortality, the WHO guide "Beyond the numbers" was launched in 2004 to encourage not just estimating the number of maternal deaths to know the magnitude of the problem but also to understanding why and where the women died to be able to do something about it [5–10]. Following the WHO recommendation, the Ministry of Health (MOH) – in Ethiopia established the Maternal Death Review and Response (MDSR), a system to count and investigate all maternal deaths to generate and avail real-time information for decision-making Page 2 of 12 in 2013. Since 2014, the MDSR has been integrated with the national Public Health Emergency Management (PHEM) system. The MDSR system is expected to avail reliable and quality data and information in real-time on the burden, causes, and contributing factors of maternal deaths and preventability of fatalities in the nation, thereby assisting with timely responses for improving maternal in Ethiopia [11, 12]. To date, several promising achievements have been gained. However, one of the challenges in eliminating preventable maternal death in Ethiopia is the absence of information that shows the magnitude and causes of maternal deaths to assist with decision-making regarding the responses [8, 9]. Therefore, this study was conducted to determine the MDSR system implementation status and describe the health system’s readiness for generating and availing good quality data and evidence for the decision-making process in Ethiopia. Scope of the evaluation and evaluation questions This national MDSR system evaluation covers the three components of the Maternal Death Surveillance and Response system in Ethiopia’s community and health facility health system structure. The scope of this national MDSR system evaluation is shown below (Fig. 1). This system evaluation addresses the below-indicated evaluation (...truncated)