Abstract
Implementation of maternal death surveillance and response (MDSR) is crucial to reduce maternal deaths. In Suriname, MDSR was not implemented until 2015. We describe the process of MDSR implementation in Suriname and share the "lessons learned," as experienced by the health care providers, national maternal death review committee members, and public health experts. Before 2015, maternal deaths were identified using death certificates and by active surveillance in the hospitals. Based on the recommendations from a 2010-2014 Reproductive Age Mortality Survey in Suriname, a maternal death review committee has improved the identification of maternal deaths and has audited every death since 2015. Although this review committee initiated several actions to implement MDSR together with health care providers, the involvement of the Ministry of Health (MOH) was crucial. Therefore, the Maternal Health Steering Committee was recently installed as a direct working arm of MOH to guide MDSR implementation. One of the main barriers to implementing MDSR in Suriname has been the lack of action following recommendations. Delineating roles and responsibilities for action, establishing accountability mechanisms, and influencing stakeholders in a position to act are critical to ensure a response to the recommendations. To implement MDSR, the 5 Cs-commitment, "no blame, no shame" culture, coordination, collaboration, and communication-are crucial.
Highlights
The reduction of maternal deaths was the focus of Millennium Development Goal 5 in 2000, and it remained a priority in the Sustainable Development Goals established in 2015.1–3 In addition to counting maternal deaths, it is essential to identify underlying causes and contributing factors to gain more insight into the gaps in care to prevent avoidable deaths.[4]
The maternal mortality ratio declined with time from 226 per 100,000 live births in 1991– 1993 to 154 per 100,000 live births in 2010, Suriname was designated by the Pan American Health Organization (PAHO) in 2010 as one of the 10 priority countries in Latin America and the Caribbean for reduction of maternal mortality.[9,10,11]
Several intentions existed to improve surveillance and classification in Suriname for years, but integrated reviews of maternal deaths were not performed until the installation of a national maternal mortality review committee in 2015 (Figure 1)
Summary
The reduction of maternal deaths was the focus of Millennium Development Goal 5 in 2000, and it remained a priority in the Sustainable Development Goals established in 2015.1–3 In addition to counting maternal deaths, it is essential to identify underlying causes and contributing factors to gain more insight into the gaps in care to prevent avoidable deaths.[4]. To reduce maternal and perinatal mortality, the MOH performed an analysis in 2007, followed by different action plans and reports, each presenting similar recommendations, but the plans were not implemented.[22,23,24] Implementation was less successful than intended due to a lack of human resources, poor communication, and scarce coordination.[23,25] these plans and reports were little known among health care providers and other important stakeholders needed for the response.[23,25] Surveillance had barely improved since 2000 and maternal death audits were not conducted until mid-2015.10,21. The committee MaMS, established in November 2015, gathers (bi)monthly and audits every pregnancy-related death in the nation.[26] The committee consists of 4 gynecologists/obstetricians, 1 midwife, 1 internal medicine specialist, 1 BOG representative, 2 medical students, and several external consultants.[26] Most members are consultants from 4 of the 5 major hospitals in Suriname where most births take place; primary health care is not represented. Sharing of cases (exchange of data) with the BOG and vice versa (not yet performed regularly)
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