Maternal and perinatal death surveillance and response in low- and middle-income countries: a scoping review of implementation factors.

Mary V Kinney,David Roger Walugembe,Peter Waiswa,Asha George,Phillip Wanduru

doi:10.1093/heapol/czab011

Abstract

Maternal and perinatal death surveillance and response (MPDSR), or any form of maternal and/or perinatal death review or audit, aims to improve health services and pre-empt future maternal and perinatal deaths. With expansion of MPDSR across low- and middle-income countries (LMIC), we conducted a scoping review to identify and describe implementation factors and their interactions. The review adapted an implementation framework with four domains (intervention, individual, inner and outer settings) and three cross-cutting health systems lenses (service delivery, societal and systems). Literature was sourced from six electronic databases, online searches and key experts. Selection criteria included studies from LMIC published in English from 2004 to July 2018 detailing factors influencing implementation of MPDSR, or any related form of MPDSR. After a systematic screening process, data for identified records were extracted and analysed through content and thematic analysis. Of 1027 studies screened, the review focuses on 58 studies from 24 countries, primarily in Africa, that are mainly qualitative or mixed methods. The literature mostly examines implementation factors related to MPDSR as an intervention, and to its inner and outer setting, with less attention to the individuals involved. From a health systems perspective, almost half the literature focuses on the tangible inputs addressed by the service delivery lens, though these are often measured inadequately or through incomparable ways. Though less studied, the societal and health system factors show that people and their relationships, motivations, implementation climate and ability to communicate influence implementation processes; yet their subjective experiences and relationships are inadequately explored. MPDSR implementation contributes to accountability and benefits from a culture of learning, continuous improvement and accountability, but few have studied the complex interplay and change dynamics involved. Better understanding MPDSR will require more research using health policy and systems approaches, including the use of implementation frameworks.

Highlights

Maternal and perinatal death surveillance and response (MPDSR), or any form of maternal and/or perinatal death review or audit, is a process used to improve health services and pre-empt future avoidable deaths (Hounton et al 2013; Independent Expert Review Group 2014; Every Woman Every Child 2015)
In an effort to unpack the complexities of the MPDSR implementation process, we discuss the findings according to each lens: service delivery, societal and systems (Figure 1; George et al 2019)
The team had regular meetings to discuss our understanding of the concepts and documented our decisions. This scoping review identifies and describes implementation factors relating to MPDSR in low- and middle-income countries (LMIC) settings applying an implementation framework and health systems thinking, allowing for deeper understanding of implementation

Summary

Introduction

Maternal and perinatal death surveillance and response (MPDSR), or any form of maternal and/or perinatal death review or audit, is a process used to improve health services and pre-empt future avoidable deaths (Hounton et al 2013; Independent Expert Review Group 2014; Every Woman Every Child 2015). As an intervention, it is a continuous cycle of identification, notification and review of maternal and/or perinatal deaths followed by actions to address identified contributing factors and to prevent future deaths through acting on gaps identified in the audit (Kinney et al 2019). Investigation of quality improvement processes, including audit and feedback (Ivers et al 2012), benefits from the use of implementation theory and frameworks to understand and explain factors that influence implementation outcomes (Hulscher et al 2013; Davidoff et al 2015; Nilsen 2015; Akachi and Kruk 2017; Kruk et al 2017; Persson 2017; Topp 2017)

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Conclusion