Implementation of maternal and perinatal death surveillance and response (MPDSR) in humanitarian settings: insights and experiences of humanitarian health practitioners and global technical expert meeting attendees

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Study Justification:
– Maternal and perinatal death surveillance and response (MPDSR) is a crucial system for identifying and preventing future deaths.
– While MPDSR has been implemented in low-and-middle income settings, there is limited documentation of its application in humanitarian settings.
– The study aims to address this gap by exploring the insights and experiences of humanitarian health practitioners and global technical expert meeting attendees regarding MPDSR in humanitarian settings.
Highlights:
– Significant obstacles to full implementation of MPDSR in humanitarian settings were identified, including overburdened services, disincentives to reporting, accountability gaps, a blame approach, and politicization of mortality.
– Concerns about health worker security and moral distress were also highlighted as unique challenges in humanitarian contexts.
– Despite the challenges, there were examples of successful MPDSR implementation leading to concrete actions to prevent deaths and improved understanding of contextual factors in humanitarian settings.
– The study emphasizes the need for an adapted approach to MPDSR in humanitarian contexts, with varying implementation strategies based on different phases of crises.
– Successful advocacy efforts and improved access and quality of care have been observed as outcomes of MPDSR in humanitarian settings.
Recommendations:
– Develop guidance specifically tailored to MPDSR in humanitarian contexts to ensure feasibility and effectiveness.
– Increase documentation and learning from experiences with MPDSR in humanitarian settings.
– Address the identified obstacles to full implementation, such as overburdened services, disincentives to reporting, accountability gaps, and a blame approach.
– Prioritize the security and well-being of health workers in humanitarian settings.
– Advocate for the institutionalization and implementation of MPDSR within humanitarian organizations.
Key Role Players:
– World Health Organization (WHO)
– United Nations Children’s Fund (UNICEF)
– Centers for Disease Control and Prevention (CDC)
– Save the Children
– United Nations Population Fund (UNFPA)
– United Nations High Commissioner for Refugees (UNHCR)
– Humanitarian health practitioners
– Global technical experts
Cost Items for Planning Recommendations:
– Development of guidance materials
– Training and capacity-building programs
– Research and documentation efforts
– Advocacy campaigns
– Implementation support and monitoring activities
– Security measures for health workers in humanitarian settings

Background: Maternal and perinatal death surveillance and response (MPDSR) is a system of identifying, analysing and learning lessons from such deaths in order to respond and prevent future deaths, and has been recommended by WHO and implemented in many low-and-middle income settings in recent years. However, there is limited documentation of experience with MPDSR in humanitarian settings. A meeting on MPDSR in humanitarian settings was convened by WHO, UNICEF, CDC and Save the Children, UNFPA and UNHCR on 17th–18th October 2019, informed by semi-structured interviews with a range of professionals, including expert attendees. Consultation findings: Interviewees revealed significant obstacles to full implementation of the MPDSR process in humanitarian settings. Many obstacles were familiar to low resource settings in general but were amplified in the context of a humanitarian crisis, such as overburdened services, disincentives to reporting, accountability gaps, a blame approach, and politicisation of mortality. Factors more unique to humanitarian contexts included concerns about health worker security and moral distress. There are varying levels of institutionalisation and implementation capacity for MPDSR within humanitarian organisations. It is suggested that if poorly implemented, particularly with a punitive or blame approach, MPDSR may be counterproductive. Nevertheless, successes in MPDSR were described whereby the process led to concrete actions to prevent deaths, and where death reviews have led to improved understanding of complex and rectifiable contextual factors leading to deaths in humanitarian settings. Conclusions: Despite the challenges, examples exist where the lessons learnt from MPDSR processes have led to improved access and quality of care in humanitarian contexts, including successful advocacy. An adapted approach is required to ensure feasibility, with varying implementation being possible in different phases of crises. There is a need for guidance on MPDSR in humanitarian contexts, and for greater documentation and learning from experiences.

Based on the provided description, here are some potential innovations that could improve access to maternal health in humanitarian settings:

1. Mobile health (mHealth) applications: Develop and implement mHealth applications that can be used by healthcare providers in humanitarian settings to collect and analyze data on maternal and perinatal deaths. These applications can facilitate real-time reporting, data sharing, and analysis, enabling timely response and prevention of future deaths.

2. Community-based interventions: Implement community-based interventions that aim to increase awareness and knowledge about maternal health, promote early detection of complications, and encourage timely access to healthcare services. This can be done through community health workers, peer support groups, and community education programs.

3. Telemedicine: Utilize telemedicine technologies to provide remote consultations and support for healthcare providers in humanitarian settings. This can help bridge the gap between limited healthcare resources and the need for specialized maternal health expertise.

4. Strengthening health systems: Focus on strengthening the overall health systems in humanitarian settings, including improving infrastructure, training healthcare providers, and ensuring the availability of essential medicines and supplies for maternal health care.

5. Partnerships and coordination: Foster partnerships and coordination among humanitarian organizations, governments, and local communities to ensure a comprehensive and integrated approach to maternal health. This can help avoid duplication of efforts, maximize resources, and improve access to maternal health services.

6. Addressing security concerns: Develop strategies to address security concerns for healthcare providers working in humanitarian settings, including providing adequate security measures, training, and support. This can help alleviate concerns and ensure the safety of healthcare providers, enabling them to deliver essential maternal health services.

7. Advocacy and policy development: Advocate for policies and guidelines that prioritize maternal health in humanitarian settings. This can help create a supportive environment for implementing and sustaining maternal health interventions, ensuring long-term impact and improved access to care.

It is important to note that these recommendations are based on the provided description and may need to be further tailored and adapted to specific contexts and challenges in humanitarian settings.
AI Innovations Description
Based on the provided description, the recommendation to improve access to maternal health in humanitarian settings is the implementation of maternal and perinatal death surveillance and response (MPDSR) systems. MPDSR involves identifying, analyzing, and learning from maternal and perinatal deaths in order to prevent future deaths and improve overall care.

However, it is important to address the specific challenges faced in humanitarian settings. These challenges include overburdened services, disincentives to reporting, accountability gaps, a blame approach, politicization of mortality, concerns about health worker security, and moral distress.

To ensure the effectiveness of MPDSR in humanitarian contexts, the following recommendations can be considered:

1. Adapt the approach: Recognize that the implementation of MPDSR may need to be adapted to the unique challenges and phases of humanitarian crises. Flexibility is key to ensure feasibility and effectiveness.

2. Address accountability gaps: Establish clear lines of accountability and responsibility for reporting and responding to maternal and perinatal deaths. Encourage a culture of transparency and learning rather than a blame approach.

3. Enhance implementation capacity: Strengthen the institutionalization and implementation capacity of MPDSR within humanitarian organizations. Provide training and resources to healthcare providers and staff involved in the process.

4. Improve security and well-being of health workers: Address concerns about health worker security and moral distress by providing adequate security measures, support, and counseling services.

5. Document and learn from experiences: Increase documentation and learning from experiences with MPDSR in humanitarian settings. Share best practices, successes, and challenges to inform future implementation and improve access to maternal health.

6. Develop guidance: Develop specific guidance on implementing MPDSR in humanitarian contexts. This guidance should take into account the unique challenges and provide practical recommendations for implementation.

By implementing these recommendations, it is possible to improve access to maternal health in humanitarian settings, prevent future deaths, and enhance the quality of care provided to pregnant women and newborns.
AI Innovations Methodology
To improve access to maternal health in humanitarian settings, here are some potential recommendations:

1. Strengthening Health Systems: Enhance the capacity of health systems in humanitarian settings by providing adequate resources, infrastructure, and skilled healthcare professionals. This includes ensuring the availability of essential maternal health services, such as antenatal care, skilled birth attendance, emergency obstetric care, and postnatal care.

2. Community Engagement: Promote community engagement and participation in maternal health programs. This can be achieved through community-based education and awareness campaigns, involving local leaders and community health workers, and addressing cultural and social barriers to accessing maternal health services.

3. Mobile Health Technologies: Utilize mobile health technologies, such as telemedicine and mobile applications, to improve access to maternal health services in remote or underserved areas. These technologies can facilitate remote consultations, provide health information, and enable timely referrals for high-risk pregnancies.

4. Task Shifting and Training: Implement task shifting strategies to optimize the use of available healthcare workforce. This involves training and empowering non-specialist healthcare providers, such as midwives and community health workers, to deliver essential maternal health services, under appropriate supervision and support.

5. Strengthening Referral Systems: Establish and strengthen referral systems to ensure timely and appropriate care for pregnant women with complications. This includes improving transportation and communication networks, establishing clear referral pathways, and enhancing coordination between different levels of healthcare facilities.

To simulate the impact of these recommendations on improving access to maternal health in humanitarian settings, a methodology could include the following steps:

1. Data Collection: Gather relevant data on the current status of maternal health in the specific humanitarian setting, including indicators such as maternal mortality ratio, antenatal care coverage, skilled birth attendance, and access to emergency obstetric care.

2. Baseline Assessment: Assess the baseline level of access to maternal health services and identify existing barriers and challenges. This can be done through surveys, interviews, and focus group discussions with healthcare providers, community members, and key stakeholders.

3. Intervention Design: Develop a simulation model that incorporates the recommended interventions. This model should consider the specific context of the humanitarian setting, including population demographics, healthcare infrastructure, and available resources.

4. Parameterization: Assign values to the parameters in the simulation model based on available data and expert input. This includes estimating the potential impact of each intervention on improving access to maternal health services, considering factors such as coverage, utilization, and quality of care.

5. Simulation Runs: Run the simulation model multiple times, varying the input parameters to capture different scenarios and assess the potential impact of the interventions on improving access to maternal health. This can help identify the most effective combination of interventions and estimate the expected outcomes.

6. Analysis and Interpretation: Analyze the simulation results to understand the potential impact of the recommended interventions on improving access to maternal health in the humanitarian setting. This includes quantifying changes in key indicators, such as reduction in maternal mortality ratio or increase in antenatal care coverage.

7. Sensitivity Analysis: Conduct sensitivity analysis to assess the robustness of the simulation results and identify the key factors that influence the outcomes. This can help prioritize interventions and guide decision-making.

8. Communication and Policy Recommendations: Summarize the findings of the simulation study and communicate the results to relevant stakeholders, including policymakers, healthcare providers, and humanitarian organizations. Provide evidence-based recommendations for implementing the interventions and improving access to maternal health in the specific humanitarian setting.

It is important to note that the methodology described above is a general framework and may need to be adapted based on the specific context and available data in each humanitarian setting.

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