Most maternal and newborn deaths are preventable—if women can quickly access the high-quality healthcare they need.

So it’s important for health officials to track and understand the causes and contributing factors of these deaths in order to design health programs and policies to strengthen health systems and prevent these deaths in the future. Many countries track this critical information through Maternal and Perinatal Death Surveillance and Response (MPDSR) systems.

MOMENTUM Country and Global Leadership partners with ministries of health and other national partners to strengthen their capacity to implement strong and integrated MPDSR systems. To explore the importance and impact of these efforts, we spoke to three people who are working to strengthen MPDSR in Nepal—a country that has been leading the way in this area.

Implementing MOMENTUM Country and Global Leadership’s virtual MPDSR package: The master trainer’s perspective

Dr. Kusum Thapa is a senior technical advisor with MOMENTUM Country and Global Leadership. She leads the project’s MPDSR work and is a master trainer on MPDSR.

To start, I’d like your perspective on how MPDSR systems are linked to quality care.

MPDSR systems are a really powerful tool to identify, review, and respond to gaps in quality of care. MPDSR systems provide health officials with continuous information and insights into where deaths are happening, what are the underlying causes, and what are significant factors contributing to those deaths. With this information, health officials can identify trends or patterns in care that can be addressed with quality interventions. They can also use this information to inform research and policy decisions that help ensure equitable access to care. MPDSR systems also integrate information on maternal and perinatal death—this consolidated information helps health officials create solutions that improve health and reduce death for both mom and baby.

Tell me about the tools MOMENTUM has developed to help countries strengthen their MPDSR systems.

Previously, there was no global capacity-building resource that combined both maternal and perinatal mortality surveillance in one learning package. But this was very much needed to help build the skills of health managers and frontline health workers to implement comprehensive MPDSR processes in low-resource settings. Amidst the COVID-19 pandemic, we also saw the need to pivot our capacity-building efforts into a virtual platform. To address that gap, MOMENTUM developed an integrated virtual MPDSR capacity-building package in collaboration with the World Health Organization (WHO), UNFPA and UNICEF.

Between September 2020 and March 2023, MOMENTUM and partners used this package to virtually train 214 participants from 39 countries on MPDSR. Sixty-five of these participants were then supported to train others at national, subnational, and health facility levels.

How do countries take these tools and apply them to strengthen MPDSR systems?

The package recommends countries establish MPDSR committees based on national guidelines, and link them with quality improvement committees. MOMENTUM is partnering with countries and health facilities to form or strengthen these committees and to engage members from quality improvement committees in the death audit process, thus ensuring strong linkages between MPDSR and quality of care.

Another particularly exciting part of this new package is that it uses a scorecard, adapted from WHO’s Maternal and Perinatal Death Surveillance and Response: Materials to Support Implementation guidance, to monitor maternal and perinatal data and committee responses on a monthly basis. MOMENTUM is using this scorecard with committees in Indonesia and Nepal, and collaborating with WHO South-East Asia Regional Office and the South Asian Federation of Obstetricians and Gynaecology on work in Bangladesh, India, Nepal, and Sri Lanka.

To take this approach to scale, the Family Welfare Division of Nepal’s Ministry of Health adopted the scorecard and began digitizing it in the division’s web-based MPDSR portal in 2022. Another important aspect of this package is the emphasis on a “no name, no blame” approach—as a result, participants conduct reviews in an environment where they feel safe and comfortable, and can then implement MPDSR effectively.

Achieving MPDSR impact at the national level in Nepal: The facilitator’s perspective

Ayushma Shakya, head nurse of Birat Medical College in Nepal, was recently trained as an MPDSR facilitator and is mentoring other health providers on MPDSR.

Tell me about your role in strengthening Nepal’s MPDSR system.

Over the last year, I’ve participated in MPDSR system strengthening activities. First, I was a participant in the virtual capacity-building workshop led by MOMENTUM in February 2022.

After the first virtual workshop, we formed our MPDSR committee at Birat Hospital and now we regularly conduct death audits and web-based reporting. Later, with colleagues, I co-facilitated two batches of capacity-building workshops to expand MPDSR processes to six other hospitals in the province, including B.P. Koirala Institute of Health Sciences (BPKIHS), which is an important teaching hospital in Nepal. I now also attend facility reviews and exchange meetings, and help identify actionable solutions not only in our hospital but in the whole province.

Have you seen results already?

I have seen that appropriately tracking and following up on MPDSR response plans can lead to visible improvements in the quality of care provided by a hospital. Hospital staff often get together during the provincial review meeting to share scorecard results and progress.

At first, Birat Hospital had the lowest baseline score in USAID MCSP’s MPDSR progress monitoring tool among eight MOMENTUM-supported sites . We have already seen improvements in our midline scores, as well as at other MOMENTUM-supported sites. As a result of audit findings, which showed high stillbirth rates, Birat Hospital has added new systems and equipment, such as fetal monitoring in the labor room, additional doctors, and ventilator support in the NICU. Additionally, as an MPDSR facilitator, I’ve seen similar progress in other hospitals in the province, with increased training and collaboration, and improved patient care.

Achieving MPDSR impact at the facility level in Nepal: The practitioner’s perspective

Dr. Deepa Shah is an assistant professor at BPKIHS in Nepal. She participated in a virtual MPDSR capacity-building workshop and facilitators training and is now delivering the virtual MPDSR capacity building to other providers.

What progress are facilities making?

Our hospital is making significant progress in MPDSR reviews and gaining valuable knowledge in the process. We participated in the virtual MPDSR workshop at the provincial level organized by MOMENTUM.

After the workshop, we updated the BPKIHS MPDSR committee based on national guidelines, conducted regular meetings, identified contributing factors, and formulated response plans. We tailored our response to what the MPDSR scores indicated were the biggest challenges. So far, we’ve focused on delays in receiving adequate, quality care when a patient reaches a facility. We intend to coordinate with local government officials to also address delays in seeking care during an obstetric emergency and reaching an appropriate obstetric facility.

We also oriented junior staff on MPDSR. Considering the need for trained staff in the near future, we plan to include MPDSR in the onboarding curriculum of our incoming resident doctors.

Moreover, we also learn a lot from other hospitals’ experiences during the MOMENTUM-organized review meetings. This has been an excellent learning opportunity; often we face common challenges and issues.

How are you measuring that progress?

It’s too early to determine the statistical significance of the progress shown in the MPDSR progress monitoring tool, but all facilities now implement and maintain a web-based MPDSR scorecard to track progress.

The most significant, tangible achievements so far center on addressing delays in receiving adequate, quality care when a patient reaches a facility. With MOMENTUM’s support, at BPKIHS we have developed new guidelines and reinforced existing ones for high-risk case management of sepsis, placenta previa, and hypertensive disorders.

Globally, governments and implementing partners like MOMENTUM continue to work together to strengthen MPDSR systems around the world that are improving maternal and perinatal care—and ultimately contribute to achieving the Sustainable Development Goals.