Nigeria still has one of the highest Maternal Mortality Rates (MMR) in the world. The 2018 Nigeria Demographic and Health Survey (NDHS) estimates the country’s MMR ratio as 512 deaths per 100,000 live births.
Also, a global maternal mortality report titled ‘Trends in maternal mortality 2000 to 2020’ released this year showed that the country records 82,000 maternal deaths every year. This translates to 225 deaths from maternal mortality every day.
This is far from the Sustainable Development Goals (SDGs) target of 70 per 100,000 live births.
Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
How effective implementation of MPCDSR will reduce maternal, child deaths in Nigeria
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Medical experts say the reduction rate of these deaths has been slow, as many of the contributory factors remain unaddressed.
This underscores the need for interventions to reduce the rate of maternal, newborn and child deaths.
The World Health Organisation (WHO) and United Nations Children’s Fund (UNICEF) recommend that all countries institutionalise maternal death reviews as a key strategy to prevent maternal deaths.
In 2013, WHO launched the Maternal Death Surveillance and Response (MDSR) guidance to strengthen notification, review and response to maternal deaths.
According to MSD for Mothers, to achieve high-quality maternity care, every maternal death, wherever it occurs, should be counted, reported and examined—and the findings from these reviews should drive action to prevent future deaths.
In 2016, the Federal Ministry of Health adopted the Maternal and Perinatal Death Surveillance and Response (MPDSR). Last year, the federal government launched the revised guidelines and tools for the MPCDSR programme.
Speaking during the launch, the former Minister of Health, Dr Osagie Ehanire, said, “The initiative has indeed been expanded to incorporate child mortality audit, making it now the Maternal Perinatal and Child Death Surveillance and Response (MPCDSR). The enabling bill has been passed by the National Assembly, and is awaiting presidential assent.”
There were many calls on President Muhammadu Buhari to assent to the MPCDSR bill but he didn’t till the end of his administration earlier this year.
According to a public health specialist, Dr Sakina Bello, the “Maternal Perinatal and Child Death Surveillance and Response (MPCDSR) is used to monitor and review maternal and perinatal deaths in order to identify the underlying causes and contributing factors, and to develop interventions to prevent future deaths.”
Bello, who is also the Senior Programme Advisor, Reproductive Health/Family Planning of Pathfinder International Nigeria, said it is a crucial component of improving maternal and child health.
However, she said the effectiveness of the system can vary based on factors such as implementation, resources, healthcare infrastructure and government commitment.
She said Nigeria faces numerous challenges in its healthcare system, including inadequate access to quality healthcare in some regions, a lack of skilled healthcare professionals, insufficient resources and poor infrastructure, adding that, “These challenges can impact the effectiveness of the MPCDSR system.”
How passage of MPCDSR bill will help improve maternal and child health
With the non-passage of the MPCDSR bill by former President Muhammadu Buhari, the onus is on the 10th assembly to pass the law again and transmit it to President Bola Ahmed Tinubu for assent.
President of the Society of Gynaecology and Obstetrics of Nigeria (SOGON), Dr Habib Sadauki, said, “The Maternal Perinatal and Child Death Surveillance and Response (MPCDSR) is a laudable intervention that can potentially reduce maternal and newborn deaths.
“It empowers each community, health facility and the states to reflect on deaths incurred in their domain and respond with locally appropriate solutions for preventing the recurrence of similar deaths.”
He said the passage of the MPCDSR bill into law will serve as one of the indelible legacies to the people of Nigeria.
Dr Sakina Bello, on her part, said an effective MPCDSR system allows for the timely identification of health system weaknesses, clinical deficiencies, and other factors contributing to maternal and perinatal deaths.
She said this early identification enables swift corrective actions and improvements in healthcare service delivery which ensures continuous quality improvement.
“The MPCDSR bill would establish a formal framework for monitoring and reviewing maternal and perinatal deaths.
“This systematic approach enables healthcare facilities to identify and document cases of maternal and perinatal deaths accurately. It provides a standardised process for investigating the causes and contributing factors behind these deaths,” she said.
She said the implementation of the bill would lead to the collection of reliable data on maternal and perinatal deaths.
“This data can then be analysed to identify patterns, trends and common causes of deaths. Evidence-based decisions can be made to develop targeted interventions and strategies to address these specific issues, including policy development, and advocacy efforts for increased funding and resources in maternal and child health.
“Ultimately, the effective implementation of the MPCDSR system supported by the passage of the bill can lead to a reduction in maternal and perinatal mortality rates. By identifying and addressing the root causes of deaths, healthcare outcomes can be significantly improved,” she stated.
She said overcoming opposition or challenges with the MPCDSR bill requires a strategic and comprehensive approach that addresses concerns, identifies and engages stakeholders like healthcare professionals, community leaders, women groups, etc. to increase awareness and communicate the benefits of the system.
It will “Also establish a feedback mechanism to understand challenges and tackle them early enough; continuous advocacy and communication among relevant stakeholders,” she added.
Feasibility of implementing MPCDSR across the country, especially in private sector
The public health specialist, Dr Sakina Bello, said it is possible to implement the MPCDSR system across an entire country, adding that the involvement of both public and private healthcare sectors could significantly enhance the effectiveness and reach of the system.
She said, “This can be achieved through collaboration and partnership between stakeholders across government, public healthcare sector, private healthcare providers, non-governmental organisations (NGOs), and international partners. Creating partnerships ensures that resources, expertise and data are shared to achieve common goals.”
The expert said government could play a key role by passing legislation or policies that require both public and private healthcare facilities to participate in the MPCDSR system.
While saying this ensures that all maternal and perinatal deaths are reported, reviewed and responded to regardless of the sector, she added that community engagement and sensitisation can also contribute to that.
Findings reveal that Lagos State for instance is one of the states in the country that has a good scorecard for the implementation of the MPCDSR programme. The state’s MPCDSR system involves a committee of health professionals meeting regularly at hospitals and at the state level to examine information about the circumstances around every death and make recommendations about what actions need to be taken to prevent deaths from happening due to similar reasons.
Dr Moshood Salawu, Senior maternal and perinatal death surveillance and response (MPDSR) Advisor for Options, a global health organization that has been supporting the federal government in the implementation of MPCDSR, said there is need to address the challenges with the response component of the programme across the country.
He said “In order to achieve the goal of the MPCDSR which is to reduce preventable maternal and child deaths, the response component must be effective. And Options is working with states to generate these actions.”
He said the implementation of the community model of the MPCDSR in Soba ward of Kaduna State by Options led to a decline in the maternal and perinatal deaths in the ward.
“It was a form of pilot study to see how best to reduce the maternal and perinatal deaths in the community because most of these deaths happen in the community, not only at the facility level.”
