The Cultural Environment Behind Successful Maternal Death and Morbidity Reviews

Session: Optimal Learning from Maternal Deaths and Near Misses: How Can We Facilitate Change?

Presenter: Gwyneth Lewis, Institute for Maternal Health, University College London
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In many countries the introduction of death and near-miss reviews at national or facility level are being promoted as part of their efforts to improve maternal and newborn health. Many international organisations as well as WHO support this. When successful the lessons learnt from such in-depth case reviews lead to recommendations which, when implemented, result in beneficial changes. However, unless they are well planned and take place in a supportive administrative and professional environment, with the objective of genuinely seeking to identify and overcome the barriers to improving service delivery and quality of care, they generally fail. It can then take years to rebuild support and confidence to enable the process to start again. Thus their introduction needs to be planned and implemented with a great deal of care. This short presentation, backed up with a more detailed peer-reviewed paper,* will discuss the successes and failures observed in over 30 years personal work in implementing national and local maternal death and near-miss reviews around the world. The countries included range from the high-income to those in Africa, Asia and Central and Eastern Europe. Several principles appear to be common to their successful introduction. These include a supportive culture at personal, institutional and national level, underpinned by the fostering of professionalism and the development of an ethos of safety. The presentation will also provide practical examples of how barriers to their acceptability have been overcome by imaginative solutions. It also concludes that reviews undertaken at a local level are as beneficial as those at a regional or population level and should be encouraged as a routine part of the quality improvement agenda for each and every health care facility.