Opening the Black Box of Maternal and Newborn Deaths in Kenya: A Report on Technical Support for Implementation of Maternal and Perinatal Death Surveillance and Response

Author(s): MEASURE Evaluation PIMA

Year: 2017

Abstract:

Kenya aims to reduce its high maternal mortality rate from 362 deaths per 100,000 live births to 200 deaths per 100,000 live births by 2030. Maternal and perinatal death surveillance and response (MPDSR) is an essential, high‑impact element of obstetric and newborn care and a game-changing approach to attaining this goal. In 2008, the Kenya Ministry of Health (MOH) adopted the World Health Organization’s technical guidelines on maternal death reviews and incorporated a perinatal component. A 2014 audit of the implementation of maternal death reviews showed weaknesses, such as a lack of knowledge of classification of causes of death in accord with the International Classification of Diseases, low levels of reporting of maternal deaths, and a lack of reporting forms. These issues show that health workers in maternal and neonatal health programs face challenges in providing specific services to eliminate the deaths of women and newborns. WHO has described these kinds of data gaps—in Kenya and elsewhere—as the “black box of maternal mortality.” The missing data are necessary for Kenya to track preventable maternal and newborn deaths precisely and in real time and to respond effectively.

MEASURE Evaluation PIMA, funded by the United States Agency for International Development, helped with the audit, the development of maternal and perinatal death surveillance and response guidelines, tools for implementing the guidelines, and efforts to strengthen maternal and perinatal death surveillance and response. This report outlines those efforts and lessons.

In Kenya, knowledge of MPDSR as a high-impact intervention has increased, especially among health workers, despite varying degrees of implementation by county MPDSR committees. With global and national commitments to eliminate preventable maternal, child, and newborn deaths, and Kenya’s efforts toward these goals, there is promise that the vision for a functional MPDSR system will be achieved. Experience from efforts to institutionalize MPDSR in the five focus counties shows that although reporting is still low, information on the extent and characteristics of maternal and perinatal deaths is becoming more available and accessible. Specific maternal and perinatal mortality data from the “black box” are increasingly accessed, analyzed, and used for policy and service delivery.