Towards improving maternal and perinatal death surveillance and response in the African region: an analysis of 25 countries from 2015 until 2022.

Africa renewed its efforts to document maternal and perinatal deaths in 2014 following the release of the WHO's maternal and perinatal death surveillance and response (MPDSR) guidelines. Successful implementation of MPDSR requires timely notification and a thorough documentation of maternal and perinatal deaths, the development of causal pathways, and the enactment of targeted improvement (change) actions to prevent future avoidable deaths. Similar to the Plan-Do-Study-Act (PDSA) iterative process used in the Model for Improvement (MFI), MPDSR rests on robust data reporting systems without which quality improvement initiatives are ineffective. Unfortunately, many African health systems have significant challenges with data collection and reporting, often compounded by a disconnect between public and private sectors, which erode efforts to improve MPDSR. Over the past decades, countries across Africa have produced MPDSR reports that, despite often appearing comprehensive, mask underlying operational deficiencies. These reports consistently highlight substantial barriers to implementing effective death reviews. Findings show that of 47 countries, 25 (53%) provided MPDSR reports, with East and Southern Africa contributing more than half. Notably, under 30% and 12% of maternal and neonatal deaths in the District Health Information Software (DHIS) were notified to MPDSR, and about 63% of maternal deaths were reviewed. Our analysis of MPDSR reports from 25 African countries, covering 2015 to 2022, supplemented by data from DHIS, reveals critical issues: a widespread shortage of skilled maternity healthcare workers trained in MPDSR, inadequate data harmonisation and lack of standardised maternal and newborn health metrics, insufficient funding, the absence of functioning MPDSR committees at facility level and weak leadership committed to maternal and newborn health goals. Addressing these bottlenecks is essential for strengthening MPDSR efforts and should guide WHO and other development partners to scale up maternal and perinatal death surveillance across Africa.