Table 3 Maternal death surveillance cycle and implications for participating hospitals

1. Identification of cases

Develop policy (or enforce existing policy) that all maternal cases within the hospital be reported to a designated unit (possibly the clerk’s office of the maternity unit?).

Someone from the maternity unit should be designated to routinely (e.g. weekly or biweekly) visit (or call) all the possible departments where a woman of reproductive age may receive care and inquire about deaths and determine pregnancy status and cross check maternal death case numbers.

2. Data collection

Standard case note taking and medical record maintenance/storage should be enforced. Remedial training and sensitization on the importance of good record keeping practices should be provided. Systematic case-note audits should be regularly conducted. Additional funding from the Ministry of Health and appropriate collaborative partners should be provided to sustain and institutionalize good record keeping practices.

Coordinate with the safe motherhood program (or designated community health personnel) so they can follow up with cases in the community.

3. Data analysis

Basic and advanced courses/training in ICD-10 coding, cause of death certification should be provided for appropriate healthcare personnel.

Medical doctor or medical officer should facilitate maternal death audits.

Feedback loop to all appropriate healthcare staff, especially to those who were involved with caring for the patient in question.

4. Recommendations

Healthcare personnel formulate recommendations with senior staff.

Additional funding from the Ministry of Health and appropriate collaborative partners should be provided to implement the recommendations.

Senior staff should take lead and ensure recommendations are implemented.

5. Evaluation

Indicators should be formulated and agreed upon by healthcare personnel and senior management. Routine evaluation conducted accordingly.