This is the abstract presentation of Sayantan Chowdhury of UNFPA Bangladesh, which was presented as part of the 9th session of #APCRSHR10 Virtual, on the theme of "Humanitarian response and sexual and reproductive health and rights (SRHR) in Asia and the Pacific". C H A I R Chonghee Hwang Senior Manager, Family Planning 2020 (FP2020) P L E N A R Y S P E A K E R Tomoko Kurokawa Humanitarian Advisor, UNFPA Asia Pacific "Building Resilience across the Humanitarian Development Peacebuilding Nexus" A B S T R A C T P R E S E N T E R S * Sahlil Ahmed | Challenges Health Workers Face While Providing Sexual and Reproductive Health Services to Rohingya Refugees in Refugee Camps in Cox’s Bazar, Bangladesh: A Qualitative Study * Sayantan Chowdhury | Genesis of maternal mortality surveillance and response in the Rohingya refugee crisis * Sigma Ainul | Contraceptive non-use among the Rohingya and changing dynamics in post-displacement to Bangladesh * Manju Karmacharya | Transitioning from Minimum Initial Service Package to Comprehensive SRHR services responding Rohingya crisis in protracted Emergency in Cox’s Bazar, Bangladesh For more information on this session go to www.bit.ly/apcrshr10virtual9 #SRHR #sexualhealth #reproductiverights #familyplanning #womenshealth #genderequality #SDGs #BodilyAutonomy #humanitariancrisis #humanitariandisaster #pandemic

1. Genesis of Maternal Mortality
Surveillance and Response in the
Rohingya Refugee Crisis – A Case Study
Sayantan Chowdhury and Endang Handzel

2. Background

3. Background
• In order to reduce the mortality of this
vulnerable population, local and international
non-governmental organizations (NGO) built
capacity for basic public health infrastructure
including mortality surveillance.
• So it was interesting to know the
development and establishment of the
maternal and perinatal mortality surveillance
system in the Rohingya Refugee camps

4. Objective
To understand the establishment, development
and implementation process of Maternal and
Perinatal Mortality Surveillance and Response
system (MPMSR) in the Rohingya refugee crisis

5. Case
Description
• Methods:
• The case study included the operational area of
MPMSR in the refugee camps.
• Data were obtained through key informant interviews
and systematic document review from 2017–2019.
• Study site:
• All the 34 refugee camps in Ukiya & Teknaf sub-
districts in Cox’s Bazar
• Facilities providing SRHR services to the refugees
• Data collection:
• A total 18 KII was done with Implementers at different
level (community and facility), MPMSR committee
members, researchers using a interview guideline
• Document reviews (Meeting minutes, Reports,
Bulletins)
• Data Analysis:
• Inductive qualitative content analysis

6. Findings
1. Establishment and development of
MPMSR
2. Implementation process of MPMSR

7. 1. Establishment and Development
Aug. 2017
New influx of Rohingya
Population from
Rakhine to CXB
Nov.–Dec. 2017
General mortality
surveillance form
developed
Feb. 2018
General mortality
surveillance
implemented in some
camps

8. Establishment
and
Development
Population and
demographic
survey
conducted by
UNFPA-ICDDRB
Mar. 2018
Situational
analysis maternal
and perinatal
mortality
surveillance
(CDC-UNFPA)
Apr 2018
MM audit form
(UNHCR) piloted
for some MM
cases at facilities
May 2018
Sept 2018
Mar 2019
July 2019
Sept 2019
Collaboration
between UNFPA
and CDC to
establish MM
surveillance and
RAMOS started
Dissemination of
the RAMOS
EWARS was
introduced to
notify mortalities
Formation of
steering
committee
(MPMSR
committee) under
the SRH-WG
Introduction of
the prospective
MPMSR

9. 5.5
9.7
1.4
13.6
12.7
5.7
8.3
11.6
1.8
10.0
13.6
6.2
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
<=28 days >28 days - 5 years 6-11 years 12-49 years 50-70 years 71+years
Percent
Age Group
Percent of deaths by age and gender in The
Rohingya Camps September 2017 – August 2018
F M

10. Location of death among women of
reproductive age and among pregnancy-
related deaths
Location of death among WRA deaths (n-327) Location of death among PRD (n=82)
68%
5%
17%
9%
1%
At home
On the road
Camp hospital
Government
hospital
Private
clinic/hospital
54%
6%
25%
15%
At home
On the road
Camp hospital
Government
hospital

11. Prospective
Mortality
Surveillance
Apr. 2019
Maternal and neonatal mortality
surveillance designed
EWARS mortality component
designed and training conducted
June–Aug. 2019
Perinatal death review and VA
training and piloted
Monitoring framework drafted
Aug.–Sep. 2019
Refresher VA and facility death
review training

12. Implementation of
Maternal and
Perinatal Mortality
System and Response
(MPMSR) in Rohingya
Response

13. Implementation
of the Maternal
Mortality
Surveillance
2.1 Coordination Mechanism
2.2 Maternal and Perinatal Mortality
Surveillance System

14. Health Sector (cluster) Coordination in Rohingya
Response
• Total partners – over 100 including INGOs, NGOs, UN agencies.
• Coordinated under leadership – Civil Surgeon’s Office of Cox’s Bazar District, Directorate
General Health Services Coordination Center (DGHS) and the World Health Organization
(WHO)
• 3 tiered coordination structure - District, Sub-district (Upazila) & Union
• Strategic advisory group (SAG) – District Level (Advisory role to the health sector
coordinator)

15. Working Groups for Health Coordination
(2019) in Rohingya Response
• Sexual and Reproductive Health (SRH):
chaired by UNFPA
• Mental Health and Psychosocial Support
(MHPSS): chaired by IOM and UNHCR
• Community Health Workers (CHW): chaired
by UNHCR
• Epidemiology and Case Management (ECM):
chaired by WHO
• In addition, coordination of support to the
District hospital & Upazila health facilities.
Health
Sector
SRH WG
MPMSR
Committee
MPMSR Sub
Committee
MHPSS WG CHW WG ECM WG

16. MPMSR System
Facility
Death
review
Facility
Death
Audits
Community Mortality
Surveillance – Reporting
through EWARS
WRA
Verbal
Autopsies
MPMSR committee
Healthcare
Providers
MPMSR Sub-
committee
CHWs in the camps
WHO-epi team
VA Team

17. MPMSR - A system for reporting the findings and recommendations of reviews into
maternal & perinatal deaths in FDMN camp settings
Identification &
Notification
Review of maternal
deaths
Actions to improve
quality of care

18. Framework for the MPMSR
Community based Maternal
Mortality Surveillance
system
Facility based Maternal &
Perinatal Mortality
Surveillance system

19. Community based Maternal & Perinatal Mortality Surveillance Data Flow – Updated
April 2019

20. Agency focal for CHWVA Team (Midwives)
MPMSR
Committee
MIS
VA Team (Midwives)

21. Community based maternal mortality surveillance

22. Conclusion
• The surveillance is well accepted by the system at all levels
with enthusiasm from all the important stakeholders.
• The maternal mortality surveillance coordinator’s position
denotes a deep commitment to address maternal and
perinatal mortality and creates accountability amongst the
SRH working group
• The committee is at the center of the MPMSR system by
supervising data collection and analysis, helping to initiate
review and organizing audit process, developing
recommendations and facilitating their dissemination and by
being responsible for the monitoring and evaluation
component

23. Conclusion
• Facility and community based components of the
Maternal mortality surveillance systems is equally
enforced
• Reviews of maternal deaths are done
systematically and classified according to medical
and non-medical causes (such as 3 delays model).
Identification of avoidable factors are frequent.
• Verbal autopsies are systematically undertaken in
case of identification of community maternal
death.

24. Conclusion
• Lack of systematic follow-up or monitoring of
formulated recommendations to actionable
response
• Lack of planning for the capacity development the
CHWs, service providers and other stakeholders
involved in the surveillance
• Lack of clarity on integrating the MPMSR system
with the well established National MPDSR system

25. Anek Dhonnobadh – Many Thanks