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APCRSHR10 Virtual abstract presentation of Sayantan Chowdhury
This case study explores the establishment and implementation of a maternal and perinatal mortality surveillance and response system (MPMSR) in the Rohingya refugee crisis, highlighting efforts by NGOs to improve public health infrastructure. Data collected through interviews and document reviews from 2017 to 2019 reveal the development process and challenges faced, including the need for better follow-up on recommendations and integration with existing national systems. Overall, the surveillance system is regarded as effective and is supported by a strong commitment from stakeholders.
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APCRSHR10 Virtual abstract presentation of Sayantan Chowdhury
- 1. Genesis of MaternalMortality Surveillance and Response in the Rohingya Refugee Crisis – A Case Study Sayantan Chowdhury and Endang Handzel
- 2.
- 3. Background • In orderto 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 theestablishment, development and implementation process of Maternal and Perinatal Mortality Surveillance and Response system (MPMSR) in the Rohingya refugee crisis
- 5. Case Description • Methods: • Thecase 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 anddevelopment of MPMSR 2. Implementation process of MPMSR
- 7. 1. Establishment andDevelopment 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 >28days - 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 deathamong 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 andneonatal 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 PerinatalMortality System and Response (MPMSR) in Rohingya Response
- 13. Implementation of the Maternal Mortality Surveillance 2.1Coordination 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 forHealth 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 - Asystem 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 theMPMSR 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 forCHWVA Team (Midwives) MPMSR Committee MIS VA Team (Midwives)
- 21. Community based maternalmortality surveillance
- 22. Conclusion • The surveillanceis 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 andcommunity 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 ofsystematic 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
Editor's Notes
- #9 Result from ICDDRB report - Situation analysis report In September 2018, UNFPA with technical support from CDC collaborated to establish a maternal mortality surveillance system on the model of accepted standards for maternal mortality surveillance systems with adaptions for an emergency humanitarian context. A retrospective analysis of data of one year was done to establish a baseline. The lessons learned during the study helped to establish key components for a robust surveillance system and helped to further shape the community health worker mortality reporting. In April 2019, WHO and collaborating partners implemented the Early Warning, Alert and Response System (EWARS) as a electronic notification system to notify mortalities of all ages and enable mer verbal autopsy teams of WRA mortalities. In July 2019 the steering commiee named "Maternal and Perinatal mortality surveillance and response (MPMSR)" commiee under the SRH Working Group was established. This committee is have been established to facilitate the audit of maternal deaths, to develop recommendations and to ensure and monitor their implementation.
- #10 When you see this graph, lead for general death, other de WRA death 13.6 Neonates : 13.8
- #18 It is a tool for reporting the findings and recommendations of investigations into maternal deaths in refugee settings Every maternal death (a refugee or a national) that occurs within a camp setting (at home or a health center or during referral) should be systematically reviewed Collected information and decisions taken are reported Maternal mortality review process will be undertaken at two levels: Community level Facility level MPDSR system by supervising data collection and analysis, helping to initiate review and organizing audit process, developing recommendations and facilitating their dissemination