Community-based Maternal and Perinatal Death Surveillance and Response: a comparative case study of implementation realities from humanitarian contexts

Abstract

Background Implementation of community-based Maternal and Perinatal Death Surveillance and Response (CB-MPDSR) in crisis-affected settings offers an opportunity to adapt humanitarian programming and mount solutions to directly improve maternal and neonatal health among those most in need. This study aimed to understand factors that influence implementation of CB-MPDSR approaches across diverse humanitarian contexts. Methods A comparative case study was conducted in December 2021-July 2022 to assess CB-MPDSR implementation in 4 diverse humanitarian settings: Cox’s Bazar (CXB) refugee camps, Ugandan refugee settlements, South Sudan, and Yemen. Desk reviews and 39 semi-structured key informant interviews were conducted. Thematic content analysis was employed to understand the adoption, penetration, and fidelity of CB-MPDSR approach and elucidate cross-setting learning. Findings Adoption of CB-MPDSR varied: refugee contexts in CXB and Uganda had well-established systems involving active pregnancy and mortality surveillance and verbal autopsy. In Yemen, implementation was reliant upon passive reporting mechanisms, while implementing partners in South Sudan employed a mix of strategies. Financial, human resources, and socio-cultural dynamics limited implementation, especially the notification and review of perinatal deaths. Strategic engagement of community stakeholders improved participation, trust, and transparency between communities and health systems. Conclusions CB-MPDSR offers insights into important systemic and cultural factors contributing to mortality within crisis-affected settings. Our results call for more research investment in understanding how to effectively adapt CB-MPDSR and development of operational guidance to assist humanitarian actors in introducing or bolstering CB-MPDSR approaches, so as to support a system reflective of complex realities faced by these diverse and mobile communities.