A practical approach to measuring MPDSR implementation: findings from a cross-sectional assessment in regional referral hospitals in Uganda

Abstract

Background: Uganda adopted maternal and perinatal death surveillance and response (MPDSR) in 2017 and has put concerted effort into scaling up and using data on MPDSR to avert preventable deaths. However, formal analysis of MPDSR implementation processes among health facilities in Uganda has been limited. The purpose of this study was to assess the implementation of MPDSR processes in referral hospitals in Uganda, using a tested measurement approach.

Methods: From November to December 2022, a cross-sectional study was conducted to assess MPDSR implementation processes in Uganda's referral hospitals. The tool, adapted from previous studies, uses a 30-point scoring guide to measure progress markers across six stages of implementation. Data collectors visited 15 regional and national referral hospitals and conducted interviews with two members of the MPDSR committee per facility. Descriptive statistics were used to summarize scores by construct and total scores for the facilities. A content analysis from open-ended questions provided contextual insights.

Results: The average score for MPDSR implementation among referral hospitals in the study was 20.2 out of 30 (range 16 - 27) possible points, which falls in a category showing evidence of routine practice and integration. Progress markers which had particularly low scores included: written staff agreements about MPDSR and orientation of new staff to death reviews. No hospital reported having a budget to support death review meetings. Almost all committee members listed specific ways that MPDSR led to positive changes in quality of care.

Conclusion: The overall score of 20.2 was somewhat higher when compared to other countries who have applied this measurement approach (in four countries, average 18.98). Only four of the surveyed hospitals demonstrated sustained practice of MPDSR, suggesting that there is still much work to be done to institutionalize MPDSR in Uganda's referral hospitals. Specific action areas can be pinpointed using the findings on progress markers. The scored MPDSR implementation assessment tool was easy to use and well accepted. We recommend annually updating the tool to reflect new directions and developments in MPDSR implementation, and routine use to self- or externally assess hospitals' implementation of MPDSR.

Keywords: Implementation assessment; MPDSR; Maternal and perinatal death surveillance and response; Referral hospitals; Tertiary care; Uganda.