The barriers of maternal death review implementation in Sudan : a qualitative assessment

Abstract

Introduction: Maternal death review (MDR) is a cycle and involves identification of maternal death cases, data collection, analysis, recommendation, action and evaluation. The maternal mortality ratio is still high in Sudan. Maternal death reviews were established in 2009 as a qualitative improvement tool to support other strategies targeting maternal death reduction. The objective of this thesis was to explore the implementation of the maternal death reviews in Sudan as a way of assessing the health system care response and changes in maternal health care from the national, state and facility level. Method: This thesis is a qualitative primary analysis of secondary data. National level data and data from four states (including respective health care facilities from the states) were selected for assessment. Qualitative content analysis was utilised as the method of analysis. The software program Opencode 4.0 was utilised to analyse the manifest content to enable the creation of codes, categories, sub-categories and themes. Results: Two main themes were derived; “Inadequate integrated design and desired systemic strengths” and “Muddling through unstructured and ineffective processes”. The first theme revealed the dependence on, and independence of the MDR from the health system and segregation from the health information system (HIS). The second theme revealed that the processes in the MDR were inconsistent and ineffective. Conclusion: This study concludes that the design and the organisational structure of the MDR created systemic barriers that made MDR in Sudan ineffective to adequately improve quality of care.