How can researchers, policymakers, and healthcare practitioners work together to improve maternal mortality data in Ethiopia?
In what ways can researchers best translate their findings into actionable policy recommendations that are easily understood by decision-makers and front-line health workers?
What specific policy frameworks and legal protections need to be established by policymakers to create a "no-blame" environment that encourages healthcare practitioners to report every maternal death without fear of reprisal?
How can healthcare practitioners, particularly those in rural and remote areas, be empowered and equipped with the necessary tools and training to accurately identify and report maternal deaths that occur outside of formal health facilities?
What mechanisms can be put in place to ensure that data collected by healthcare practitioners informs both research priorities and policy decisions, creating a continuous feedback loop that improves the system?
Strengthening Ethiopia’s maternal health surveillance system requires not only robust data collection but also mechanisms to ensure information is translated into timely action. Below are practical approaches tailored to Ethiopia’s context, while drawing on global best practices:
1. Strengthening Collaboration between Practitioners and Policymakers
- Institutionalize Maternal Death Surveillance and Response (MDSR) within Ethiopia’s Public Health Emergency Management (PHEM) system, ensuring local data feed into national decision-making.
- Task Forces & Technical Working Groups: Link frontline health workers, woreda/zonal health offices, and the Ministry of Health in routine joint review meetings. Ethiopia’s EthOSS (Ethiopian Obstetric Surveillance System) pilots demonstrate the power of clinician-led surveillance networks.
- Academic Partnerships: Expand successful collaborations like Addis Continental Public Health Institute and Harvard’s maternal health programs to strengthen operational research and policy translation.
2. Translating Information into Action
- “1:3:25” Model for Policymakers: Summarize findings in 1-page key messages, 3-page executive briefs, and 25-page detailed reports. This structure helps decision-makers act quickly.
- Digital Dashboards: Ethiopia’s District Health Information System 2 (DHIS2) and OpenMRS can be upgraded to provide real-time maternal mortality dashboards accessible from federal to kebele level.
- Rapid Feedback Loops: Link MDSR with IDSR (Integrated Disease Surveillance and Response) for weekly or monthly reporting so patterns can trigger immediate local interventions (e.g., stock-outs, referral delays).
3. Building a “No-Blame” Culture for Reporting
- Confidential Enquiries: Expand the EthOSS approach, which emphasizes system learning rather than individual blame.
- Safe Spaces for Discussion: Regular case review meetings should highlight preventable factors (transport, blood shortages, referral delays) without penalizing individual health workers.
- Policy Protection: MOH directives should safeguard staff who report adverse events, reducing fear and encouraging transparency.
4. Empowering Frontline Health Workers
- Training Health Extension Workers (HEWs) in verbal autopsy, rapid notification, and use of mobile platforms (SMS/CommCare/ODK) to report maternal outcomes.
- Equip Facilities with standardized reporting tools and simple maternal audit templates, harmonized with national indicators.
- Supportive Supervision: Regional health bureaus should provide mentorship and periodic refresher training to sustain quality reporting.
5. Creating a Feedback and Accountability Mechanism
- Transparent Data Sharing: Quarterly public reports at federal and regional level showing trends, hotspots, and progress.
- Community Accountability: Involve women’s groups and civil society in maternal death audits, reinforcing demand for better services.
- Incentives for Performance: Recognition schemes for facilities that demonstrate complete and timely reporting (non-financial rewards such as certificates, public acknowledgment).
By combining clear communication tools (like the 1:3:25 model and dashboards) with Ethiopia’s existing surveillance frameworks (MDSR, EthOSS, PHEM), the country can strengthen the feedback loop from data → action → learning. A no-blame culture, empowered health workers, and transparent reporting will ensure maternal death surveillance not only generates information but drives meaningful change in reducing maternal mortality.