From Passive Surveillance to Response: Suriname's Efforts to Implement Maternal Death Surveillance and Response

Lachmi R. Kodan; Kim J. C. Verschueren; Geertje Boerstra; Inder Gajadien; Robert S. Mohamed; Lily D. Olmtak; Satish R. Mohan; Kitty W. M. Bloemenkamp

doi:10.9745/GHSP-D-20-00594

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FIGURE 1
Timeline of Local Plans to Reduce Maternal Mortality in Suriname up to 2015
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FIGURE 2
Maternal Death Surveillance and Response in Suriname in 2020
Source: Adapted from the World Health Organization.⁷
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FIGURE 3
Facilitators and Barriers in Establishing Maternal Death Surveillance and Response in Suriname as Experienced by Committee Maternal Mortality Suriname Members, Health Care Providers, and Public Health Experts
Abbreviations: BOG, Bureau of Public Health; MDSR, Maternal Death Surveillance and Response; MaMS, Maternal Mortality Suriname, MOH, Ministry of Health; PAHO, Pan American Health Organization.
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FIGURE 4
Timeline of Maternal Health Initiatives in Suriname, 2015 to Present
Abbreviation: M(P)DSR: maternal (& perinatal) death surveillance and response.
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FIGURE 5
Flowchart of Organization of Maternal Health in Suriname Adapted From the National Maternal Health and Mortality Reduction Priority Plan 2019–2020³⁶
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FIGURE 6
The Ideal Paradigm of the Maternal and Perinatal Death Surveillance and Response Cycle for Suriname
Abbreviation: MPDSR, maternal and perinatal death surveillance and response.

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TABLE 1.

Summary of the Implementation Status of Maternal Death Surveillance and Response in 2020

Already Established

To Be Established

Installation of a national review committee (MaMS) and a maternal health mortality reduction steering committee
Coordination framework and terms of references
Institutional MDSR focal points designated and trained in surveillance and active case detection
Quality-of-care working group operational

National policy for notification of maternal deaths
Official installation of committee MaMS and the 4 working groups for maternal health, reinforce the health promotion and perinatal data working group^a
Facility-based audits of every case, organized by MDSR focal points
Verbal autopsies by MDSR focal points^b
Specialized assessors for facility audit preparation (nurses, doctors) and external audits (BOG)
Timely dissemination of recommendations
Monitoring and evaluation

Abbreviations: BOG, Bureau of Public Health; MaMS, Maternal Mortality Suriname; MDSR, Maternal Death Surveillance and Response.
↵a Perinatal data working group was installed, but only sporadically active.
↵b Only incidentally performed until now.

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TABLE 2.

Summary of Recommendations From Committee Maternal Mortality Suriname Members, Health Care Providers, and Public Health Experts to Strengthen Maternal Death Surveillance and Response in Suriname

Legislation
Ensure no disciplinary/litigation measures Notification of maternal death within 24 hours^a Include pregnancy checkbox on the death certificate^b Timely completion of death certificate Autopsy for maternal deaths of unknown cause
Finances and human resources
Empower BOG by capacity strengthening Support committee MaMS (administrative personnel, logistics) Capacity building of the institutional MDSR focal points Include MDSR in preservice training curricula Involve health care workers and create awareness (bottom-up approach) Involve and educate the community Funding
Enabling policies
Ensure structural facility-based review Install special secretariat for MDSR at BOG/MOH Enable communication and dissemination of findings and recommendations

Abbreviations: BOG, Bureau of Public Health; MaMS, Maternal Mortality Suriname; MDSR, Maternal Death Surveillance and Response; MOH, Ministry of Public Health.
↵a Institutions and funeral agencies were recently requested to report maternal deaths within 24 hours.
↵b As a temporary solution, a pregnancy checkbox slip is attached to the “C form.”