TY - JOUR T1 - Maternal Death Surveillance and Response: A Tall Order for Effectiveness in Resource-Poor Settings JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 333 LP - 337 DO - 10.9745/GHSP-D-17-00308 VL - 5 IS - 3 AU - Marge Koblinsky Y1 - 2017/09/27 UR - http://www.ghspjournal.org/content/5/3/333.abstract N2 - Most countries with high maternal (and newborn) mortality have very limited resources, overstretched health workers, and relatively weak systems and governance. To make important progress in reducing mortality, therefore, they need to carefully prioritize where to invest effort and funds. Given the demanding requirements to effectively implement the maternal death surveillance and response (MDSR) approach, in many settings it makes more sense to focus effort on the known drivers of high mortality, e.g., reducing geographic, financial, and systems barriers to lifesaving maternal and newborn care.See related article by Smith et al.While extensive efforts to reduce maternal mortality through a maternal death surveillance and response (MDSR) investigation approach in Kenya were laudable, they fell far short in a number of ways toward having any tangible impact. In low- and middle-income countries (LMICs) with high maternal mortality, resources are better spent addressing obvious causes through interventions with proven effectiveness.The MDSR strategy aims to improve quality of care and reduce maternal deaths by investigating individual maternal deaths and taking action to avoid remediable causes. As reported in this issue of GHSP, the MDSR (or an early variant thereof) was first introduced in Kenya in 2004.1 At that time, the Kenyan maternal mortality ratio (MMR) was estimated at over 700 deaths per 100,000 live births. As of 2015, a decade later, the MMR was not significantly different, at an estimated 510 per 100,000 live births.2 Yet there were further efforts to strengthen and implement the MDSR nationally. We explore the aims and implementation steps of the MDSR as launched by the World Health Organization (WHO) in 2013; the recent process of MDSR implementation in Kenya and its results; the long history of maternal death audits including response efforts; and the effectiveness of MDSR in other LMICs.As WHO stated … ER -