Assessment of the implementation of health facility based maternal death audit recommendations in Kabarole district

Abstract

Introduction Kabarole district has implemented facility based maternal death audits (MDAs) since 2010. MDAs have a potential to inform improvement of obstetric care and to reduce maternal deaths if MDA recommendations are implemented. Currently, there is limited documented evidence on the implementation of MDA recommendations in Kabarole district. Objectives The objective of this study was to assess the implementation of MDA recommendations based on health facility based maternal death audits in Kabarole district. Methodology This was a descriptive cross-sectional study that used both qualitative and quantitative aspects. MDA forms were reviewed retrospectively to determine the proportion of MDAs with recommendations and proportion of MDA recommendations that were implemented. Key informant interviews were done with DHT members, in-charges of the health facilities and maternity wards to explore factors that influenced the implementation of MDA recommendations at health facilities. A thematic content analysis was applied to qualitative data. A univariate analysis using SPSS version 23 was used to determine the frequencies and proportions of MDA recommendations implemented. Results A total of 231 maternal deaths occurred at the four health facilities from 2012 to 2016 and only 93(40.3%) of the MDA forms were available at the facilities. All (93/93) of the maternal audit forms reviewed had recommendations documented. Implementation of MDA recommendations varied with the different health system blocks, for example: (1) most (90.4%) of the health work force related recommendations were well implemented due to feedback given to staff in maternity ward and active follow up done by the maternity ward leaders and (2) majority of the health service delivery related recommendations (78.6%) and medical supplies and equipment related recommendations (76.5%) were poorly implemented due to inadequate; human resource, funding and feedback, support supervision and follow up. A smaller proportion (34.4%) of the health information related MDA recommendations were not implemented at the health facilities due to lack of feedback attributed to the weak communication channel between health facilities, District Health Team (DHT) and Ministry of Health (MOH). Health system factors affecting implementation of MDA recommendations were: Political and administrative participation and commitment; inadequate funding; staff training, staff attitudes and motivation, attendance of MDA meetings, staff attrition, shortage of critical health workers, weak communication channel between the community, health workers, health facility, DHO, and MOH; lack of support supervision and functional maternal death audit committees. Conclusion and recommendation A significant proportion of MDA recommendations that were beyond the health facility were not implemented. There is a need to address the communication gap among the stake holders by having DHT members, VHTs, health facility administrators and other concerned staff other than those in maternity ward attending MDA meetings and participating in the making of recommendations. Targeted support supervision from the MOH and DHT regarding MDAs will enable them identify areas of weakness in regards to the conduct of MDAs and implementation of recommendations and design appropriate interventions to address the identified gaps.