Analysis of Political Priority for the Maternal Death Surveillance and Response (MDSR) Policy

The inability to count identify causes of maternal death has been called a “scandal of invisibility”. In 2011, the Maternal Death Surveillance and Response (MDSR) policy was introduced by the World Health Organization following the recommendations of the Information and Accountability for Women’s and Children’s Health (CoIA). The CoIA, co-chaired by Prime Minister Stephen Harper and the President of Tanzania, oversees global reporting and accountability on women’s and children’s health, and proposes actions to improve accountability at national level such as establishing a system for registration of births, deaths and causes of death by 2015. By counting every maternal death, identifying the causes and assessing the true magnitude of maternal mortality, the overall objective of the MDSR is to provide information that effectively guides immediate and longer term action and compel policy makers and decision makers to give the problem the attention and responses it deserves.

Global health initiatives vary in the amount of political priority they receive and it is important to understand why initiatives succeed or fail in attracting political support. Global political priority which is the degree to which international and political leaders actively give attention to an issue, and back up that attention with finances, technical support and human resources. MDSR implementation is underway in 46 low and middle income countries (LMICs) and as it is a relatively new policy, it is important to assess how much political priority the policy is generating in order to identify challenges and barriers for successful implementation.

There are gaps and weaknesses in the field of health policy analysis in LMICs with a lack of theoretical grounding and the main question is often “what happened” to the neglect of “what explains what happened”. Therefore, to analyse political priority for the MDSR, a published framework for assessing political priority was adapted to study four factors that determine the degree of political priority:

• Policy community: the network of individuals and organisations who are involved in the issue including those who support and oppose the policy. A particular area of focus within the policy community is institutions that have mobilized resources, implemented programmes and supported research in the area of maternal death reviews
• Frame: the way the MDSR is understood and portrayed publicly with the aim to secure attention and advocacy for MDSR
• Policy windows:the political moments that have acted as opportunities for advocates to influence decision makers
• Policy characteristics: the features of the policy that act as barriers and facilitators for its implementation

34 stakeholders representing various sectors and working at both the global and country levels participated through interviews, survey and questionnaires to provide a picture of the processes and politics surrounding MDSR introduction, adoption and implementation. Published literature and policy documents provided complementary information for the analysis. The results of the analysis will inform where the MDSR stands with respect to the amount of political priority it is currently generating and on practical level, the barriers and challenges it is facing. The ultimate aim of the analysis is to generate a set of policy recommendations for successful implementation of the MDSR.