Confidential Enquiry into Maternal Deaths in Namibia, 2018–2019: A Local Approach to Strengthen the Review Process and a Description of Review Findings and Recommendations

What is already known on this subject?

To analyse and improve quality of care, a national maternal death review is recommended.

In Namibia successful implementation was hampered by a blame culture.

Around the world, healthcare providers are frequently blamed by decision makers when a woman dies.

Limited literature is available on how this issue could be addressed.

What this study adds?

It was possible to improve implementation by focussing on increasing trust of healthcare providers in the review process.

This was achieved by addressing fear of being blamed, dissemination of findings and acting on the recommendations forthcoming from the review.

Objectives First objective was to strengthen the national maternal death review, by addressing local challenges with each step of the review cycle.

Second objective was to describe review findings and compare these with available findings of previous reviews.

Methods Confidential Enquiry into Maternal Deaths methodology was used to review maternal deaths.

To improve reporting, the national committee focussed on addressing fear of blame among healthcare providers.

Second focus was on dissemination of findings and acting on recommendations forthcoming the review.

Reviewed were reported maternal deaths, that occurred between 1 April 2018 and 31 March 2019.

Results Seventy maternal deaths were reported; for 69 (98.6%) medical records were available, compared to 80/119 (67.2%) in 2012–2015.

Reported maternal mortality ratio increased with 48% (92/100,000 live births compared to 62/100,000 in 2012–2015).

Obstetric haemorrhage was leading cause of death in the past three reviews.

The “no name, no blame” policy, aiming to identify health system failures, rather than mistakes of individuals, was repeatedly explained to healthcare providers during facility visits.

Recommendations based on findings of the review, such as retaining experienced staff, continuous in-service training and guidance, were shared with decision makers at regional and national levels.

Healthcare providers received training based on review findings, which resulted in improved management of similar cases.

Conclusions for Practice Enhanced implementation of Confidential Enquiry into Maternal Deaths was possible after addressing local challenges.

Focussing on obtaining trust of healthcare providers and feeding back findings, resulted in better reporting and prevention of potential maternal deaths.