Work package 2 – Opti-MaP

Work package 2
Creating an Enabling Legal Environment for
the Implementation of MPDSR

Rationale

International, regional, and national laws and policies recognise that the reduction of preventable maternal and new-born mortality requires the development and implementation of an effective MPDSR system, consisting of a comprehensive legal and regulatory environment. Legislation can facilitate accountability, including the creation of a participatory and transparent institutional framework that has mandatory legal powers and duties to conduct surveillance, collate information, review maternal and perinatal deaths, and recommend timely interventions in respect of modifiable factors at facilities and in the community.

WHO advocates for a “No-Blame” legal and policy ecosystem to promote transparency, learning, and accountability. Yet, the fear of blame is a major barrier to effective MPDSR systems. Legal guarantees need to be developed to ensure protection for individuals who participate in MPDSR through ensuring confidentiality of data in the review process, while not removing effective remedies from the families of the victims (separate from MPDSR).

Objectives

We want to identify and analyse existing laws, regulations, and policies relevant to MPDSR, and to highlight opportunities, gaps, barriers and inconsistencies in strengthening the legal accountability of MPDSR.

We will investigate how legislation can enhance the accountability of MPDSR systems, including:

budget allocation
effective implementation of recommendations derived from MPDSR data and analysis
establishing legally mandated roles and responsibilities for various stakeholders

We want to identify and propose legal solutions that foster a “no blame approach” within MPDSR systems by ensuring the confidentiality of MPDSR information, and by clarifying opportunities for families to seek remedies through other mechanisms (separate from the MPDSR system).

Our work so far

We have conducted a desk review of the laws, policies and guidelines that govern the MPDSR process in Uganda, Ethiopia and Ghana. We have also conducted interviews with legal stakeholders such as judges, prosecutors, lawyers, civil society and health professionals exploring how they perceive legal accountability in the context of MPDSR and the barriers and facilitators of strengthening the legal environment in the three countries.

We held legal stakeholder workshops in Ghana, Ethiopia and Uganda with 94 stakeholders (Uganda- 29, Ghana- 31 and Ethiopia- 34) comprising judges, prosecutors, lawyers, civil society, public health/maternal health practitioners.

Each country has developed a plan for creating a law to protect MPDSR data so that it cannot be used for prosecuting health workers who participated in death review meetings. In each country, we have also identified remedial mechanisms that provide avenues for community members/patients who have complaints. CAB members have provided feedback on the proposed remedial mechanisms in each country.

Remedies and Redress Mechanisms – advice for bereaved families who wish to make a complaint

1. At Health Facility Level

•Midwife, medical director, or CEO

•Patient rights desk or complaints office

•Psycho-social support services

•Complaint handling or ethics committees

2. Community Level

•Community health workers

•Local health committees or leaders

•Local administration or civil society organisations

3. Administrative Bodies

•District, regional, or national health authorities

•Parliamentary oversight bodies

•Human Rights Commission

•Ombudsman

Leads