Strengthening the system of Confidential Enquiry into Maternal Deaths (CEMD) in Lesotho

[摘要] English: The purpose of this study was to describe through Appreciative Inquiry (AI), thestrengths, opportunities and aspirations of all stakeholders involved in theConfidential Enquiry into Maternal Deaths (CEMD) system in Lesotho. This wasdone with an intention of supporting and strengthening the work of this system.The study was conducted using a qualitative descriptive design and AppreciativeInquiry as a research technique. AI draws from the principle of positivism, where bystrengths base, rather than problems are a point of focus to resolve problems.The researcher was seeking to appreciate the best of what the system is, bydiscovering its strengths. The participants used their strength base to envision thebest of what the system could be. They also drew strategies that will enable them toattain the envisaged future CEMD in Lesotho. Data collection along with primarydata analysis was conducted in a one day AI workshop.The participants for the study were selected using non-probability selection andcomprised of representatives of all stakeholders of CEMD in Lesotho. The samplesize was 20 participants comprising of four (4) members of QMMH maternal mortalityreview committee, ten (10) Maternal Mortality Assessors each representing one ofthe ten districts in Lesotho and six (6) members of the LCCEMD, two of which alsorepresented the MOH.The results of the study reflected five main themes that portray the strengths of theCEMD system in Lesotho; namely government commitment to CEMD, an effectivefeedback mechanism, strong communication system, a strong support systemfollowing maternal death and Maternal Death Review (MDR) and lastly an effectivetraining and monitoring system. The participants used these strengths as the base tomap out an envisaged ideal system of CEMD in five years, which was reflected in acollage form.The dream phase depicted more government commitment where a revolutionagainst maternal deaths was declared, urging government to commit more resourcesto CEMD. Interlinks and integration of the efforts of other disciplines in curbingmaternal deaths was encouraged. Strengthening communication, Advocacy for MDRand dissemination of key messages about safe motherhood are seen as crucial in strengthening CEMD in Lesotho. Participants lobbied for support of the carers of thediseased mother as well as those involved in MDR. They recommended a system oftrust with an element of debriefing and counseling to avert psychological impact ofMDR. Training and monitoring need to be more decentralized for capacity buildingon both MDR processes and skills acquisition in caring for pregnant mothers.During the design phase participants realized that with only one year to 2015, thetarget of reducing maternal deaths by 75 % may not be realized. They howeverrealized that it is possible to prevent primitive maternal deaths; those that areavoidable. They drew a bold affirmative statement 'Lesotho amazes the world:Primitive Maternal deaths down to zero by 2015. A plan to realize this included:strengthening information sharing, improving the infrastructure for Maternal and childhealth (MCH) services, ensuring availability of Human resources and commodities.The researcher concluded that with the positive attitude, the stakeholders of CEMDin Lesotho were able to realize the strengths of the system and used them as aplatform of improving it. An improved system is likely to yield recommendations thatwill enable Lesotho to improve maternal health and curb maternal deaths. The studywas concluded with recommendations for clinical practice, pre-service and in-serviceeducation, research, the LCCEMD, and regulatory bodies for health professions.

[发布机构] University of the Free State