Maternal and neonatal death surveillance and response in Liberia: An assessment of the implementation process in five counties

Objective To evaluate the implementation of the maternal and neonatal death surveillance and response (MNDSR) system at county level in Liberia. Methods Secondary analysis of data from a cross-sectional study carried out in March 2016, using both quantitative and qualitative methods to collect data in five counties based on set criteria. Three health facilities were selected in each county through the Health Management Information System (HMIS) by random sampling. The evaluation was also carried out in one catchment community per health facility and at the county referral hospital. Primary data were collected through individual interviews and a review of MNDSR tools and structure. Data were analyzed using thematic analysis. Results Implementation of the MNDSR system was very low in the five counties. Only two out of the five counties were currently conducting MNDSR. MNDSR guidelines and standard operating procedures were not available at the county level. Only 12 (23.5%) health facilities had a maternal and neonatal death review committee. Less than a quarter of the assessed community members could correctly give the definition of a maternal or neonatal death. Conclusion The MNDSR system is weak in Liberia, at county, health facility, and community levels. Strong national commitment is needed in collaboration with diverse partners for successful implementation of the system.