Table 7 Summary of reported service delivery challenges and proposed solutions

Factors influencing identification of cases

 Delay of mothers to reach the health facility

**

 Only health facility deaths are reviewed

*

 Difficult to collect information from the community

*

Factors influencing review meeting

 Inadequate support supervision

***

 Non functionality of the existing MPDR committees

***

 Heavy workload

***

 Lack of copies of policy documents, guidelines, protocols

**

 No MPDR committees

*

 High number of perinatal deaths

*

Factors influencing use of findings

 Inadequate funding

**

 Non implementation of recommendations

*

 Late release of funds

*

 No follow-ups by the district

*

Solutions to the service delivery challenges

Identification of cases

 Training of Village health teams

***

 Community sensitization on benefits of MPDR and need to seek health care services early

*

 Early referral from the lower level units

*

Review meetings

 Provision of allowances during MPDR meetings

***

 Formation of MPDR committees

**

 Rescheduling of review meetings to less busy days

*

Use of findings

 District and MoH should implement review recommendations

***

 Support supervision of health facilities

***

 Ministry of health to fund MPDR activities for sustainability

*

 Follow-up on health facilities to implement review recommendations

**

Health workforce challenges and proposed solutions in conducting MPDR

Challenges

Lack of training of MPDR committee members

***

Lack of allowances to motivate MPDR committee members

***

Lack of training of health workers on MPDR

***

Fear of litigation

**

Few health workers

*

Reluctance of MPDR committee members

*

Staff attrition

*

Proposed solutions

 Train members of MPDR committee

***

 Train all health workers on MPDR

***

Conduct continuous medical education on MPDR

**

Recruit more staff

*

Design staff retention policy at district/health facility level

*