The Legal Framework for MDSR in Ethiopia’s Health System

Overview Importance of the legal framework in guiding MDSR International examples of successful models Common concerns Protections within an MDSR system Confidentiality Anonymity Establishing a “No blame” culture

International Examples Malaysia & Sri Lanka Both countries experienced dramatic improvements in maternal & newborn health Formal MDR and confidential enquiry systems established MDR processes adopted ‘no blame’ approach Emphasised to all that purpose of MDSR to learn from each death and prevent others

International experience: India ‘Maternal & Perinatal Death Inquiry and Response’ (MAPEDIR) Verbal autopsies to address family, community, health services and policy level determinants Motherhood is a top priority of India’s Rural Health Mission Confidential, non-threatening environment to allow documentation and analysis of factors leading to adverse maternal outcomes Informed consent and confidentiality ensured Confidentiality protected when sharing findings Result has been openness in reporting, trust across the system and better data

Fundamental principles to protect an MDSR: Confidentiality strictly maintained Anonymity of all concerned “No name, no blame” institutionalised Community liaison at every level

Confidentiality: a Code of conduct Local data collectors and involved health care workers are the only staff who see the names of deceased Knowledge contained within review committees All individuals (including committee members) who access identifying data sign a non-disclosure confidentiality agreement (kept on record)

Draft Disclaimer (Non-disclosure confidentiality agreement) We, the members of the ---- review committee, agree to maintain anonymity and confidentiality for all the cases discussed at this meeting, held on [DATE]. We pledge not to talk to anyone outside this meeting about details of the events analysed here, and will not disclose the names of any individuals involved, including family members or health care providers.

Anonymity Notes and reports protect the patient, friends, family and staff members involved Names obscured on case notes used in review No names recorded on abstraction forms Family informed of the purpose of the investigation and how data will be used

Essentials of no blame Acknowledgment throughout system that mistakes do happen Constructive approach to learning from every death Identifying preventive measures for the future remains the priority Use of multi-professional committee to build team solidarity and understanding that each role valuable to the MDSR process Participation of community representatives to explain value & results to wider audience