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 ExamplesMalaysia & 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