Maternal and Perinatal Death Surveillance and Response (MPDSR) Guideline 2015
Training Manuals & Eng /Nepali Version Guidelines Included.

Since the 1990s Nepal has initiated various mechanisms to improve maternal and newborn mortality registration with the support of the World Health Organization (WHO). In 1990 Maternal Death Review (MDR) was first implemented in Paropakar Maternity and Women’s Hospital and in 2003 the Perinatal Death Review was introduced as a supplement to MDR.

By 2006 Maternal and Perinatal Death Review (MPDR) had been implemented in 6 hospitals and by 2013 a total of 42 hospitals had adopted the MPDR process (MoHP 2014). MPDR is one of the tools used to monitor and improve quality of care at the facility level, this process is very important to improve the quality of services. However, the
reviews have not achieved satisfactory results as expected and the commitment from the facilities and monitoring from higher authority is still weak.

The primary goal of maternal and perinatal death surveillance and response (MPDSR) is reducing preventable maternal and perinatal mortality. MPDSR involves a continuous surveillance and action cycle of identification, quantification, notification and review of all maternal deaths. The interpretation of the aggregated information is used to recommend actions that will prevent future deaths.

The “S” in MPDSR emphasizes the importance of surveillance for a relatively rare but critical event such as maternal death. The “R” in MPDSR focuses on the response portion of the surveillance. MPDSR allows the stakeholders to link the health information system and the data on maternal deaths to quality of care improvement processes, at both local and national level.

Maternal Death Surveillance and Response (MDSR) is designed to measure and track
all maternal deaths in real time, to understand the underlying factors contributing to mortality and to provide guidance for how to respond to and prevent future deaths. The system builds on experiences from MDR, but also helps us understand the events surrounding maternal deaths. MDSR aims at linking the health information system and quality
improvement processes from local to national level, and acts as a continuous surveillance mechanism.

The surveillance cycle includes identification of cases, collection of information, analyzing findings, recommendations for action and evaluation and refining of the system. Particular focus is on identifying and addressing the avoidable factors and action part of the surveillance, so that the information obtained can be acted upon to prevent future deaths. MDSR can be expanded to include perinatal deaths and is hence referred to as Maternal Perinatal Death
Surveillance and Response (MPDSR).

With the goal to eliminate preventable maternal and perinatal mortality by obtaining and using information on each maternal and perinatal death to guide public health actions and monitor their impact, Government of Nepal (GoN) is implementing MPDSR through Ministry of Health (MoH), Department of Health Services (DoHS), Family Health Division (FHD). FHD has developed following training packages to expand and further build on the MPDR process and expand MPDR to MPDSR.

  • MPDSR training for hospital staff and MPDSR training for:
    • District level stakeholders on introduction to MPDSR
    • FCHVs on identification and notification of death
    • ANMs/HA/Sr AHW on screening of pregnancy related deaths
    • District VA team on conducting verbal autopsy of pregnancy related deaths
    • District MPDSR committee to review the VA forms and prepare an action plan

Implementation of Maternal and Perinatal Death Surveillance and Response ( MPDSR) Maternal and Perinatal Death Surveillance and Response (MPDSR) was designed to measure and track all maternal deaths in real time, to understand the underlying factors contributing to mortality and to provide guidance for how to respond to and prevent future deaths. This is a continuous identification, notification, quantification and determination of causes and avoidability of all maternal and perinatal deaths, as well as the use of this information to respond with actions that will prevent future deaths. GoN prioritized and implemented MPDSR in FY 2073/74 MPDSR with further strengthening and expansion. MPDSR was scaled up in 21 districts out of which 7 districts in this fiscal year (Bajhang, Dailekh, Palpa,Myagdi, Nuwakot, Taplegung and Rautahati, and 99 Hospitals(both public and private) in FY2075/76. Government of Nepal (GoN) developed MPDSR guidelines 2015. In these districts, both community maternal deaths, hospital maternal deaths and hospital perinatal deaths are reviewed and responses planned.


Community-based MPDSR: Community based MPDSR program was implementing in 21 districts 99 hospitals. In community-based MPDSR program community, maternal deaths and perinatal deaths are reviewed and responses planned.
Hospital based MPDSR: Currently 99 hospitals are implementing MPDSR program. In hospitals, each maternal death is reviewed individually and perinatal deaths are reviewed in a monthly basis.

Formation of MPOSR Committees at different levels

As per the MPDSR guidelines 2015, there was National MPDSR Committee chaired by the Director General, Directorate of Health Services and MPDSR Technical Working Group(TWG)chaired by Director, Family Health Division. In addition, there are health facility levels MPDSR committees and palika level committees with separate VA and cause of death assignment teams for community MPDSR program. For each hospital implementing MPDSR, there is MPDSR committee formed as per the level of the hospital.
MPDSR Onsite coaching program
Family Health Division conducted on-site coaching program to support the districts and hospitals for implementing MPDSR program. The on-site coaching program was done in district for community based MPDSR and hospitals for hospital based MPDSR. During this program available data, forms and documents were reviewed and discussion was done which mainly focused to address the preventable issues.

Review of Implementation of Maternal and Perinatal Death Surveillance and Response (MPDSR)
A review of MPDSR program was conducted in this fiscal year with an objective to review the update progress on MPDSR in implementing hospitals. Review was conducted in Biratnagar, Butwal, Kathmandu and Dhangadhi which covered all implementing hospitals in Nepal 2-3 person from each hospital were invited from each hospital to participate in the review.
One stop Crisis Management Centre (OCMC)
One stop crisis management oorientation program was successfully completed in five different district hospital it Chautara, Sindhupalchowk, Dhulikhel, Kavrepalsnchowk, Sandhikharka, Argakhachi, Taulihawal, Kapilbastu and Prithivichandra (Nawalparasi) hospitals. The objective of the program was to enhance service provider’s knowledge and skill regarding case management.

Issues and constraints and recommendation for Implementation of Maternal and Perinatal Death Surveillance and Response (MPDSR)

Implementation of Maternal and Perinatal Death Surveillance and Response (MPDSR) Guideline 2015

Implementation of Maternal and Perinatal Death Surveillance and Response (MPDSR) Guideline 2015-Nepali Version