Uncovering Barriers to Maternal Mortality Audits: An Unseen Challenge IN PRESS

Abstract

Indonesia has the third highest maternal mortality rate in ASEAN. The Maternal Perinatal Death Surveillance and Response (MPDSR) program was established to reduce the high maternal mortality rate. However, the effectiveness of maternal audit implementation is still experiencing many obstacles, not only in Indonesia but also in various countries around the world. This study aims to describe the obstacles faced by the MPDSR team in assessing maternal mortality in Lombok Island, which was ranked eighth in Indonesia and significantly affected the national total. We used qualitative study with case study design through in-depth interviews with nine informants from two MPDSR program holders at the Health Offices on Lombok Island and one Maternal Perinatal Death Notification (MPDN) application coordinator at the West Nusa Tenggara Provincial Health Office in 2022. Data were analyzed using the thematic analysis approach. Triangulation were done by method triangulation, triangulation between researchers, triangulation of data sources, and theoretical triangulationt. The results showed that the problems faced by the MPDSR team, including ineffective of MPDSR program socialization, budget limitations of MPDSR program activities, feature issues in the MPDN application, the ratio between labor and workload was less than ideal, incomplete and delayed collection of maternal mortality data, lack of communication between MPDSR teams, health workers have not been trained in the data entry process, reluctance of the health department towards health workers and hospitals, labor outside of medical supervision, no monitoring of maternal mortality cases in wards other than obgyn, health workers did not understand the categorization of causes of maternal death according to ICD-10 code, the assessment was still conducted in a hybrid manner, not all cases were assessed, there was still a culture of blaming when assessment activity took place, and suboptimal monitoring of the sustainability of MPDSR recommendation. Problems and constraints in the implementation of maternal mortality audit assessments were complex, with different variations between districts, so it was necessary to establish communication and discussion to find strategies and solutions based on a priority scale.