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Strengthening Maternal Mortality Surveillance

Indigenous midwives during a training session in Guatemala


The Ministry of Health of Guatemala seeks assistance to develop a strategic plan to explore maternal and child mortality and morbidity.  To meet this goal, TRAction will work to strengthen the Maternal and Child Mortality and Morbidity Surveillance System (SVMM in Spanish). In addition to this technical assistance, the experience of implementing the surveillance system will be captured in a case study so lessons learned can be applied to similar efforts.





Guatemala: Alta Verapaz Department



Technical Assistance:

  • Assessment of the quality of maternal health services at different levels of care, including assessment of staff competencies and review of community engagement for birth preparedness.
  • Updated competence of health personnel in hospitals, health centers and posts in comprehensive maternal care including counseling for antenatal care, recognition of danger signs during pregnancy, delivery, postpartum and newborn care, appropriate referral, birth and emergency plans, and postpartum use of family planning methods.

Specifically included:

  • At birthing centers, training in the use of the partograph, active management of the third stage of labor (AMTSL), postpartum and newborn care, danger signs, initial management of complications and timely referral;
  • At higher levels of care, training in management of maternal and neonatal complications: use of partograph, AMTSL and resolution, institutional labor induction and post-partum family planning;
  • Update / staff training and monitoring of hospitals and health centers in newborn care: helping babies breathe (ABR in Spanish) and kangaroo mother care (MK in Spanish); and
  • Introduction of all staff to the concepts of quality management including team work, emphasis on the client, use of data for decision making and process improvement.
  • Definition and training in models of respective and culturally appropriate maternal care.
  • Definition and set up of the monitoring of quality of care indicators across pilot sites.
  • Technical assistance for the establishment and functioning of Maternal Mortality Surveillance Committees in prioritized Districts in Alta Verapaz, using an updated application protocol.

Case Study:

The objectives of the SVMM Case Study were to document the surveillance system’s implementation in the Alta Verapaz health-service network, as well as to evaluate the results, system strategies, experiences, and lessons learned by the main actors. These results seek to reduce maternal deaths and to scale-up the surveillance system to other Health Areas in Guatemala. The USAID|TRAction Project provided technical assistance to evaluate the enabling environment;  implemented a diploma course on maternal-newborn care; organized awareness-raising campaigns to actively seek data on maternal mortality; provided funding for surveillance-committee meetings to disseminate the protocol and strengthen communication within the service network, and established better communications via mobile telephone through DASAV/Tulasalud.


Both quantitative and qualitative methods were used to explore the SVMM’s implementation and the perceptions of actors involved in its development.  Quantitative instruments included information records and surveys of health-service personnel in the 19 Health Area Districts.  Qualitative methods included in-depth interviews with system participants and departmental officials in 8 out of the 19 districts where over 50% of maternal deaths in the area are concentrated. Departmental documentation was used as an additional source of information.


The quantitative study found that there was an increase in the active search for maternal death records, which achieved 100% in 2013, and an increase in the number and percentage of deaths of women of reproductive age that were investigated. A critical link analysis was performed on 100% of maternal-death cases.  In addition, the number of deaths that were registered as maternal deaths decreased from 74 in 2012 to 44 in 2013, and the number of referred deaths increased from 50% to 61.4%.  This can be attributed to the efforts to raise staff awareness and to the training provided through technical assistance.
Following are other quantitative results:
  • Deaths at home and in transit decreased, and the rate of institutional deliveries increased.
  • The percentage of preventable maternal deaths in 2013 increased compared to 2012: 47.3% to 72.7%.
  • Community and institutional teams are integrated at the District level.  This is evident in the 8 Districts that were analyzed.
  • The demand for antenatal care has increased.  There are now more midwives and pregnant women who recognize danger signs.
  • There is less under-reporting of maternal deaths.
  • There is better integration with providers and improvements in antenatal services.
Some of the most important qualitative results are:
  • SVMM strategies have been adequate and have established more discipline thanks to support from the technical cooperation
  • Feedback has contributed to raising awareness on the importance of the system.
  • Sharing the system has been a very important factor in efforts to reach all involved actors.
  • The Departmental Committee’s work and case analyses have improved.
Lessons Learned
  • SVMM training and sharing are essential factors for its optimal implementation.
  • An efficient monitoring and evaluation system must be specifically implemented for each SVMM task.
  • Follow-up on implementation in every area must be established and responsibilities must be assigned, both to analyze maternal deaths and to execute all other activities.
  • Much support and involvement by the MSPAS is required in terms of planning, logistics, and supervision of the system.
  • Not all results showing a decrease in deaths are fully attributable to the SVMM.
  • A few more years are required to obtain more accurate results.

Click here to read a case study that documents implementation of the maternal mortality surveillance system in Alta Verapaz. This is a Spanish-language case study. 


Implemented by USAID|TRAction Project 


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