Health System Readiness to Manage Maternal Death Data and Avail Evidence for Decision-Making Through Maternal Death Surveillance System in Ethiopia, 2020

Health System Readiness to Manage Maternal Death Data and Avail Evidence for Decision-Making Through Maternal Death Surveillance System in Ethiopia, 2020 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Health System Readiness to Manage Maternal Death Data and Avail Evidence for Decision-Making Through Maternal Death Surveillance System in Ethiopia, 2020 Abduilhafiz A. Endris, Tizita Tilahun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2031541/v2 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Mar, 2023 Read the published version in BMC Health Services Research → Version 2 posted 8 You are reading this latest preprint version Show more versions Abstract Background: - Maternal mortality remains a major health problem in Ethiopia. To generate contextual evidence, Maternal Death Surveillance and Response system was introduced in 2013. This assessment is conducted to describe the health system's readiness to avail evidence for decision-making through MDSR system in Ethiopia. Method: - Cross-sectional study designed using the modified WHO framework for evaluating disease surveillance systems was used. Using a multistage sampling, 631 health facilities and 539 health posts were selected. Pretested survey questionnaires designed using ODK software were used. Trained field epidemiology residents were used for data collection from September 2019 to April 2020. Text descriptions, graphs, maps, and tables were used to present the study findings. Findings: - Final study finding shows that 400 (77.1 percent) health facilities and 264 (71.5 percent) health posts claimed that they are implementing the MDSR system. Of the total implementing health facilities, 349 (87.3 percent) of them have a death review committee, and only 42 (12.4 %) were functional. About 89.4% of health centers and 79.4% of hospitals had sub-optimal readiness for maternal death identification and notification. Among implementing health posts, 39 (14%) and 231 (87.5%), of them had locally translated community case definitions and established mechanisms for receiving death reports from the community. Only 23 (6.96 percent) and 18 (26.47 percent) MDSR implementing health centers and hospitals had optimal readiness to investigate and review maternal deaths. Additionally, surveillance officers and HEWs at 6 (1.5 percent) and 24 (9.1 percent) systems implementing health facilities and health posts were engaged in data analysis and evidence generation at least once during 2019/20. Conclusions and Recommendations: - Sub-optimal MDSR system implementation is registered. Revitalizing the system by addressing all system components is critical. Having a national-level roadmap for MDSR system implementation and mobilizing all available resources and stakeholders to facilitate this is vital. It is also critical to establish a system for routine data quality monitoring and assurance integrated with the existing PHEM structure. Having a system for routine capacity building, advocacy, and monitoring and evaluation of the availability and functionality of MDSR committees at health facilities are all critical. Health System Readiness MDSR System Evaluation Ethiopia Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 1. Introduction 1.1. Global Overview of the Maternal Mortality Globally, Maternal mortality continued to be a significant public health concern. According to a recent estimate by WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division, about 295,000 maternal deaths occurred in 2017. The global number of maternal deaths per 100,000 live births stands at 211; translating estimated 808 women dying every day. Additionally, poor socio-economic conditions, health care system-associated factors, disease burden, and complex interactions were indicated as major factor that accounts for a mortality differential. In 2017, maternal mortality ranged from 462 per 100 000 live births in the least developed countries to 11 per 100 000 live births in high-income countries. The report also indicated that low and middle-income countries in Sub-Saharan Africa and Southern Asia make up 86% of global maternal deaths [ 1 ][ 2 ]. Based on the Sustainable Development Goals (SDGs) goal for 2030, all countries should reduce MMR by two-thirds of their 2010 baseline level. The average global target is an MMR of less than 70/100 000 live births by 2030. One of the cross-cutting actions for eliminating preventable maternal mortality is improving metrics, measurement systems, and data quality to ensure that all maternal deaths are counted. However, accurate information on how many women died, where they died, and why they died is essential yet currently inadequate [ 3 ]. To significantly reduce maternal deaths in a poor resource setting, World Health Organization (WHO) and its partners recommend a new method. The new method focuses on counting every death and collecting information to permit an effective response that prevents future deaths- maternal death reviews like maternal death surveillance and response system. On the path to ending preventable maternal mortality, the WHO guide “Beyond the numbers” was launched in 2004 to encourage not just estimating the number of maternal deaths to know the magnitude of the problem but also to understanding why and where the women died to be able to do something about it [ 4 ][ 5 ][ 6 ][ 7 ][ 13 ][ 14 ]. 1.2. Burden of Maternal Mortality in Ethiopian Ethiopia has one of the highest Maternal Mortality Rates (MMR) globally, with an estimated maternal mortality ratio of 412 maternal deaths per 100,000 live births [ 10 ]. One of the challenges in eliminating preventable maternal death in Ethiopia is the absence of information that shows the magnitude and causes of maternal deaths to assist with decision-making regarding the responses [ 7 ], [ 11 ]. Following the WHO recommendation, the Ministry of Health – Ethiopia (MOH) established the Maternal Death Review and Response (MDSR), a system to count and investigate all maternal deaths to generate and avail real-time information for decision-making in 2013. Since 2014, the MDSR has been operating integrated with the national Public Health Emergency Management (PHEM) system. The MDSR system is expected to avail reliable and quality data and information in real-time on the burden, causes, and contributing factors of maternal deaths and preventability of fatalities in the nation, thereby assisting with timely responses for improving maternal in Ethiopia[ 12 ] [ 13 ]. To date, several promising achievements have been gained. For instance, the availability of national and woreda databases with more than 3500 reported maternal deaths were reported and used to monitor the trend of significant causes and contributing factors of maternal deaths at the different administrative levels. The MDSR databases have become the primary source of evidence to plan maternal services at national and woreda levels. Using evidence from the MDSR system, stakeholders including FMOH, health system administrative structures, health facilities, and partners, have started and implemented several initiatives to improve maternal health service delivery [ 13 ]. Even if the MDSR system provides crucial support to the health system through the databases, there are multiple system implementation challenges and shortcomings which reduce its benefits. A significant difference in system implementation performance and implementation coverage between implementing administrative structures and the limited capacity of the system to detect the expected magnitude of the problem were among the many. Therefore, this study was conducted to determine system implementation status and describe the readiness of the health system for generating and availing good quality data and evidence for the decision-making process at all health system levels in Ethiopia. Scope of the Evaluation This national MDSR system assessment covers the three components of maternal death surveillance and response system in Ethiopia's community and health facility health system structure. The scope of this national MDSR system evaluation is shown in the below figure. (Fig. 1 ) Evaluation questions addressed by this system evaluation are indicated in the table below. (Table 1 ) Table 1 Evaluation questions addressed by this national MDSR system evaluation, national MDSR system evaluation, Ethiopia, 2020 System components Evaluation Questions Structure of the systems • To what extent does the Maternal Death Surveillance and Response system structure exist and function at the health system level and community structure? Supporting functions • Do the Maternal Death Surveillance and Response system have sufficient supporting functions for detecting, notifying, reporting, investigating, reviewing, and evidence generation? Core functions • To what extent can the Maternal Death Surveillance and Response system detect, register, report, investigate, review, analyze and avail evidence for relevant actors? 2. Methods 2.1. Study Setting and Period This evaluation was conducted at the national level. It included all the nine regional states of Ethiopia; Tigray, Afar, Amhara, Oromia, Somali, Benishangul Gumuz, Southern People Nations and Nationalities (SNNP), Gambella, and Harari, and two city administrations, Addis Ababa and Dire Dawa. This evaluation was conducted from September 2019 to April 2020. 2.2. Study Design A cross-sectional study was used to assess selected health facilities (hospitals and health centers) and health posts in all regions and city administrations. A modified version of the WHO framework for evaluating communicable disease surveillance systems and monitoring and evaluation framework for the MDSR system for Ethiopia were used to design and evaluate the system[ 13 ][ 14 ]. Three components of the MDSR system are assessed (1) Structure of the system, (2). Core components of the system, and (3). Supporting functions of the system Selected indicators are used to assess components of the system (See Annex 1) 2.3. Source Population Experts working in the area of Maternal Death Surveillance and Response systems in health facilities (hospitals and health centers) and community-level health system structures (health posts) were the study population for this system evaluation. Inclusion and Exclusion Criteria Inclusion Criteria : Public health centers, hospitals, and health posts Exclusion Criteria : Private health facilities and special clinics with a focus on other than maternal health (e.g., dental, eye clinic, etc.) Public health facilities and health posts that were operational within the last fiscal year. 2.4. Study Participants The study participants for this evaluation included samples of: MDSR or PHEM experts or another responsible officer at selected health facilities Health Extension Workers at catchment health posts of selected health centers 2.5. Sample Size Determination and Sampling Technique Assuming that the nature of the study units (health facilities and hospitals), hierarchical or nested structures (i.e., health facilities are nested in districts, districts are nested in zones, and zones are nested in the regions), this study considers the clustering effect units and expressed in terms of design effect. During the determination of the sample size for this study First, all regions were selected as primary sampling units. Second, the required number of health centers and hospitals were selected randomly using stratified random sampling techniques based on the type of facilities as stratifying variables. \({N=N}_{1}+ {N}_{2}\) , where \({N}_{1}\) total number of health centers and \({N}_{2}\) is the total number of hospitals under investigation in Ethiopia Z α/2 = is the critical value of the standard normal distribution that corresponds to the level of confidence \({\sigma }^{2}\) = combined or pooled variance of system performance based on the indicators to measure the system \(ϵ\) = the margin of error so that the degree of accuracy of our estimate for variance estimate has to be less than some given accuracy or marginal error ( \(ϵ\) ), i.e. \(\frac{{Z}_{\alpha /2}*\sigma }{ \sqrt{n}}<ϵ\) and \(Deff=1+\left(m-1\right)*\rho ,\) \(\rho\) is interra-correlation with the cluster due to similarity of observation within the region than between region which considered to be non-zero value but not one i.e. between 0 and 1 [conservative choice is 0.33 commonly] say 1.2 from the literature so far in the health study m average number of observations within clusters [regions]: average number of [health centers and/or hospitals] The required sample size, n = \({n}_{1}\) [sample of health centers] + \({n}_{2}\) [sample of hospitals] Thus, the final sample size for the study based on the parameters is computed as: \({n}_{i}>\left[\frac{{Z}_{\frac{\alpha }{2}}^{2}*{\sigma }^{2}+{ϵ}^{2} }{ {ϵ}^{2}+\frac{{Z}_{\frac{\alpha }{2}}^{2}*{\sigma }^{2}}{{N}_{i}}}\right]*Deff\) , \(i=\text{1,2}\) for hospitals and health centers Or it can be simpered as \({n}_{0i}>\left[\frac{{Z}_{\frac{\alpha }{2}}^{2}*{\sigma }^{2} }{ {ϵ}^{2}}\right]\) as initial population size but the study population size is known, then the required sample size for \({i}^{th}\) strata were computed using \({n}_{0i}\) and \({N}_{i}\) as: \({n}_{i}=\frac{{n}_{0i}*{N}_{i}}{{n}_{oi}+{N}_{i}-1}\) , \(i=\text{1,2}\) denoting the sample of health center size or hospital size determined. Thus, the sample size is computed based on the available parameters using the above formula: The total sample size computed as \(n={n}_{health centers}+{n}_{hospitals}=629\) Where \({N}_{i}\) is \({i}^{th}\) population size I = 1, 2 denoting the total number of health facilities and Hospitals, \(Deff\) is design effect considered to 1.2 for this study and \({\sigma }^{2}\) can be obtained from previous studies or pilot assessments. For this study, approximation from the variance of binomial distribution representing that the combined or pooled variance of the system is being performed based on all the indicators and estimated as \({\widehat{\sigma }}^{2}={s}^{2}\) = \(\frac{n}{n-1}\widehat{p}(1-\widehat{p})\) , where \(\widehat{p}=0.5\) is the probability that the system is being performed or functioning by applying a correction for continuity due approximating the continuous random variable [normal] by discrete one [ binomial], \({s}^{2}\) is sample variance estimating population parameter and for large sample size \(\frac{{n}}{{n}-1}=1\) . Then the total sample size is given by: $${n}={{n}}_{1}+{{n}}_{2}$$ Sample allocation: - Once the total sample that represented the available health facilities to generate the relevant information was determined, then sample allocation was made based on the probability proportional to their size [PPS] for each region, i.e., using \(\frac{n}{N}=\frac{{n}_{r}}{{N}_{r}}\) , Then the sample allocated for each region was computed with \({n}_{r}=\frac{n}{N}*{N}_{r}\) , where \({n}_{r}\) is sample size allocated for each region, \({N}_{r}\) is the total number of health centers or hospitals for \({r}^{th} r=\text{1,2}, \dots , 11\) , \(N\) is the total number of health facilities under investigation. The number of health facilities (health centers and hospitals) allocated for each region proportional to their existing health facilities is summarized in the table below. (Table 2 ) Table 2 Total number of sample sizes allocated for each region during national-level system evaluation of Maternal Death Surveillance and Response system, 2020 Type of Facility Sample size allocated to the regions Amhara Afar AA Oromia SNNPR Gambella Somali BNG DD Harari Tigray Health centers 118 14 14 236 100 5 27 7 2 1 29 Hospital 20 2 3 18 17 2 3 2 1* 1* 9 Total 138 16 17 254 117 7 30 9 3 2 38 *Note: - The sample size is round up for Dire Dawa and Harari regions because the population estimate was below. 2.6. Data Collection Tools, Quality Management, and Evidence Generation Standardized quantitative assessment tools were prepared to incorporate the required information at the health center and health post levels. Before actual data collection time, the tools were pre-tested in areas outside of the selected districts for the study. Refinement of data collection tools and procedures was carried out based on observations from field-level pre-testing. To facilitate the data collection, separate standard questionnaires were administered for; 1) Health Extension Workers at the visited Health Posts 2) Public Health Emergency Management focal person and/or MCH officer at catchment health centers 3) Public Health Emergency Management focal person and/or MCH officer at hospitals All quantitative data collection tools were designed using ODK electronic data entry template with integrated data quality assurance features to be administered using android-based tablet computers. Collected data from the ODK database was exported to Stata 14 for cleaning and analysis. Descriptive statics were employed with woreda or district disaggregation to determine the implementation status of the national maternal death surveillance and response system at health facility and community levels. Survey Implementation - Field epidemiology residents mobilized from different universities were assigned as data collectors for the evaluation. Besides, members of the national MDSR Technical Working Group (TWG) and MDSR officers working at regional health bureaus were assigned as the regional and central coordinators. All data collectors were trained for three days on general data collection guidelines, data collection methods, sampling and data collection procedures, the contents of each data collection tool, and the basic components of the Maternal Death Surveillance and Response system. Verification of data collected for its accuracy and completion was done by field supervisors in the field before sending it to central. The validated data were then transferred from each tablet to a secure central server in the national PHEM data management center. Each data collection team’s implementation was tacked by the central data manager and assigned central survey coordinator based on the output from the collected data. Finally, data cleaning (screening data for duplication, internal consistency, out-of-range and invalid values, and outliers) was carried out during and after the completion of the data collection time and before the final data analysis and information generation process. 2.7. Sampling Strategy Multistage sampling techniques were used to select health facilities for the study. Random numbers were generated to select health facilities (health centers and hospitals). During the determination and allocation of the required number of health facilities (total number of health centers and hospitals), the ratio of health facilities (hospitals vs health centers) in the nation was considered. Health posts were selected by default. Meaning, that one health post under the selected health center is selected to be included in the study. The procedure followed to select health facilities (health centers and hospitals) with their catchment health posts is summarized in the below-indicated diagram. (Fig. 2 ) Selection of health facilities: - To give a chance for all facilities to be included in the final list of health facilities for the study, the last facilities for the survey were selected using the lottery method. All available health facilities were considered during the process. Then selected health facilities were visited by the assessment team. Approaches used for selection of catchment HPs and woreda structures: - Health posts were selected based on the health centers selected for the evaluation. One of the catchment health posts was selected automatically and visited during the assessment. Approaches used for selection of respondents at health facilities and health posts: - Facility-level surveillance focal persons responsible for coordinating MDSR-related activities were the primary targets for selection. If the indicated officers and focal persons were not available during the visit, experts who are part of the MDSR committee of the facility were automatically selected for the interview. If that is not available, required data was collected from the health facility head or deputy head or MCH expert, or team leaders. Survey Implementation Status of MDSR system evaluation Among the selected health facilities for the assessment, the data collection team didn’t visit some health facilities in different geographical areas due to different factors. A summary of the visited health facilities, health posts, and their geographical distribution is indicated in the tables and figures below. (Table 3 , and Figs. 3 and 4 ) Survey respondents: - Mix of professionals/experts and officials working at health facilities and health posts were selected as a respondent during data collection. Summary the type of health professionals who participated in this survey are summarized in the table below. (Table 3 ) Table 3 Position of the interviews, and their relation with MDSR system by region, National MDSR system evaluation, Ethiopia, 2020 Regions Categories Tigray Afar Amhara Oromia Somali B.Gum SNNPR Gambella Harari A. A D. D National Health facility level MDSR system Implementation Health centers Available 273 78 849 1317 165 40 731 32 8 97 15 3545 Sampled (N) 29 14 118 236 27 7 100 5 1 14 2 553 Visited (n) 24 11 99 203 23 8 56 3 1 14 3 445 % 82.8 78.6 83.9 86.0 85.20 114.3 56.0 60.0 100.0 100.0 150.0 80.5 Hospital Available 31 6 73 101 10 6 28 3 1 13 2 274 Sampled (N) 9 2 20 18 3 2 17 2 1 3 1 78 Visited (n) 10 2 18 15 3 2 16 3 1 3 1 74 % 111.1 100.0 90.0 83.3 100.0 100.0 94.1 150.0 100.0 100.0 100.0 94.9 Community MDSR Implementation HPs Planned (n) 29 14 118 236 27 7 100 5 1 NA 2 539 Visited (n) 12 10 97 165 21 8 53 2 1 NA 0 369 Percentage (%) 50.0 71.4 82.2 69.9 77.8 114.3 53 40 100 NA 0 68.5 Position of the interviewee N (%) CEO/Medical. Director 16 (47.1) 0 (0.0) 17 (14.5) 29 (13.3) 15 (57.6) 0 (0.0) 21 (29.2) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 98 (18.8) Senior Clinician 0 (0.0) 0 (0.0) 1 (0.8) 4 (1.8) 0 (0.0) 0 (0.0) 1 (1.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 6 (1.7) Senior Midwife 9 (26.5) 0 (0.0) 4 (3.4) 14 (6.4) 1 (3.8) 1 (10.0) 7 (9.7) 0 (0.0) 0 (0.0) 1 (5.8) 0 (0.0) 37 (7.1) Surveillance Focal Person 9 (26.5) 13 (100.0) 93 (79.5) 139 (63.8) 10 (38.5) 9 (90.0) 39 (54.2) 6 (100.0) 2 (100.0) 16 (94.12) 4 (100.0) 340 (65.5) Others 0 (0.0) 0 (0.0) 2 (1.7) 32 (14.6) 0 (0.0) 0 (0.0) 4 (5.6) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 38 (7.3) 3. Findings 3.1. System Implementation Status (I). Health facility level MDSR system implementation: - A total of 400 (77.1%) health facilities (332 or 74.6 percent of them were health centers, and 68 or 91.9 percent were hospitals) were implementing the MDSR system out of the total 519 health facilities visited. Findings on the geographical distribution of MDSR system implementation health facilities show significant variation among regions of the nation. Emerging regions like Somali and Afar regions had the lowest proportion of MDSR implementing health facilities which are 2 (7.7%) and 2 (15.2%), respectively. Whereas all visited health facilities in Addis Ababa, Dire Dawa, Harari, and Benishangul Gumuz regions were found to be MDSR systems implementing health facilities. (Table 4 and Fig. 5 ) Regarding the duration of MDSR system implementation, a total of 116 (59.5 percent) health facilities have been implementing the system for more than three years. All visited health facilities in Tigray, Harari, and Dire Dawa city administrations were among health facilities that have been implementing the system for more than three years. (Fig. 6 ) (II). Community-level MDSR system implementation - A total of 369 heath posts found in all regions except in Addis Ababa and Dire Dawa city administration were visited to assess community-level MDSR system implementation status. A total of 264 (71.5 percent) were found to be MDSR system implementing health posts. As like facility-level MDSR system implementation, a significant difference was observed among regions in community-level MDSR system implementation. All visited health posts in Benishangul-Gumuz, 92 (94.8%) health posts in the Amhara region, and 126 (76.4%) health posts in the Oromia regions were implementing the system. On the contrary, none of the visited health posts in Gambella, Afar, and Harari regions implemented the system. Among the MDSR system implementing health posts in Ethiopia, 159 (60.0%) and 89 (33.6%) of them reported that they have been implementing the system for more than three years and one to three years respectively. A higher proportion of implementing health posts in Tigray 5 (83.3%) and Benishangul Gumuz 6 (75.0%) has been implementing the system for more than three years. The only implementing health post from the Somali region started implementing the system in the assessment year. (Table 4 ) Table 4 Health facilities MDSR system implementation status by type of health facilities and region, National MDSR system evaluation, Ethiopia, 2020 Variables Tigray Afar Amhara Oromia Somali Ben-G SNNPR Gambella Harari A. A Dire D National Health facility level MDSR system - MDSR system implementation status Total Visited health facilities 34 13 117 218 26 10 72 6 2 17 4 519 MDSR system Implementing HFs 25 (73.5) 2 (15.4) 112 (95.7) 170 (77.9) 2 (7.7) 10 (100) 52 (72.2) 4 (66.7) 2 (100) 17 (100) 4 (100) 400 (77.1) Implementation by Type of Facilities Health Center 17 (70.8) 0 (0.00) 94 (94.9) 155 (76.4) 1 (4.4) 8 (100.0) 37 (66.1) 2 (66.7) 1 (100.0) 14 (100.0) 3 (100.0) 332 (74.6) General Hospital 4 (66.7) 1 (100.0) 3 (100.0) 10 (100.0) 1 (33.3) 2 (100.0) 6 (100.0) 1 (100.0) 0 (0.00) 0 (0.00) 1 (100.0) 29 (87.9) Primary Hospital 3 (100.0) 1 (100.0) 10 (100.0) 2 (100.0) 0 (0.00) 0 (0.00) 8 (88.9) 1 (50.0) 0 (0.0) 0 (0.0) 0 (0.0) 25 (92.6) Referral Hospital 1 (100.0) 0 (0.0) 5 (100.0) 3 (100.0) 0 (0.0) 0 (0.0) 1 (100.0) 0 (0.0) 1 (100.0) 3 (100.0) 0 (0.0) 14 (100.0) Community level MDSR system - MDSR system implementation status Total n o of visited HPs 12 10 97 165 21 8 53 2 1 369 Implementing HPs 6(50.0) 0(0.0) 92 (94.8) 126 (76.4) 1(4.5) 8 (100.0) 31(58.5) 0(0.0) 0(0.0) 264 (71.5) Years of MDSR system implementation = 3 years 5(83.3) 0(0.0) 57 (61.3) 83(65.9) 0(0.0) 6(75.0) 8(25.8) 0(0.0) 0(0.0) 159 (60.0) 3.2. Maternal Death Identification or Detection and Notification (I). Health facility level MDSR system: - Of the 400 visited MDSR systems implementing health facilities, 162 (40.5%) and 169 (42.3%) of them had case definitions and maternal death notification format for facilitating the identification and formal notification of maternal deaths to facility level PHEM focal persons, respectively. All health facilities in Dire Dawa and Harari regions and the majority of facilities in 13 (52%) Tigray, 55 (49.1%) Amhara, and 47 (27.6%) Oromia had case definitions for maternal death identification. All implementing health facilities in Somali and 1 health facility in the Gambella region had case definitions for maternal death in their health facilities during the data collection time. Additionally, a higher proportion of facilities in Tigray 15 (60%) and Benishangul Gumuz 7 (70.0%) regions had a maternal death notification format for the formal death notification process. A total of 224 (56.0%) MDSR implementing health facilities also reported that they assigned experts for routine review of registration books and client charts in their health institutions for identification of maternal death that is not reported. The majority of these health facilities were from Tigray, Amhara, SNNPR, and Gambella but health facilities in Afar had no assigned personnel for register review routinely. (Table 5 ) This study finding also shows, that more than three-fourth (75.5%) of MDSR implementing facilities (both health centers and hospitals) had established mechanisms for identification and formal notification of maternal deaths occurred at different departments in their health facilities. Most of the health facilities were from Amhara and Oromia. Furthermore, from a total of 332 MDSR implementing health centers, 314 (94.6%) also reported the availability of an established mechanism for detecting and receiving notification of maternal death reports from the community. (Table 5 ) Regarding the overall readiness of the visited health facilities (hospitals and health centers) for identification and notification of maternal deaths, only 37 (11.6 percent) health centers and 14 (20.6 percent) hospitals had appropriate readiness for conducting maternal death identification and notification process in their health facilities. (Table 5 ) Community level MDSR system - Among visited health posts, 39 (14%) of the health posts had locally translated community case definitions for maternal death. The vast majority, 231 (87.5%), of the health posts had reported the availability of established mechanisms for receiving maternal death reports from the community. The two-standard sources of maternal death reports were from the health development army 205(88.7%) and direct community report 155(67.1%). (Table 5 ) Furthermore, this assessment finding also reveals that a total of 203 (76.9%) MDSR implementing health posts had established a system to screen death of women of reproductive age group occurred in their catchment community mainly through house-to-house visits (91.1%), during meetings with community members (43.8%) and report from any community member (56.2%). A total of 5(83.3%), 68(73.9%), 98(77.8%), 6(75%), and 26(83.9%) health posts from Tigray, Amhara, Oromia, Benishangul Gumuz, and SNNPR reported that they had this platform to routinely screen death of women of reproductive age group using selected criteria respectively (Table 5 ). Table 5 – Indicators for Identification and notification of maternal death at health facilities by regions, national MDSR system evaluation, Ethiopia, 2020 Variables Scale Tigray Afar Amhara Oromia Somali B-Gum SNNP Gambella Harari A.A D.D National Health facility level MDSR system - Identification and notification Number of MDSR implementing HFs. Count 25 2 112 170 2 10 52 4 2 17 4 400 Availability of case definition (n = 400) Count (%) 13 (52) 1 (50) 55 (49.1) 47 (27.6) 0 3 (30) 28 (53.8) 1 (25) 2 (100) 8 (47.1) 4 (100) 162 (40.5) Availability of N. format (n = 400) Count (%) 15 (60) 2 (100) 39 (34.8) 68 (40) 1 (50) 7 (70) 24 (46.2) 1 (25) 1 (100) 8 (47.1) 3 (75) 169 (42.3) Mechanism to receiving MD at HCs (n = 400) Count (%) 22 (88) 2 (100) 82 (73.2) 134 (78.8) 1 (50) 7(70) 36(69.2) 1 (25) 1 (50) 13 (76.5) 3 (75) 302 (75.5) Availability of experts to review Charts (n = 400) Count (%) 18 (72) 0 75 (67) 74 (43.3) 1 (50) 7 (70) 31 (59.6) 4 (100) 1 (50) 9 (52.9) 4 (100) 224 (56) Overall readiness of health center for I&N (n = 332) Count (%) 6 (37.5) 0 10 (11.2) 10 (6.6) 0 2 (25) 5 (14.7) 0 0 2 (14.3) 2 (66.7) 37 (11.6) The established mechanism for receiving death from the community (n = 332) Count (%) 16 (94.1) 0 87 (92.6) 147(94.8) 1(100) 8(100) 37(100) 0 1 (100) 14 (100) 3(100) 314 (94.6) Overall readiness of hospitals for I&N (n = 68) Count (%) 6 (75) 0 3 (16.7) 1 (6.7) 0 0 2 (13.3) 1 (50) 0 0 1 (100) 14 (20.6) Health Post-level MDSR system - Identification and notification No of Implementing HPs 6 92 126 1 8 31 264 HP with case definition Locally translated Count (%) 1(16.7) 18(19.6) 13(10.3) 0 0 7(22.6) 39 (14.8) Available Mechanism for receiving notification from communities = Yes Count (%) 5(83.3) 80(87) 111(88.1) 1(100) 6(75) 28(90.3) 231(87.5) Means of receiving MD from the community(n = 264) By HDA Count (%) 5(100) 75(93.8) 92(82.9) 1(100) 6(100) 26(92.9) 205(88.7) Direct from community 5(100) 54(67.5) 69(62.2) 1(100) 3(50) 23(82.1) 155(67.1) Screening of WRA (women of reproductive age) (%) 5(83.3) 68(73.9) 98(77.8) 0 6(75) 26(83.9) 203 (76.9) Methods of maternal death identification and notification (n = 204) House visit Count (%) 5(100) 60(88.2) 89(90.8) NA 6(100) 25(96.2) 185(91.1) During meeting Count (%) 4(80) 20(29.4) 49(50) NA 1(16.7) 15(57.7) 89(43.8) Notification from any community member Count (%) 5(100) 33(48.1) 58(59.2) NA 2(33.3) 17(65.4) 115(56.2) 3.3. Maternal Death Registration, Archiving, and Reporting Practice Health Facility level MDSR system: - Among the assessed 400 MDSR system implementing health facilities, 301 (75.1%) of them archive maternal death reports. All MDSR systems implementing health facilities in Dire-Dawa, Benishangul Gumuz, Addis Ababa, and Harari region archived maternal death reports in their health facilities. But, none of the MDSR systems implementing health facilities in the Afar region had archived maternal death reports during the visit. Additionally, a total of 390 (97.5%) visited implementing health facilities had means of communication for maternal death data reporting to the next level. (Table 6 ) Community level MDSR system: - Of the visited MDSR implementing health posts in the nation, 73(27.7%) and 208(78.8%) of them had a rumor logbook for registering maternal death notifications and maternal death PHEM weekly reporting format, respectively. A total of 245 (92.8%) of the health posts reported having a means of communication to send and receive MDSR-related reports (Table 6 ) Based on this evaluation findings, the most commonly used means of communication for sending maternal death reports by the health posts across the nation was a combination of paper and phone 137(55.9%) followed by the paper-based only 62(25.2%), and paper, phone, and text message 28(11.4%) respectively. The type of communication used by the health posts significantly varies across the respective regions (Table 6 ). Table 6 Summary of indicators for maternal death registration, archiving and reporting practice at health facilities by regions, national MDSR system evaluation, Ethiopia, 2016 Region Tigray Afar Amhara Oromia Somali Gumuz SNNP Gambella Harari Addis A D.D National Health facility level MDSR system - Maternal Death Registration, Archiving, and Reporting Practice Number of HFs 25 2 112 170 2 10 52 4 2 17 4 400 Archiving practice of maternal D report 22 (88.0) 0(0.0) 88 (78.6) 125 (73.1) 1 (50.0) 10 (100.0) 29 (55.8) 3 (75.0) 2 (100.0) 17 (100.0) 4 (100.0) 301 (75.1) Communication means available 23 (92.0) 2 (100.0) 110 (98.2) 166 (97.6) 2 (100.0) 10 (100.0) 52 (100.0) 4 (100.0) 2 (100.0) 15 (88.2) 4 (100.0) 390 (97.5) PHEM weekly reporting format 22(88.0) 2(100.0) 101(91.0) 140(82.8) 2(100.0) 8(80.0) 37(71.4) 1(25.0) 2(100.0) 13(76.5) 4(100.0) 330(83.5) Rumor logbook 17(68.0) 1(50.0) 72(64.9) 11(6.5) 0(0.0) 7(70.0) 2(4.1) 1(25.0) 0(0.0) 9(52.9) 4(100.0) 124(31.4) Registration book 21(84.0) 2(100.0) 84(75.7) 126(74.6) 1(50.0) 10(100.0) 25(51.0) 1(25.0) 2(100.0) 6(35.3) 4(100.0) 282(71.4) MDRF format 11(44.0) 1(50.0) 53(47.8) 82(48.5) 2(100.0) 7(70.0) 21(42.9) 1(25.0) 1(50.0) 9(52.9) 4(100.0) 192(48.6) Health post-level MDSR system - Maternal Death Registration, Archiving, and Reporting Practice Implementing HPs 6 92 126 1 8 31 264 Revised PHEM format (N = 264) 5(83.3) 85(92.4) 89(70.6) NA 5(62.5) 24(77.4) 208(78.8) Rumor Logbook 6(100.0 59(64.1 0(0.0) 0(0.0) 1(12.5) 7(22.6) 73(27.7 Registration book (N = 264) 6(100) 81(87.1) 103(81.7) NA 7(67.5) 15(48.4) 212(80.0) Communication means 6(100.0 86(93.5 116(92. 0(0.0) 8(100.0 29(93.5 245(92. Types of communication available for MD in HP Paper-based 1(16.7) 10(11.6 37(31.9 NA 3(37.5) 11(37.9 62(25.2 Phone call 0 1 (1.1) 15(12.9 NA 0 1 (3.4) 17(6.9) Text message 0 1 (1.1) 0 NA 0 0 1(0.4) Paper and phone 5 (83.3) 72(83.7 38(32.8 NA 5 (62.5) 17(58.6 137(55. All 0 2 (2.3) 26(22.4 NA 0 0 28(11.4 3.4. Maternal Death Investigation and Review Practice Health facility level MDSR system - A total of 158 (39.5%) of health centers reported that they have an assigned responsible expert (surveillance focal person) to monitor the investigation of reported deaths in their health centers. The majority 3 (75%) and 34 (65.38%) of health centers from Dire-Dawa and SNNPR regions reported that they have an assigned surveillance focal person to investigate maternal death reports from the catchment communities. Additionally, 349 (87.2%) health facilities (both health centers and hospitals) had a maternal death review committee in their respective institutions. Among the visited MDSR system implementing health facilities, 23 (6.96%) of health centers have optimal readiness to perform the overall maternal death investigation and review process. A total of 2 (66.67%), 6(16.22%), and 3 (17.65%) health centers were reported from Dire-Dawa, SNNPR, and Tigray which satisfy these criteria. Based on this study’s findings, health centers in Gambelia, Harari, and Somali were not ready to implement the overall maternal death investigation and review process. On the other hand, 18(26.47%) hospitals are fully capable for investigating and reviewing maternal death in their facilities. MDSR implementing hospitals from Gambelia, Harari, Addis Ababa, and Somali regions had no optimal readiness to investigate and review maternal deaths in their hospitals. (Table 7 ) Community level MDSR system - Of the visited MDSR implementing health posts, 28 (10.6%) had locally translated verbal autopsy format to investigate maternal deaths in their catchment area. Regarding responsible persons to investigate community deaths, a total of 96 (36.4%) implementing health posts said that catchment health facility surveillance focal is responsible for investigating suspected maternal death that occurred in their catchment area followed by health extension workers 150 (56.8%). (Table 7 ) 3.5. Maternal death data management, information generation, and sharing Health facility MDSR system: - Out of the respondents at 400 MDSR implementing health facilities visited, only 6 (1.5%) of respondents claimed they were engaged with routine analysis and information generation of maternal death data in their health facilities at least once. Among the facilities involved in routine data analysis and information generation, three were from the Amhara region, two were from the Oromia region and one health facility was from the SNNPR region. Additionally, a total of 298 (74.5%) of them had a platform to share MDSR findings with all stakeholders (Fig. 7 ). Community level MDSR system: - Out of the respondents at the visited MDSR system implementing health posts, only 24 (9.1%) of them claimed that they were engaged in routine data aggregation, analysis, and information generation of Maternal death data reported from catchment communities at least once. Additionally, a total of 223 (84.5%) health posts claimed that they had a platform for sharing MDSR-related information for all stakeholders in their catchment area. (Fig. 8 ) Table 7 Summary of indicators for maternal death investigation and review practice by region, national MDSR system evaluation, Ethiopia, 2020 Variables Tigray Afar Amhara Oromia Somali B-Gum SNNP Gambella Harari Addis A Dire D National Health facility level MDSR system - Maternal Death Investigation and confirmation Implementing HFs 25 2 112 170 2 10 52 4 2 17 4 400 Availability of experts to investigate suspected MD in HF (n = 400) 11(44) 2(100) 79(70.54) 115(67.65) 1(50) 7(70) 41(78.85) 3(75) 1(50) 4(23.53) 4(100) 268(67) Responsible expert to monitor the investigation of reported deaths = Yes 5(20) 1(50) 42(37.5) 65(38.24) 1(50) 1(10) 34(65.38) 2(50) 1(50) 3(17.65) 3(75) 158(39.5) Availability of MDSR review committee for confirmation (n = 400) 23(92) 2(100) 101(90.18) 142(83.53) 2(100) 9(90) 43(82.69) 4(100) 2(100) 17(100) 4(100) 349(87.25) Availability of facility-based abstraction format(n = 400) 18(72) 1(50) 34(30.63) 34(20.12) 1(50) 6(60) 14(28.57) 1(25) 1(50) 3(17.65) 4(100) 117(29.62) Overall HC readiness for investigation and confirmation N = 332 3(17.65) 0 4(4.26) 7(4.52) 0 1(12.5) 6(16.22) 0 0 1(7.14) 2(66.67) 23(6.96) Overall hospitals readiness for Case investigation and confirmation(n = 68) 5(62.5) 1(50) 3(16.67) 3(20) 0 1(50) 4(26.67 0 0 0 1(100) 18(26.47) Health post-level MDSR system - Maternal Death Investigation and confirmation Number of Implementing HP 6 92 126 1 8 31 264 Availability of locally translated VA tool (N = 264) 2(33.3) 7(7.6) 12(9.5) 0 (0.0) 1 (12.5) 6 (19.4) 28 (10.6) Responsible to investigate MDs Catchment HF focal (N = 265) 3(50) 25(27.2 48(38.1 1(10 5(62.5) 14(45. 96(36.4 Midwives 2(33. 24(26. 38(30.2 0(0.0 1(12.5) 11(35. 76(28.8 RRT (N = 265) 3(50) 28(30.4 45(35.7 0 5(62.5) 13(41. 94(35.6 HEW (N = 265) 4(66. 53(57.6 69(54.8 0 3(37.5) 21(67. 150(56. Consent was taken for VA 6(100 25(27.2 61(48.4 0 5(62.5) 16(51. 113(42. 3.5. Available financial resources and functional computer for surveillance Regarding the availability of finance for implementing and strengthening the MDSR system and response at the health facility level, only 26(6.5%) of the health facilities reported for the availability of finance for MDSR system implementation and strengthening in their health facility, which varied across regions. However, Afar, Benishangul-Gumuz, Harari, Dire Dawa, Addis Ababa, and Somali regions did not have allocated finance for maternal death response. Nationally, about 45 (11.3%) of health facilities had functional computers for surveillance (Table 8 ). Table 8 Financial resource and availability functionality computer for MDSR system implementation by regions in Ethiopia, 2020 Regions Implementing Health Facilities Count Available finance for MDSR system implementation Count (%) Availability of functional computer for MDSR Count (%) Tigray 25 4 (16.00) 2 (8.00) Afar 2 0 (0.0) 0 (0.0) Amhara 112 15 (13.39) 12 (10.7) Oromia 170 5 (2.92) 6 (3.5) Somali 2 0 (0.0) 2 (100.0) Ben- Gumuz 10 0 (0.0) 1 (10.0) SNNPR 52 1 (1.92) 14 (26.9) Gambella 4 1 (25.00) 2 (50.0) Harari 2 0 (0.0) 1 (50.0) Addis Ababa 17 0 (0.0) 2 (11.8) Dire Dawa 4 0 (0.0) 3 (75.0) National 400 26 (6.5) 45 (11.3) 4. Discussion According to the literature on health system surveillance, having either a higher geographical coverage of a system or having evidence that shows an optimal proportion of a system implementing health system structures is required for generating representative evidence about the disease or event under surveillance. This indication can increase trust in the evidence generated by system output and allow responsible actors to use generated evidence for decision-making at all levels for the prevention and management of maternal health problems. Furthermore, this indicator can provide valuable information about the status of a surveillance system's implementation as a monitoring and evaluation tool[ 3 ], [ 13 ], [ 15 ]. According to national PHEM guidance, at least 80% of health facilities are expected to implement the MDSR to have a complete picture of the country's maternal mortality burden and surrounding factors. According to this system evaluation finding, 77.1 percent of health facilities (74.6 percent for health centers and 91.9 percent for hospitals) and 71.5 percent of visited health posts were implementing facility and community-based MDSR systems, respectively, at the national level. Despite being lower than the expected national level standard and study findings from Guinea community-based maternal deaths surveillance, this figure is higher than the figure discovered during a baseline survey conducted in 2015 to assess the status of death review implementation in low- and middle-income countries [ 16 ][ 17 ] [ 18 ]. This study finding also reveals that the geographical distribution of MDSR system-implementing health facilities in the country varies significantly across different regional structures. In emerging regions, system implementation is extremely low. whereas agrarian and municipal administrations performed relatively well in terms of system implementation at health facilities. Considering that emerging regions have a significant proportion of health facilities in the nation, these lower regional achievement in emerging regions significantly contributes to the lower national level implementation status. This can lead to gaps in the generation of reliable evidence and its application in decision-making. The lack of MDSR training or orientation for HEWs and community health agents, a lack of supportive supervision from higher-level structures, a lack of MDSR resources (such as locally translated case definitions for maternal death, a lower number of partners available to support the MDSR system, a financial shortage, and others) in the emerging region could explain this variation in achievement and implementation[ 19 ]–[ 21 ]. Furthermore, low levels of community engagement in emerging regions can make a significant contribution in this regard. Our argument is supported by a study finding conducted in the central part of Malawi and the eastern parts of Ethiopia which demonstrate that low levels of community engagement or participation in the MPDSR process are system implementation barriers [ 22 ]. The availability and functionality of the MDSR committee at a given health facility is a critical platform for monitoring system implementation status and ensuring the system is capable of preventing similar deaths in the future[ 4 ], [ 13 ]. Findings of this evaluation show that more than three-quarters of the visited health facilities had an MDSR committee, but only one-tenth of the facilities had a functional MDSR committee that held more than six death review coordination meetings per year. This finding demonstrates a significant gap in the availability and functionality of the required emergency coordination platforms at health facility levels, which is lower than the findings of previous studies in Guinea and Malawi [ 18 ], [ 23 ]. It could be due to a lack of support and attention received from respective institution leaders and a lack of involvement of concerned stakeholders. This argument is supported by study findings from Guinea and Malawi, which show that obtaining partners' support for MDSR-related activities is critical [ 16 ], [ 18 ]. The capacity of health facilities to detect and notify maternal deaths depends on the resources available for MDSR system implementation. Multiple inputs are required to effectively identify and notify maternal deaths while also ensuring the system runs smoothly. A case definition for maternal death, an established mechanism in place to receive maternal death reports from the community and within the facility, a notification format, and the availability of assigned experts to review departmental service delivery reports and charts are among the requirements. According to this assessment, lower than half of the visited health facilities had case definitions and maternal death notification formats. Furthermore, about 45.0 percent of MDSR-implementing health facilities had no assigned surveillance focal person and experts to conduct routine reviews of registration books and client charts to identify maternal deaths that are not reported in their health institutions. This could be attributed to internal rotation of trained staff within the facility, staff turnover, and low budget allocation for capacity-building activities for MDSR. The failure to designate a focal point may also reflect a failure to pay attention to by the respective facility managers. But this finding can point to the huge gap in this event surveillance and it can imply that there is a possibility that all maternal deaths in health facilities are not being reported to responsible bodies by the procedure indicated in the guideline and that they are having difficulty sending notifications or reporting maternal deaths due to a lack of death notification formats at the health facility level. Furthermore, it may have a significant impact on the formal documentation of maternal death reporting at the health facility level. Regarding maternal death detection and notification at the health post level, even though a vast majority of health posts, 231 (87.5 percent) reported the availability of a method for receiving maternal death reports from the community, greater than 85.0% of the visited health posts had no locally translated community case definitions for maternal death and 44 percent of HEWs have not received any training or orientation on community-level MDSR systems for at least two years or more. Considering that the majority (75.0%) of maternal deaths are expected to happen at the community level, the shortage of locally translated case definitions for maternal death and lack of training on the implementation of MDSR at the community level can significantly reduce the detection and notification of maternal deaths at the community level. this could have a significant impact on the functionality of the community-level MDSR system implementation[ 24 ]–[ 27 ]. Locally translated surveillance materials are friendlier and easier to understand which can potentially improve quality data reporting and motivation of community health workers. The lower-level readiness of health facilities and health posts evidenced here in this finding could be related to the system's ten percent implementation status after seven years of implementation in the nation[ 28 ]. According to the findings of this study, 73 (27.7 percent) of them had a rumor logbook for registering maternal death notifications and 208 (78.8 percent) of them had a maternal death PHEM weekly reporting format. Availability of the updated PHEM weekly reporting format and MDSR rumor logbook in health facilities was good in this study when compared to other tools such as the identification and notification form, facility-based abstraction form (FBAF), and updated guidelines for the Maternal Death Surveillance and Response system. This is consistent with the findings of the WHO-Afro-region study, which show that national guidelines and tools are 100% available [ 29 ]. A key finding in this assessment was the scarcity of rumor logbooks, updated MDSR guidelines, and locally translated community case definitions. It could indicate a lack of readiness for MDSR system implementation across the country's reporting regions and city administrations. The failure to print and distribute electronic versions of the locally translated tools may be the primary reason for their absence at health posts. As a result, the fact that hard copies of the tools are not being sent regularly from the national level, as well as the lack of circular communication to print and use the soft copy formats, may have contributed to the tools' limited availability. Because the maternal death review, analysis, and response elements cannot function without them, recording and documentation are essential components of MDSR. Good documentation aids the review process by establishing action points and carrying out response actions, as well as selecting appropriate contextual strategies to prevent similar deaths. All health facilities, according to the national technical guideline for MPDSR, should record, document, or archive all notified or reported deaths [ 13 ]. According to this assessment result, approximately three-fourths of implementing health facilities archived maternal death reports. Despite evidence that health facilities in Afar had a registration logbook, a PHEM weekly reporting format, and a means of communication to report to higher-level officials, the suboptimal practice of recording and archiving maternal death data is recorded. Furthermore, implementing the MDSR system in health care facilities can improve documentation practices. Other studies in Ethiopia show that once the MDSR system was implemented, the level of documentation improved, resulting in better communication and organized care, and ultimately more buy-in from stakeholders [30]. In terms of maternal death data communication infrastructure, 97.5 percent of health facilities have a communication means for reporting and receiving maternal death reports from their catchment areas. Furthermore, 92.8 percent of health posts reported having a method of communication for sending and receiving MDSR-related reports. This allows for the reporting of deaths to the next level and timely access to maternal health information, as well as the dissemination of feedback from a higher level. However, the majority of the MDSR implementing health facilities and health posts visited use a hard copy for service delivery registry and a combination of paper and phone (55.9%), with a paper-based one-fourth for information communication. Our findings contrast with those of another study conducted in Guinee, which discovered that all visited health facilities use electronic data communication and have maternal death databases [ 23 ]. This could be due to Ethiopia's lower level of attention to the issue, as well as a lack of funds and infrastructure in comparison to the indicated country. In terms of the overall readiness of the visited health facilities (hospitals and health centers) for maternal death identification and notification, about 90.0% of health centers and 80.0% of hospitals had no expected readiness to conduct the maternal death identification and notification process in their health facilities. Besides, among the MDSR system implementing health facilities visited, about 75.0% (23) had no required readiness to conduct the overall maternal death investigation and review process. Besides, this study also reveals that the overall readiness of health facilities for investigation and review varies across different regions in the nation. The disparities in detecting and notifying maternal deaths across regions may be due to a lack of trained human resources, a lack of training, a lack of guidelines and formats, work overload, and health care workers' negative attitudes toward maternal death detection and notification. Furthermore, about 90.0% of MDSR system implementing health posts had no locally translated verbal autopsy formats to investigate maternal deaths in their catchment area. Additionally, the investigation of deaths at the community level didn’t follow uniform implementation at the national level as indicated by the HEWs response on who is responsible to investigate their catchment area. Based on this finding 36.4 percent of implementing health posts stated that the catchment health facility surveillance focal is in charge of investigating suspected maternal deaths that occurred in their catchment area, followed by health extension workers 56.8 percent. 5. Conclusions And Recommendations 5.1. Conclusions This system evaluation profiled the MDSR system performance status at the health facility and community level across all regions and city administrations of Ethiopia. Findings of this evaluation suggested that the overall maternal death identification, maternal death data management, and evidence generation process for individual and programmatic response at health facility and community levels is suboptimal and may be resulted in a compromised evidence-based decision-making process at all levels significantly. Overall readiness of the health system to manage maternal death data and generate evidence for the decision-making process is very low as evidenced by the questionable availability and functionality of the current national-level MDSR system. It needs reasonable efforts for improvement in terms of the system’s core functions, supporting functions, and structure of the system. Even though there may be a long list of surrounding factors for this suboptimal achievement, the lower-level-level commitment of experts assigned to coordinate MDSR-related activities at the health facilities and health facilities’ leadership commitment takes the greater portion. Additionally, findings on the community-level MDSR system implementation status uncover that a significant gap is observed in community MDSR systems in capturing and investigating community death. System implementation and performance in emerging regions were significantly lower in all surveillance system components. Besides, the MDSR system coordinating bodies at health facilities was not satisfying. Even though most of the implementing health facilities established a committee in their respective institutions, a significant number of the committees were not functional as evidenced by the absence of routinely scheduled meetings to discuss on maternal death as per the guidance. In our attempt to describe the characteristics of core function, due to the shortage or absence of recording, reporting, notification, and investigation format and assigned trained focal person to coordinate MDSR-related activities at the health facility level, there may be a significant number of maternal deaths which are not recorded or reported. Moreover, the practice of routine data analysis was low, violating the surveillance’s goal and cannot proceed beyond the counting of deaths. Furthermore, the study indicates the gross variation among regions in implementing the MDSR system. For policymakers, this could imply that performance variation will ultimately affect the policy and strategy to be designed based on evidence generated by the system. Designing a strategy to address the stated gap is needed to effectively utilize the system for future planning and resource allocation. The evidence indicated above can lead to a conclusion that the system is not well-equipped to handle the very objective of the surveillance, which was to eliminate preventable maternal death by obtaining and using the information on each maternal death to guide public health action. On top of these, since maternal death is one of the priority public health problems of the nation and the system is operating integrated with the existing surveillance system the national PHEM system should accomplish several tasks to improve the system. 5.2. Recommendation Even though the system is not working as expected, this system evaluation showed that the national-level MDSR system implementation in Ethiopia is partially satisfactory and encouraging. Significant progress has been made, but gaps remain, and upgrading the current system offers a unique opportunity to implement the necessary structural changes and exploit the system to its potential. To help the system achieve the settled objectives by the system, revitalization of the MDSR system at the national level and addressing all the components of the system is very critical. This revitalization should be well organized and designed by engaging all relevant stakeholders to address the critical issues found during the assessment. Having a well-prepared national-level roadmap for implementing the MDSR system with an implementation plan addressing all relevant stakeholders is critical. Besides, establishing a system to monitor the availability and functionality level of emergency coordination platforms and facilitate the system integration with other Public Health Emergencies (PHEs) under surveillance is vital. Additionally, reduction of the expected layers/process to be accomplished by the MDSR process at facility and community levels (a less relevant process) is required. Besides, establish sentinel sites as a comparative data platform for the already operating population-based surveillance system. Establishing a system that advocates for context-specific evidence-based preparedness and prevention of obstetric emergency-related maternal mortality using a vulnerability risk assessment and mapping approach should be designed for a programmatic response. Specific recommendations categorized under WHO building blocks are provided below. 1. Leadership and governance Establishing a system to monitor emergency coordination platforms’ availability and functionality at all levels with required advocacy is vital. Engage professional associations, private sectors, and other relevant stakeholders in the MDSR system at all levels. Considering the system as a ‘’flagship’’ program to foster the implementation and monitoring and evaluation at the health facility and community level. 2. Workforce Establish a system for routine capacity building, and gap filling, and provide refresher training for the assigned PHEM officers and review committee members at health facilities Ensure well integration of MDSR and PHEM at health facilities Ensure the integration of the current MDSR training module in the Health Extension Workers (HEW) Training Package and other health science pre-service training packages for sustainability 3. Health care financing Ensure sustainable financial support for the system implementation, strengthening, monitoring, and evaluation. 4. Health Information System for MDSR Establish well-organized data management system for the MDSR system integrated with the existing national PHEM Establishing a system for routine data quality monitoring and data quality assurance integrated with the PHEM system Digitalization for real-time data collection, evidence generation, and sharing 5. Service delivery System should be designed to fit emerging regions’ health service delivery to address implementation gap and monitoring and evaluation Design a system for implementing repeated advocacy on MDSR at all levels of health system administrators / higher officials/politicians 6. Logistics and supply Sustainable system should be designed to provide required resources for maternal death identification, reporting, information generation, and sharing Avail pocket guide for health extension workers and health facility level MDSR review committee members Availing computer and internet service for data management at health facilities Declarations Ethics Approval and Consent to Participate The assessment protocol received ethical clearance from Ethiopian Public Health Institute, Scientific and Ethical Research Office (SERO). A support letter from EPHI was also written to all selected woredas, regional health bureaus, and selected health facilities and health posts indicating the objective and final aim of the evaluation. An individual informed consent was also sought from study participants by informing them about the evaluation’s purpose, significance, and contents. Each respondent was allowed consenting or refusing to participate in the study after receiving complete information about the study. All methods were performed in accordance with the relevant guidelines and regulations (e.g., Declaration of Helsinki). Consent for Publications All authors read the final version of this manuscript and approve for publication. Availability of Data and Materials The datasets used for this study are available from the corresponding author upon reasonable request. Competing Interests The authors declare that they have no competing interests. Fundings This system evaluation is funded by UNFPA Ethiopia office. Authors Contribution Protocol preparation and literature review: AAE, TT. Data analysis and interpretation: AAE, TT: Drafting of the manuscript and revision of the manuscript: AAE, TT. All authors read and approved the final manuscript. Acknowledgment First and foremost, we would like to acknowledge UNFPA for the financial support to conduct this evaluation from the tool preparation, data collection, and report write-up period. We are also very grateful to study participants and experts who contributed a lot to the successful accomplishment of this study and other experts who participated from tool development to report write-ups. Health officials working at all health system levels and survey team members (data collectors, supervisors, regional and central coordinators) also deserve our deepest appreciation and gratefulness for their willingness and support during the study period. Abbreviations HFs - Health Facilities; HPs - Health Posts; MCH - Maternal and Child Health; MDSR - Maternal Death Surveillance and Response; MMR - Maternal Mortality Rate; ODK - Open Data Kit; PHEM - Public Health Emergency Management; PHEs - Public Health Emergencies; SDG - Sustainable Development Goals; SERO - Scientific and Ethical Research office; SNNPR - South Nation Nationality and Peoples Region; TWG - Technical Working Group; UNFPA - United Nations Population Fund; UNICEF - United Nations International Children's Emergency Fund; WHO - World Health Organization. References [1] U. N. WHO, UNICEF, UNFPA, WORLD BANK GROUP and M. Mortality, “Trends in Maternal Mortality from 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division,” in Composites in Infrastructure - Building New Markets , 2000, pp. ix–xii. doi: 10.1016/b978-185617368-1/50001-5. [2] World Bank, TRENDS IN MATERNAL MORTALITY 2000 to 2017 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division , vol. 2. 2019. DOI: 10.1111/padr.12033. [3] United Nations, “Transforming our world: the 2030 Agenda for Sustainable Development. United Nations Sustainable knowledge platform,” 2015. doi: https://sustainabledevelopment.un.org/post2015/transformingourworld. [4] WHO, UNFPA, and CDC, Maternal Death Surveillance and Response Techincal Guidance . 2004. [5] S. Prasad, “Enhancing international accountability for maternal mortality and morbidity: The work of civil society at the United Nations Human Rights Council,” in Maternal Mortality, Human Rights and Accountability , 2013, pp. 85–110. doi: 10.4324/9780203684214. [6] WHO, “Maternal, newborn, child and adolescent health,” 2019. [7] W. H. Organization, “Reviewing maternal deaths and complications to make pregnancy safer Beyond the Numbers,” 2004. [8] C. for Disease Control, “Saving Mothers Giving Life: Monitoring and Evaluation Overview: Phase 1 Report, 2014,” 2014, [Online]. Available: https://www.cdc.gov/reproductivehealth/global/publications/pdfs/monitoringandevaluationoverview.pdf [9] S. M. Morbidity, “Plan of Action to Accelerate the Reduction of Maternal Mortality and Severe Maternal Morbidity MONITORING AND”. [10] The Borgen Project, “Improving maternal and child mortality in Ethiopia,” 2021. https://borgenproject.org/maternal-and-child-mortality-in-ethiopia/ [11] J. Anwar, S. Torvaldsen, M. Sheikh, and R. Taylor, “Under-estimation of maternal and perinatal mortality revealed by an enhanced surveillance system: Enumerating all births and deaths in Pakistan,” BMC Public Health , vol. 18, no. 1, pp. 1–14, 2018, doi: 10.1186/s12889-018-5363-3. [12] Ethiopian Public Health Institute, “NATIONAL TECHNICAL GUIDANCE FOR MATERNAL AND PERINATAL DEATH SURVEILLANCE AND RESPONSE,” 2017. [13] ETHIOPIAN PUBLIC HEALTH INSTITUE, National Technical Guidance for Maternal and Perinatal Death Surveillance and Response 2017 . 2017. [Online]. Available: https://www.ephi.gov.et/images/pictures/National-Maternal-and-Perinatal--Death-Surveillance-and-Response-guidance-2017.pdf [14] Geneva: World Health Organization., “Communicable disease surveillance and response systems: Alertresponse, Epidemicpandemic,” pp. 1–90, 2006, [Online]. Available: http://www.who.int/csr/resources/publications/surveillance/WHO_CDS_EPR_LYO_2006_2.pdf [15] WHO, “Communicable disease surveillance and response systems: Guide to monitoring and evaluating,” 2006. [16] M. V. Kinney, D. R. Walugembe, P. Wanduru, P. Waiswa, and A. George, “Maternal and perinatal death surveillance and response in low- And middle-income countries: A scoping review of implementation factors,” Health Policy Plan. , vol. 36, no. 6, pp. 955–973, 2021, doi: 10.1093/heapol/czab011. [17] S. Bandali et al. , “Maternal Death Surveillance and Response Systems in driving accountability and influencing change,” Int. J. Gynecol. Obstet. , vol. 135, no. 3, pp. 365–371, 2016, doi: 10.1016/j.ijgo.2016.10.002. [18] T. M. Millimouno et al. , “Evaluation of the maternal deaths surveillance and response system at the health district level in Guinea in 2017 through digital communication tools,” Reprod. Health , vol. 16, no. 1, pp. 1–11, 2019, doi: 10.1186/s12978-019-0671-3. [19] E. A. S. F. D. N. Coates, “CORE Group Polio Project Final Evaluation,” 2012. [Online]. Available: https://coregroup.org/wp-content/uploads/2017/08/CGPP_Evaluation_Final.5-30-13.pdf [20] H. Banteyerga, “Ethiopia’s health extension program: Improving health through community involvement,” MEDICC Rev. , vol. 13, p. 46, 2011. [21] P. Wendy, M. Vincent, B. Heather, “Community - Based Pandemic Preparedness Multi‐sectorial action for safer, healthier and more resilient communities Summary:,” 2001. [Online]. Available: http://towardsasaferworld.org/sites/default/files/TASWreportoncommunitypreparedness.pdf [22] P. Death, A. K. Tura, G. Fage, M. Ibrahim, and A. Mohamed, “Beyond No Blame : Practical Challenges of Conducting,” vol. 8, no. 2, pp. 1–5, 2020. [23] S. Bradley, F. Kamwendo, E. Chipeta, W. Chimwaza, H. de Pinho, and E. McAuliffe, “Too few staff, too many patients: A qualitative study of the impact on obstetric care providers and on quality of care in Malawi,” BMC Pregnancy Childbirth , vol. 15, no. 1, pp. 1–10, 2015, doi: 10.1186/s12884-015-0492-5. [24] W. R. Brieger and C. Kendall, “Learning from local knowledge to improve disease surveillance: Perceptions of the Guinea worm illness experience,” Health Educ. Res. , vol. 7, no. 4, pp. 471–485, 1992, doi: 10.1093/her/7.4.471. [25] A. Cerón, M. R. Ortiz, D. Álvarez, G. H. Palmer, and C. Cordón-Rosales, “Local disease concepts relevant to the design of a community-based surveillance program for influenza in rural Guatemala,” Int. J. Equity Health , vol. 15, no. 1, 2016, doi: 10.1186/s12939-016-0359-z. [26] T. Wuhib, T. L. Chorba, V. Davidiants, W. R. Mac Kenzie, and S. J. N. McNabb, “Assessment of the infectious diseases surveillance system of the Republicof Armenia: An example of surveillance in the republics of the former SovietUnion,” BMC Public Health , vol. 2, pp. 1–8, 2002, doi: 10.1186/1471-2458-2-3. [27] P. P. Chaki, S. Dongus, U. Fillinger, A. Kelly, and G. F. Killeen, “Community-owned resource persons for malaria vector control: Enabling factors and challenges in an operational programme in Dar es Salaam, United Republic of Tanzania,” Hum. Resour. Health , vol. 9, no. 1, p. 21, 2011, doi: 10.1186/1478-4491-9-21. [28] EPHI, “National Maternal and Perinatal Death Surveillance and Response (MPDSR) System Annual Report 2012 EFY,” no. August, 2020. [29] E. J. Kongnyuy, G. Mlava, and N. van den Broek, “Facility-Based Maternal Death Review In Three Districts In The Central Region of Malawi. An Analysis of Causes and Characteristics of Maternal Deaths,” Women’s Heal. Issues , vol. 19, no. 1, pp. 14–20, 2009, doi: 10.1016/j.whi.2008.09.008. [30] O. World Health, “Time to respond: a report on the global implementation of maternal death surveillance and response (MDSR).,” Geneva WHO , no. 64, p. ages, 2016, [Online]. Available: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=mwic&AN=2016081714%5Cnhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=mwic&AN=2016081714 Additional Declarations No competing interests reported. Supplementary Files SupplementaryDocument.docx Cite Share Download PDF Status: Published Journal Publication published 31 Mar, 2023 Read the published version in BMC Health Services Research → Version 2 posted Editorial decision: Major revision 11 Oct, 2022 Reviews received at journal 07 Oct, 2022 Reviewers agreed at journal 27 Sep, 2022 Reviewers invited by journal 26 Sep, 2022 Editor assigned by journal 26 Sep, 2022 Editor invited by journal 15 Sep, 2022 Submission checks completed at journal 15 Sep, 2022 First submitted to journal 07 Sep, 2022 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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type and region, National MDSR system evaluation, Ethiopia, 2020\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-2031541/v2/3b4f875072b2dda35ec47edd.png"},{"id":27286440,"identity":"082a859d-d0db-4526-8917-04ac380a72b7","added_by":"auto","created_at":"2022-10-03 17:43:01","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":255742,"visible":true,"origin":"","legend":"\u003cp\u003eGeographical Distribution of visited Health Posts for community level assessment by region, National MDSR system evaluation, Ethiopia, 2020\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-2031541/v2/92402fffc08a39e8709bb62b.png"},{"id":27286732,"identity":"3d5cdbfa-8971-49bf-ada9-2438df2140a9","added_by":"auto","created_at":"2022-10-03 17:48:01","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":283191,"visible":true,"origin":"","legend":"\u003cp\u003eGeographical distribution of MDSR system implementing health facilities by region, National MDSR system evaluation, Ethiopia, 2020\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-2031541/v2/9b4037705b0e942d4920d038.png"},{"id":27286061,"identity":"9e3597f8-c20f-4628-a6ce-049c67c3e6fb","added_by":"auto","created_at":"2022-10-03 17:38:01","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":42778,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of MDSR system implementing health facilities by the duration of implementation, national MDSR system evaluation, Ethiopia, 2020\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-2031541/v2/5c97692270d533c3321c5b48.png"},{"id":27286442,"identity":"d3bc6f1e-c8c6-456f-ba31-5ad2a9f61a01","added_by":"auto","created_at":"2022-10-03 17:43:01","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":42980,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of MDSR system implementing health facilities with information sharing platform for all stakeholders, National MDSR system evaluation, Ethiopia, 2020\u003c/p\u003e","description":"","filename":"Figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-2031541/v2/0a75e25f65b297487f48d08c.png"},{"id":27286066,"identity":"ce86e63c-7ee3-4e91-a0e4-d6b7f97f8979","added_by":"auto","created_at":"2022-10-03 17:38:01","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":40645,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of health posts with information sharing platform for all stakeholders, National MDSR system evaluation, Ethiopia, 2020\u003c/p\u003e","description":"","filename":"Figure8.png","url":"https://assets-eu.researchsquare.com/files/rs-2031541/v2/8afae0b4587a0ed1bc21b456.png"},{"id":44724135,"identity":"6c428b20-27dc-47bd-adf4-1a54158aa16c","added_by":"auto","created_at":"2023-10-16 20:24:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1935745,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2031541/v2/f78dcf20-ddfc-4d3d-9c8c-5002f617a9c9.pdf"},{"id":27286439,"identity":"7bfdf9cc-2163-48b4-a97b-f7d2f7df43c9","added_by":"auto","created_at":"2022-10-03 17:43:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20355,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryDocument.docx","url":"https://assets-eu.researchsquare.com/files/rs-2031541/v2/1d32ea947d95bc877c505526.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health System Readiness to Manage Maternal Death Data and Avail Evidence for Decision-Making Through Maternal Death Surveillance System in Ethiopia, 2020","fulltext":[{"header":"1. Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1. Global Overview of the Maternal Mortality\u003c/h2\u003e \u003cp\u003eGlobally, Maternal mortality continued to be a significant public health concern. According to a recent estimate by WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division, about 295,000 maternal deaths occurred in 2017. The global number of maternal deaths per 100,000 live births stands at 211; translating estimated 808 women dying every day. Additionally, poor socio-economic conditions, health care system-associated factors, disease burden, and complex interactions were indicated as major factor that accounts for a mortality differential. In 2017, maternal mortality ranged from 462 per 100 000 live births in the least developed countries to 11 per 100 000 live births in high-income countries. The report also indicated that low and middle-income countries in Sub-Saharan Africa and Southern Asia make up 86% of global maternal deaths [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e][\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on the Sustainable Development Goals (SDGs) goal for 2030, all countries should reduce MMR by two-thirds of their 2010 baseline level. The average global target is an MMR of less than 70/100 000 live births by 2030. One of the cross-cutting actions for eliminating preventable maternal mortality is improving metrics, measurement systems, and data quality to ensure that all maternal deaths are counted. However, accurate information on how many women died, where they died, and why they died is essential yet currently inadequate [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo significantly reduce maternal deaths in a poor resource setting, World Health Organization (WHO) and its partners recommend a new method. The new method focuses on counting every death and collecting information to permit an effective response that prevents future deaths- maternal death reviews like maternal death surveillance and response system. On the path to ending preventable maternal mortality, the WHO guide \u0026ldquo;Beyond the numbers\u0026rdquo; was launched in 2004 to encourage not just estimating the number of maternal deaths to know the magnitude of the problem but also to understanding why and where the women died to be able to do something about it [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e][\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e][\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e][\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e][\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e][\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2. Burden of Maternal Mortality in Ethiopian\u003c/h2\u003e \u003cp\u003eEthiopia has one of the highest Maternal Mortality Rates (MMR) globally, with an estimated maternal mortality ratio of 412 maternal deaths per 100,000 live births [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. One of the challenges in eliminating preventable maternal death in Ethiopia is the absence of information that shows the magnitude and causes of maternal deaths to assist with decision-making regarding the responses [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFollowing the WHO recommendation, the Ministry of Health \u0026ndash; Ethiopia (MOH) established the Maternal Death Review and Response (MDSR), a system to count and investigate all maternal deaths to generate and avail real-time information for decision-making in 2013. Since 2014, the MDSR has been operating integrated with the national Public Health Emergency Management (PHEM) system. The MDSR system is expected to avail reliable and quality data and information in real-time on the burden, causes, and contributing factors of maternal deaths and preventability of fatalities in the nation, thereby assisting with timely responses for improving maternal in Ethiopia[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo date, several promising achievements have been gained. For instance, the availability of national and woreda databases with more than 3500 reported maternal deaths were reported and used to monitor the trend of significant causes and contributing factors of maternal deaths at the different administrative levels. The MDSR databases have become the primary source of evidence to plan maternal services at national and woreda levels. Using evidence from the MDSR system, stakeholders including FMOH, health system administrative structures, health facilities, and partners, have started and implemented several initiatives to improve maternal health service delivery [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEven if the MDSR system provides crucial support to the health system through the databases, there are multiple system implementation challenges and shortcomings which reduce its benefits. A significant difference in system implementation performance and implementation coverage between implementing administrative structures and the limited capacity of the system to detect the expected magnitude of the problem were among the many. Therefore, this study was conducted to determine system implementation status and describe the readiness of the health system for generating and availing good quality data and evidence for the decision-making process at all health system levels in Ethiopia.\u003c/p\u003e \u003cp\u003e \u003cb\u003eScope of the Evaluation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis national MDSR system assessment covers the three components of maternal death surveillance and response system in Ethiopia's community and health facility health system structure. The scope of this national MDSR system evaluation is shown in the below figure. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eEvaluation questions addressed by this system evaluation are indicated in the table below. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation questions addressed by this national MDSR system evaluation, national MDSR system evaluation, Ethiopia, 2020\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystem components\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvaluation Questions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStructure of the systems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; To what extent does the Maternal Death Surveillance and Response system structure exist and function at the health system level and community structure?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupporting functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; Do the Maternal Death Surveillance and Response system have sufficient supporting functions for detecting, notifying, reporting, investigating, reviewing, and evidence generation?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCore functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026bull; To what extent can the Maternal Death Surveillance and Response system detect, register, report, investigate, review, analyze and avail evidence for relevant actors?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study Setting and Period\u003c/h2\u003e \u003cp\u003eThis evaluation was conducted at the national level. It included all the nine regional states of Ethiopia; Tigray, Afar, Amhara, Oromia, Somali, Benishangul Gumuz, Southern People Nations and Nationalities (SNNP), Gambella, and Harari, and two city administrations, Addis Ababa and Dire Dawa. This evaluation was conducted from September 2019 to April 2020.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Study Design\u003c/h2\u003e \u003cp\u003eA cross-sectional study was used to assess selected health facilities (hospitals and health centers) and health posts in all regions and city administrations.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eA modified version of the WHO framework for evaluating communicable disease surveillance systems and monitoring and evaluation framework for the MDSR system for Ethiopia were used to design and evaluate the system[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e][\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThree components of the MDSR system are assessed (1) Structure of the system, (2). Core components of the system, and (3). Supporting functions of the system\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSelected indicators are used to assess components of the system (See Annex 1)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Source Population\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eExperts working in the area of Maternal Death Surveillance and Response systems in health facilities (hospitals and health centers) and community-level health system structures (health posts) were the study population for this system evaluation.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion and Exclusion Criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion Criteria\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePublic health centers, hospitals, and health posts\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusion Criteria\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePrivate health facilities and special clinics with a focus on other than maternal health (e.g., dental, eye clinic, etc.)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePublic health facilities and health posts that were operational within the last fiscal year.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Study Participants\u003c/h2\u003e \u003cp\u003eThe study participants for this evaluation included samples of:\u003c/p\u003e \u003c/div\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eMDSR or PHEM experts or another responsible officer at selected health facilities\u003c/li\u003e\n \u003cli\u003eHealth Extension Workers at catchment health posts of selected health centers\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Sample Size Determination and Sampling Technique\u003c/h2\u003e \u003cp\u003eAssuming that the nature of the study units (health facilities and hospitals), hierarchical or nested structures (i.e., health facilities are nested in districts, districts are nested in zones, and zones are nested in the regions), this study considers the clustering effect units and expressed in terms of design effect.\u003c/p\u003e \u003cp\u003eDuring the determination of the sample size for this study\u003c/p\u003e \u003cp\u003eFirst, all regions were selected as primary sampling units. Second, the required number of health centers and hospitals were selected randomly using stratified random sampling techniques based on the type of facilities as stratifying variables.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\({N=N}_{1}+ {N}_{2}\\)\u003c/span\u003e \u003c/span\u003e, where \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({N}_{1}\\)\u003c/span\u003e\u003c/span\u003e total number of health centers and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({N}_{2}\\)\u003c/span\u003e\u003c/span\u003e is the total number of hospitals under investigation in Ethiopia\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eZ\u003csub\u003eα/2\u003c/sub\u003e = is the critical value of the standard normal distribution that corresponds to the level of confidence\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\({\\sigma }^{2}\\)\u003c/span\u003e \u003c/span\u003e= combined or pooled variance of system performance based on the indicators to measure the system\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\(ϵ\\)\u003c/span\u003e \u003c/span\u003e = the margin of error so that the degree of accuracy of our estimate for variance estimate has to be less than some given accuracy or marginal error (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(ϵ\\)\u003c/span\u003e\u003c/span\u003e), i.e.\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{{Z}_{\\alpha /2}*\\sigma }{ \\sqrt{n}}\u0026lt;ϵ\\)\u003c/span\u003e\u003c/span\u003e and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(Deff=1+\\left(m-1\\right)*\\rho ,\\)\u003c/span\u003e\u003c/span\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\rho\\)\u003c/span\u003e\u003c/span\u003e is interra-correlation with the cluster due to similarity of observation within the region than between region which considered to be non-zero value but not one i.e. between 0 and 1 [conservative choice is 0.33 commonly] say 1.2 from the literature so far in the health study\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003em average number of observations within clusters [regions]: average number of [health centers and/or hospitals]\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe required sample size, \u003cem\u003en\u003c/em\u003e = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({n}_{1}\\)\u003c/span\u003e\u003c/span\u003e [sample of health centers] + \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({n}_{2}\\)\u003c/span\u003e\u003c/span\u003e [sample of hospitals]\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThus, the final sample size for the study based on the parameters is computed as:\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\({n}_{i}\u0026gt;\\left[\\frac{{Z}_{\\frac{\\alpha }{2}}^{2}*{\\sigma }^{2}+{ϵ}^{2} }{ {ϵ}^{2}+\\frac{{Z}_{\\frac{\\alpha }{2}}^{2}*{\\sigma }^{2}}{{N}_{i}}}\\right]*Deff\\)\u003c/span\u003e \u003c/span\u003e, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(i=\\text{1,2}\\)\u003c/span\u003e\u003c/span\u003efor hospitals and health centers\u003c/p\u003e \u003cp\u003eOr it can be simpered as \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({n}_{0i}\u0026gt;\\left[\\frac{{Z}_{\\frac{\\alpha }{2}}^{2}*{\\sigma }^{2} }{ {ϵ}^{2}}\\right]\\)\u003c/span\u003e\u003c/span\u003e as initial population size but the study population size is known, then the required sample size for \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({i}^{th}\\)\u003c/span\u003e\u003c/span\u003e strata were computed using \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({n}_{0i}\\)\u003c/span\u003e\u003c/span\u003e and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({N}_{i}\\)\u003c/span\u003e\u003c/span\u003e as: \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({n}_{i}=\\frac{{n}_{0i}*{N}_{i}}{{n}_{oi}+{N}_{i}-1}\\)\u003c/span\u003e\u003c/span\u003e, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(i=\\text{1,2}\\)\u003c/span\u003e\u003c/span\u003edenoting the sample of health center size or hospital size determined.\u003c/p\u003e \u003cp\u003eThus, the sample size is computed based on the available parameters using the above formula:\u003c/p\u003e \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e \u003cp\u003eThe total sample size computed as\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(n={n}_{health centers}+{n}_{hospitals}=629\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003eWhere \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({N}_{i}\\)\u003c/span\u003e\u003c/span\u003e is \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({i}^{th}\\)\u003c/span\u003e\u003c/span\u003e population size I\u0026thinsp;=\u0026thinsp;1, 2 denoting the total number of health facilities and Hospitals, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(Deff\\)\u003c/span\u003e\u003c/span\u003e is design effect considered to 1.2 for this study and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({\\sigma }^{2}\\)\u003c/span\u003e\u003c/span\u003e can be obtained from previous studies or pilot assessments.\u003c/p\u003e \u003cp\u003eFor this study, approximation from the variance of binomial distribution representing that the combined or pooled variance of the system is being performed based on all the indicators and estimated as\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\({\\widehat{\\sigma }}^{2}={s}^{2}\\)\u003c/span\u003e \u003c/span\u003e=\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{n}{n-1}\\widehat{p}(1-\\widehat{p})\\)\u003c/span\u003e\u003c/span\u003e, where \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\widehat{p}=0.5\\)\u003c/span\u003e\u003c/span\u003e is the probability that the system is being performed or functioning by applying a correction for continuity due approximating the continuous random variable [normal] by discrete one [ binomial],\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\({s}^{2}\\)\u003c/span\u003e \u003c/span\u003e is sample variance estimating population parameter and for large sample size \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{{n}}{{n}-1}=1\\)\u003c/span\u003e\u003c/span\u003e. Then the total sample size is given by:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$${n}={{n}}_{1}+{{n}}_{2}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eSample allocation: -\u003c/b\u003e Once the total sample that represented the available health facilities to generate the relevant information was determined, then sample allocation was made based on the probability proportional to their size [PPS] for each region, i.e., using \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{n}{N}=\\frac{{n}_{r}}{{N}_{r}}\\)\u003c/span\u003e\u003c/span\u003e,\u003c/p\u003e \u003cp\u003eThen the sample allocated for each region was computed with \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({n}_{r}=\\frac{n}{N}*{N}_{r}\\)\u003c/span\u003e\u003c/span\u003e, where \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({n}_{r}\\)\u003c/span\u003e\u003c/span\u003e is sample size allocated for each region, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({N}_{r}\\)\u003c/span\u003e\u003c/span\u003e is the total number of health centers or hospitals for \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\({r}^{th} r=\\text{1,2}, \\dots , 11\\)\u003c/span\u003e\u003c/span\u003e, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(N\\)\u003c/span\u003e\u003c/span\u003e is the total number of health facilities under investigation.\u003c/p\u003e \u003cp\u003eThe number of health facilities (health centers and hospitals) allocated for each region proportional to their existing health facilities is summarized in the table below. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTotal number of sample sizes allocated for each region during national-level system evaluation of Maternal Death Surveillance and Response system, 2020\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of Facility\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"11\" nameend=\"c12\" namest=\"c2\"\u003e \u003cp\u003eSample size allocated to the regions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfar\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOromia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSNNPR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGambella\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSomali\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBNG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eDD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHarari\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTigray\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth centers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003e*Note: - The sample size is round up for Dire Dawa and Harari regions because the population estimate was below.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Data Collection Tools, Quality Management, and Evidence Generation\u003c/h2\u003e \u003cp\u003eStandardized quantitative assessment tools were prepared to incorporate the required information at the health center and health post levels. Before actual data collection time, the tools were pre-tested in areas outside of the selected districts for the study. Refinement of data collection tools and procedures was carried out based on observations from field-level pre-testing. To facilitate the data collection, separate standard questionnaires were administered for; 1) Health Extension Workers at the visited Health Posts 2) Public Health Emergency Management focal person and/or MCH officer at catchment health centers 3) Public Health Emergency Management focal person and/or MCH officer at hospitals\u003c/p\u003e \u003cp\u003eAll quantitative data collection tools were designed using ODK electronic data entry template with integrated data quality assurance features to be administered using android-based tablet computers. Collected data from the ODK database was exported to Stata 14 for cleaning and analysis. Descriptive statics were employed with woreda or district disaggregation to determine the implementation status of the national maternal death surveillance and response system at health facility and community levels.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSurvey Implementation\u003c/strong\u003e \u003cp\u003e- Field epidemiology residents mobilized from different universities were assigned as data collectors for the evaluation. Besides, members of the national MDSR Technical Working Group (TWG) and MDSR officers working at regional health bureaus were assigned as the regional and central coordinators.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAll data collectors were trained for three days on general data collection guidelines, data collection methods, sampling and data collection procedures, the contents of each data collection tool, and the basic components of the Maternal Death Surveillance and Response system. Verification of data collected for its accuracy and completion was done by field supervisors in the field before sending it to central. The validated data were then transferred from each tablet to a secure central server in the national PHEM data management center. Each data collection team\u0026rsquo;s implementation was tacked by the central data manager and assigned central survey coordinator based on the output from the collected data.\u003c/p\u003e \u003cp\u003eFinally, data cleaning (screening data for duplication, internal consistency, out-of-range and invalid values, and outliers) was carried out during and after the completion of the data collection time and before the final data analysis and information generation process.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.7. Sampling Strategy\u003c/h2\u003e \u003cp\u003eMultistage sampling techniques were used to select health facilities for the study. Random numbers were generated to select health facilities (health centers and hospitals). During the determination and allocation of the required number of health facilities (total number of health centers and hospitals), the ratio of health facilities (hospitals vs health centers) in the nation was considered. Health posts were selected by default. Meaning, that one health post under the selected health center is selected to be included in the study.\u003c/p\u003e \u003cp\u003eThe procedure followed to select health facilities (health centers and hospitals) with their catchment health posts is summarized in the below-indicated diagram. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cb\u003eSelection of health facilities: -\u003c/b\u003e To give a chance for all facilities to be included in the final list of health facilities for the study, the last facilities for the survey were selected using the lottery method. All available health facilities were considered during the process. Then selected health facilities were visited by the assessment team.\u003c/p\u003e \u003cp\u003e \u003cb\u003eApproaches used for selection of catchment HPs and woreda structures: -\u003c/b\u003e Health posts were selected based on the health centers selected for the evaluation. One of the catchment health posts was selected automatically and visited during the assessment.\u003c/p\u003e \u003cp\u003e \u003cb\u003eApproaches used for selection of respondents at health facilities and health posts: -\u003c/b\u003e Facility-level surveillance focal persons responsible for coordinating MDSR-related activities were the primary targets for selection. If the indicated officers and focal persons were not available during the visit, experts who are part of the MDSR committee of the facility were automatically selected for the interview. If that is not available, required data was collected from the health facility head or deputy head or MCH expert, or team leaders.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSurvey Implementation Status of MDSR system evaluation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAmong the selected health facilities for the assessment, the data collection team didn\u0026rsquo;t visit some health facilities in different geographical areas due to different factors. A summary of the visited health facilities, health posts, and their geographical distribution is indicated in the tables and figures below. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, and Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSurvey respondents: -\u003c/b\u003e Mix of professionals/experts and officials working at health facilities and health posts were selected as a respondent during data collection. Summary the type of health professionals who participated in this survey are summarized in the table below. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePosition of the interviews, and their relation with MDSR system by region, National MDSR system evaluation, Ethiopia, 2020\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"15\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRegions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTigray\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAfar\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOromia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSomali\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eB.Gum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSNNPR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGambella\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eHarari\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eA. A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eD. D\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNational\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eHealth facility level MDSR system Implementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHealth centers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvailable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e731\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e3545\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSampled (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVisited (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e445\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e83.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e86.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e85.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e114.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e56.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e150.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e80.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvailable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSampled (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVisited (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e94.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e150.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e94.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCommunity MDSR Implementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHPs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePlanned (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e539\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVisited (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e69.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e77.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e114.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e68.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"4\" nameend=\"c2\" namest=\"c1\" rowspan=\"5\"\u003e \u003cp\u003ePosition of the interviewee\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCEO/Medical. Director\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15 (57.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e98 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Clinician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e6 (1.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSenior Midwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e37 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurveillance Focal Person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e93 (79.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e139 (63.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9 (90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e39 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e16 (94.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e4 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e340 (65.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e38 (7.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Findings","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.1. System Implementation Status\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e(I). Health facility level MDSR system implementation: -\u003c/span\u003e A total of 400 (77.1%) health facilities (332 or 74.6 percent of them were health centers, and 68 or 91.9 percent were hospitals) were implementing the MDSR system out of the total 519 health facilities visited. Findings on the geographical distribution of MDSR system implementation health facilities show significant variation among regions of the nation. Emerging regions like Somali and Afar regions had the lowest proportion of MDSR implementing health facilities which are 2 (7.7%) and 2 (15.2%), respectively. Whereas all visited health facilities in Addis Ababa, Dire Dawa, Harari, and Benishangul Gumuz regions were found to be MDSR systems implementing health facilities. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding the duration of MDSR system implementation, a total of 116 (59.5 percent) health facilities have been implementing the system for more than three years. All visited health facilities in Tigray, Harari, and Dire Dawa city administrations were among health facilities that have been implementing the system for more than three years. (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003e(II). Community-level MDSR system implementation\u003c/strong\u003e \u003cp\u003e- A total of 369 heath posts found in all regions except in Addis Ababa and Dire Dawa city administration were visited to assess community-level MDSR system implementation status. A total of 264 (71.5 percent) were found to be MDSR system implementing health posts. As like facility-level MDSR system implementation, a significant difference was observed among regions in community-level MDSR system implementation. All visited health posts in Benishangul-Gumuz, 92 (94.8%) health posts in the Amhara region, and 126 (76.4%) health posts in the Oromia regions were implementing the system. On the contrary, none of the visited health posts in Gambella, Afar, and Harari regions implemented the system.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAmong the MDSR system implementing health posts in Ethiopia, 159 (60.0%) and 89 (33.6%) of them reported that they have been implementing the system for more than three years and one to three years respectively. A higher proportion of implementing health posts in Tigray 5 (83.3%) and Benishangul Gumuz 6 (75.0%) has been implementing the system for more than three years. The only implementing health post from the Somali region started implementing the system in the assessment year. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHealth facilities MDSR system implementation status by type of health facilities and region, National MDSR system evaluation, Ethiopia, 2020\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTigray\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAfar\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOromia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSomali\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBen-G\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSNNPR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGambella\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHarari\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eA. A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eDire D\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNational\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eHealth facility level MDSR system - MDSR system implementation status\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal Visited health facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e519\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMDSR system Implementing HFs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (73.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e112 (95.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e170 (77.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e52 (72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e400 (77.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eImplementation by Type of Facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94 (94.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e155 (76.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e37 (66.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e14 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e332 (74.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e29 (87.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e25 (92.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReferral Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e14 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eCommunity level MDSR system - MDSR system implementation status\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal n\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eo\u003c/span\u003e of visited HPs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eImplementing HPs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92\u003c/p\u003e \u003cp\u003e(94.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e126\u003c/p\u003e \u003cp\u003e(76.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e31(58.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e264\u003c/p\u003e \u003cp\u003e(71.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eYears of MDSR system implementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u0026nbsp;year.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3(9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e17(6.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 to 3\u0026nbsp;year.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31\u003c/p\u003e \u003cp\u003e(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35(27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20(64.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e89(33.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; = 3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57\u003c/p\u003e \u003cp\u003e(61.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e83(65.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8(25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e159\u003c/p\u003e \u003cp\u003e(60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Maternal Death Identification or Detection and Notification\u003c/h2\u003e \u003cp\u003e \u003cb\u003e(I). Health facility level MDSR system: -\u003c/b\u003e Of the 400 visited MDSR systems implementing health facilities, 162 (40.5%) and 169 (42.3%) of them had case definitions and maternal death notification format for facilitating the identification and formal notification of maternal deaths to facility level PHEM focal persons, respectively. All health facilities in Dire Dawa and Harari regions and the majority of facilities in 13 (52%) Tigray, 55 (49.1%) Amhara, and 47 (27.6%) Oromia had case definitions for maternal death identification. All implementing health facilities in Somali and 1 health facility in the Gambella region had case definitions for maternal death in their health facilities during the data collection time. Additionally, a higher proportion of facilities in Tigray 15 (60%) and Benishangul Gumuz 7 (70.0%) regions had a maternal death notification format for the formal death notification process.\u003c/p\u003e \u003cp\u003eA total of 224 (56.0%) MDSR implementing health facilities also reported that they assigned experts for routine review of registration books and client charts in their health institutions for identification of maternal death that is not reported. The majority of these health facilities were from Tigray, Amhara, SNNPR, and Gambella but health facilities in Afar had no assigned personnel for register review routinely. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis study finding also shows, that more than three-fourth (75.5%) of MDSR implementing facilities (both health centers and hospitals) had established mechanisms for identification and formal notification of maternal deaths occurred at different departments in their health facilities. Most of the health facilities were from Amhara and Oromia. Furthermore, from a total of 332 MDSR implementing health centers, 314 (94.6%) also reported the availability of an established mechanism for detecting and receiving notification of maternal death reports from the community. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eRegarding the overall readiness of the visited health facilities (hospitals and health centers) for identification and notification of maternal deaths, only 37 (11.6 percent) health centers and 14 (20.6 percent) hospitals had appropriate readiness for conducting maternal death identification and notification process in their health facilities. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCommunity level MDSR system\u003c/strong\u003e \u003cp\u003e- Among visited health posts, 39 (14%) of the health posts had locally translated community case definitions for maternal death. The vast majority, 231 (87.5%), of the health posts had reported the availability of established mechanisms for receiving maternal death reports from the community. The two-standard sources of maternal death reports were from the health development army 205(88.7%) and direct community report 155(67.1%). (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/p\u003e \u003cp\u003eFurthermore, this assessment finding also reveals that a total of 203 (76.9%) MDSR implementing health posts had established a system to screen death of women of reproductive age group occurred in their catchment community mainly through house-to-house visits (91.1%), during meetings with community members (43.8%) and report from any community member (56.2%). A total of 5(83.3%), 68(73.9%), 98(77.8%), 6(75%), and 26(83.9%) health posts from Tigray, Amhara, Oromia, Benishangul Gumuz, and SNNPR reported that they had this platform to routinely screen death of women of reproductive age group using selected criteria respectively (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Indicators for Identification and notification of maternal death at health facilities by regions, national MDSR system evaluation, Ethiopia, 2020\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"15\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTigray\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAfar\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOromia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSomali\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eB-Gum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSNNP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGambella\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eHarari\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eA.A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eD.D\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003eNational\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"15\" nameend=\"c15\" namest=\"c1\"\u003e \u003cp\u003eHealth facility level MDSR system - Identification and notification\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNumber of MDSR implementing HFs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAvailability of case definition (n\u0026thinsp;=\u0026thinsp;400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e28 (53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e4 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e162 (40.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAvailability of N. format (n\u0026thinsp;=\u0026thinsp;400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e68 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e3 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e169 (42.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMechanism to receiving MD at HCs (n\u0026thinsp;=\u0026thinsp;400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82 (73.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e134 (78.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7(70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e36(69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e13 (76.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e3 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e302 (75.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAvailability of experts to review Charts (n\u0026thinsp;=\u0026thinsp;400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75 (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e74 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e31 (59.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e9 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e4 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e224 (56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall readiness of health center for I\u0026amp;N (n\u0026thinsp;=\u0026thinsp;332)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e37 (11.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eThe established mechanism for receiving death from the community (n\u0026thinsp;=\u0026thinsp;332)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (94.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87 (92.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e147(94.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e37(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e14 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e3(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e314 (94.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall readiness of hospitals for I\u0026amp;N (n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e14 (20.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"15\" nameend=\"c15\" namest=\"c1\"\u003e \u003cp\u003eHealth Post-level MDSR system - Identification and notification\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNo of Implementing HPs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHP with case definition Locally translated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18(19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7(22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e39 (14.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAvailable Mechanism for receiving notification from communities\u0026thinsp;=\u0026thinsp;Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e80(87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e111(88.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e28(90.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e231(87.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMeans of receiving MD from the community(n\u0026thinsp;=\u0026thinsp;264)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBy HDA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75(93.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e92(82.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e26(92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e205(88.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDirect from community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54(67.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e69(62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23(82.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e155(67.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eScreening of WRA (women of reproductive age)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68(73.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e98(77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e26(83.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e203 (76.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMethods of maternal death identification and notification (n\u0026thinsp;=\u0026thinsp;204)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60(88.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e89(90.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25(96.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e185(91.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring meeting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20(29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e15(57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e89(43.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNotification from any community member\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33(48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e58(59.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e17(65.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e115(56.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Maternal Death Registration, Archiving, and Reporting Practice\u003c/h2\u003e \u003cp\u003e \u003cb\u003eHealth Facility level MDSR system: -\u003c/b\u003e Among the assessed 400 MDSR system implementing health facilities, 301 (75.1%) of them archive maternal death reports. All MDSR systems implementing health facilities in Dire-Dawa, Benishangul Gumuz, Addis Ababa, and Harari region archived maternal death reports in their health facilities. But, none of the MDSR systems implementing health facilities in the Afar region had archived maternal death reports during the visit. Additionally, a total of 390 (97.5%) visited implementing health facilities had means of communication for maternal death data reporting to the next level. (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cb\u003eCommunity level MDSR system: -\u003c/b\u003e Of the visited MDSR implementing health posts in the nation, 73(27.7%) and 208(78.8%) of them had a rumor logbook for registering maternal death notifications and maternal death PHEM weekly reporting format, respectively. A total of 245 (92.8%) of the health posts reported having a means of communication to send and receive MDSR-related reports (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eBased on this evaluation findings, the most commonly used means of communication for sending maternal death reports by the health posts across the nation was a combination of paper and phone 137(55.9%) followed by the paper-based only 62(25.2%), and paper, phone, and text message 28(11.4%) respectively. The type of communication used by the health posts significantly varies across the respective regions (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of indicators for maternal death registration, archiving and reporting practice at health facilities by regions, national MDSR system evaluation, Ethiopia, 2016\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTigray\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAfar\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOromia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSomali\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eGumuz\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSNNP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGambella\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHarari\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAddis A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eD.D\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNational\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eHealth facility level MDSR system - Maternal Death Registration, Archiving, and Reporting Practice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNumber of HFs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eArchiving practice of maternal D report\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (88.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88 (78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e125 (73.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e29 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e301 (75.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCommunication means available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110 (98.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e166 (97.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e52 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e15 (88.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e390 (97.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePHEM weekly reporting format\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(88.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e101(91.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e140(82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e37(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e13(76.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e330(83.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRumor logbook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(68.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72(64.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7(70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2(4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9(52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e124(31.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRegistration book\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(84.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84(75.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e126(74.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25(51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6(35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e282(71.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMDRF format\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53(47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82(48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7(70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21(42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9(52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e192(48.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eHealth post-level MDSR system - Maternal Death Registration, Archiving, and Reporting Practice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eImplementing HPs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRevised PHEM format (N\u0026thinsp;=\u0026thinsp;264)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85(92.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89(70.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e24(77.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e208(78.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRumor Logbook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59(64.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7(22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e73(27.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRegistration book (N\u0026thinsp;=\u0026thinsp;264)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81(87.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e103(81.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7(67.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e15(48.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e212(80.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCommunication means\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86(93.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e116(92.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8(100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e29(93.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e245(92.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eTypes of communication available for MD in HP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaper-based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10(11.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37(31.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11(37.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e62(25.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhone call\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15(12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e17(6.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eText message\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1(0.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaper and phone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72(83.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38(32.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17(58.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e137(55.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26(22.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e28(11.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Maternal Death Investigation and Review Practice\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eHealth facility level MDSR system\u003c/strong\u003e \u003cp\u003e- A total of 158 (39.5%) of health centers reported that they have an assigned responsible expert (surveillance focal person) to monitor the investigation of reported deaths in their health centers. The majority 3 (75%) and 34 (65.38%) of health centers from Dire-Dawa and SNNPR regions reported that they have an assigned surveillance focal person to investigate maternal death reports from the catchment communities. Additionally, 349 (87.2%) health facilities (both health centers and hospitals) had a maternal death review committee in their respective institutions. Among the visited MDSR system implementing health facilities, 23 (6.96%) of health centers have optimal readiness to perform the overall maternal death investigation and review process. A total of 2 (66.67%), 6(16.22%), and 3 (17.65%) health centers were reported from Dire-Dawa, SNNPR, and Tigray which satisfy these criteria. Based on this study\u0026rsquo;s findings, health centers in Gambelia, Harari, and Somali were not ready to implement the overall maternal death investigation and review process.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eOn the other hand, 18(26.47%) hospitals are fully capable for investigating and reviewing maternal death in their facilities. MDSR implementing hospitals from Gambelia, Harari, Addis Ababa, and Somali regions had no optimal readiness to investigate and review maternal deaths in their hospitals. (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCommunity level MDSR system\u003c/strong\u003e \u003cp\u003e- Of the visited MDSR implementing health posts, 28 (10.6%) had locally translated verbal autopsy format to investigate maternal deaths in their catchment area. Regarding responsible persons to investigate community deaths, a total of 96 (36.4%) implementing health posts said that catchment health facility surveillance focal is responsible for investigating suspected maternal death that occurred in their catchment area followed by health extension workers 150 (56.8%). (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e3.5. Maternal death data management, information generation, and sharing\u003c/h2\u003e \u003cp\u003e \u003cb\u003eHealth facility MDSR system: -\u003c/b\u003e Out of the respondents at 400 MDSR implementing health facilities visited, only 6 (1.5%) of respondents claimed they were engaged with routine analysis and information generation of maternal death data in their health facilities at least once. Among the facilities involved in routine data analysis and information generation, three were from the Amhara region, two were from the Oromia region and one health facility was from the SNNPR region. Additionally, a total of 298 (74.5%) of them had a platform to share MDSR findings with all stakeholders (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eCommunity level MDSR system: -\u003c/b\u003e Out of the respondents at the visited MDSR system implementing health posts, only 24 (9.1%) of them claimed that they were engaged in routine data aggregation, analysis, and information generation of Maternal death data reported from catchment communities at least once. Additionally, a total of 223 (84.5%) health posts claimed that they had a platform for sharing MDSR-related information for all stakeholders in their catchment area. (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of indicators for maternal death investigation and review practice by region, national MDSR system evaluation, Ethiopia, 2020\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTigray\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAfar\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOromia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSomali\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eB-Gum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSNNP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eGambella\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHarari\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAddis A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eDire D\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNational\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eHealth facility level MDSR system - Maternal Death Investigation and confirmation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eImplementing HFs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAvailability of experts to investigate suspected MD in HF (n\u0026thinsp;=\u0026thinsp;400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79(70.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e115(67.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7(70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e41(78.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4(23.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e268(67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eResponsible expert to monitor the investigation of reported deaths\u0026thinsp;=\u0026thinsp;Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e65(38.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e34(65.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3(17.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3(75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e158(39.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAvailability of MDSR review committee for confirmation (n\u0026thinsp;=\u0026thinsp;400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e101(90.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e142(83.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9(90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e43(82.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e349(87.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAvailability of facility-based abstraction format(n\u0026thinsp;=\u0026thinsp;400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34(30.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34(20.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6(60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14(28.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1(25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3(17.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e117(29.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall HC readiness for investigation and confirmation N\u0026thinsp;=\u0026thinsp;332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(17.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(4.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(4.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6(16.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1(7.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2(66.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e23(6.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverall hospitals readiness for Case investigation and confirmation(n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(16.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4(26.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e18(26.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eHealth post-level MDSR system - Maternal Death Investigation and confirmation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNumber of Implementing HP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAvailability of locally translated VA tool (N\u0026thinsp;=\u0026thinsp;264)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e(19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e28\u003c/p\u003e \u003cp\u003e(10.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eResponsible to investigate MDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatchment HF focal (N\u0026thinsp;=\u0026thinsp;265)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25(27.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48(38.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14(45.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e96(36.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(33.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24(26.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38(30.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11(35.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e76(28.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRRT (N\u0026thinsp;=\u0026thinsp;265)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28(30.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45(35.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13(41.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e94(35.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHEW (N\u0026thinsp;=\u0026thinsp;265)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(66.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53(57.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69(54.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21(67.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e150(56.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eConsent was taken for VA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25(27.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61(48.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5(62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e16(51.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e113(42.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e3.5. Available financial resources and functional computer for surveillance\u003c/h2\u003e \u003cp\u003eRegarding the availability of finance for implementing and strengthening the MDSR system and response at the health facility level, only 26(6.5%) of the health facilities reported for the availability of finance for MDSR system implementation and strengthening in their health facility, which varied across regions. However, Afar, Benishangul-Gumuz, Harari, Dire Dawa, Addis Ababa, and Somali regions did not have allocated finance for maternal death response. Nationally, about 45 (11.3%) of health facilities had functional computers for surveillance (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFinancial resource and availability functionality computer for MDSR system implementation by regions in Ethiopia, 2020\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImplementing Health Facilities\u003c/p\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvailable finance for MDSR system implementation Count (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAvailability of functional computer for MDSR Count (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTigray\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (16.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (8.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmhara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (13.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOromia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (3.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomali\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBen- Gumuz\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSNNPR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (26.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGambella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHarari\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAddis Ababa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (11.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDire Dawa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (75.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNational\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (11.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eAccording to the literature on health system surveillance, having either a higher geographical coverage of a system or having evidence that shows an optimal proportion of a system implementing health system structures is required for generating representative evidence about the disease or event under surveillance. This indication can increase trust in the evidence generated by system output and allow responsible actors to use generated evidence for decision-making at all levels for the prevention and management of maternal health problems. Furthermore, this indicator can provide valuable information about the status of a surveillance system's implementation as a monitoring and evaluation tool[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to national PHEM guidance, at least 80% of health facilities are expected to implement the MDSR to have a complete picture of the country's maternal mortality burden and surrounding factors. According to this system evaluation finding, 77.1 percent of health facilities (74.6 percent for health centers and 91.9 percent for hospitals) and 71.5 percent of visited health posts were implementing facility and community-based MDSR systems, respectively, at the national level. Despite being lower than the expected national level standard and study findings from Guinea community-based maternal deaths surveillance, this figure is higher than the figure discovered during a baseline survey conducted in 2015 to assess the status of death review implementation in low- and middle-income countries [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e][\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study finding also reveals that the geographical distribution of MDSR system-implementing health facilities in the country varies significantly across different regional structures. In emerging regions, system implementation is extremely low. whereas agrarian and municipal administrations performed relatively well in terms of system implementation at health facilities. Considering that emerging regions have a significant proportion of health facilities in the nation, these lower regional achievement in emerging regions significantly contributes to the lower national level implementation status. This can lead to gaps in the generation of reliable evidence and its application in decision-making. The lack of MDSR training or orientation for HEWs and community health agents, a lack of supportive supervision from higher-level structures, a lack of MDSR resources (such as locally translated case definitions for maternal death, a lower number of partners available to support the MDSR system, a financial shortage, and others) in the emerging region could explain this variation in achievement and implementation[\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u0026ndash;[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Furthermore, low levels of community engagement in emerging regions can make a significant contribution in this regard. Our argument is supported by a study finding conducted in the central part of Malawi and the eastern parts of Ethiopia which demonstrate that low levels of community engagement or participation in the MPDSR process are system implementation barriers [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe availability and functionality of the MDSR committee at a given health facility is a critical platform for monitoring system implementation status and ensuring the system is capable of preventing similar deaths in the future[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Findings of this evaluation show that more than three-quarters of the visited health facilities had an MDSR committee, but only one-tenth of the facilities had a functional MDSR committee that held more than six death review coordination meetings per year. This finding demonstrates a significant gap in the availability and functionality of the required emergency coordination platforms at health facility levels, which is lower than the findings of previous studies in Guinea and Malawi [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. It could be due to a lack of support and attention received from respective institution leaders and a lack of involvement of concerned stakeholders. This argument is supported by study findings from Guinea and Malawi, which show that obtaining partners' support for MDSR-related activities is critical [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe capacity of health facilities to detect and notify maternal deaths depends on the resources available for MDSR system implementation. Multiple inputs are required to effectively identify and notify maternal deaths while also ensuring the system runs smoothly. A case definition for maternal death, an established mechanism in place to receive maternal death reports from the community and within the facility, a notification format, and the availability of assigned experts to review departmental service delivery reports and charts are among the requirements.\u003c/p\u003e \u003cp\u003eAccording to this assessment, lower than half of the visited health facilities had case definitions and maternal death notification formats. Furthermore, about 45.0 percent of MDSR-implementing health facilities had no assigned surveillance focal person and experts to conduct routine reviews of registration books and client charts to identify maternal deaths that are not reported in their health institutions. This could be attributed to internal rotation of trained staff within the facility, staff turnover, and low budget allocation for capacity-building activities for MDSR. The failure to designate a focal point may also reflect a failure to pay attention to by the respective facility managers. But this finding can point to the huge gap in this event surveillance and it can imply that there is a possibility that all maternal deaths in health facilities are not being reported to responsible bodies by the procedure indicated in the guideline and that they are having difficulty sending notifications or reporting maternal deaths due to a lack of death notification formats at the health facility level. Furthermore, it may have a significant impact on the formal documentation of maternal death reporting at the health facility level.\u003c/p\u003e \u003cp\u003eRegarding maternal death detection and notification at the health post level, even though a vast majority of health posts, 231 (87.5 percent) reported the availability of a method for receiving maternal death reports from the community, greater than 85.0% of the visited health posts had no locally translated community case definitions for maternal death and 44 percent of HEWs have not received any training or orientation on community-level MDSR systems for at least two years or more. Considering that the majority (75.0%) of maternal deaths are expected to happen at the community level, the shortage of locally translated case definitions for maternal death and lack of training on the implementation of MDSR at the community level can significantly reduce the detection and notification of maternal deaths at the community level. this could have a significant impact on the functionality of the community-level MDSR system implementation[\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u0026ndash;[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Locally translated surveillance materials are friendlier and easier to understand which can potentially improve quality data reporting and motivation of community health workers. The lower-level readiness of health facilities and health posts evidenced here in this finding could be related to the system's ten percent implementation status after seven years of implementation in the nation[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the findings of this study, 73 (27.7 percent) of them had a rumor logbook for registering maternal death notifications and 208 (78.8 percent) of them had a maternal death PHEM weekly reporting format. Availability of the updated PHEM weekly reporting format and MDSR rumor logbook in health facilities was good in this study when compared to other tools such as the identification and notification form, facility-based abstraction form (FBAF), and updated guidelines for the Maternal Death Surveillance and Response system. This is consistent with the findings of the WHO-Afro-region study, which show that national guidelines and tools are 100% available [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. A key finding in this assessment was the scarcity of rumor logbooks, updated MDSR guidelines, and locally translated community case definitions. It could indicate a lack of readiness for MDSR system implementation across the country's reporting regions and city administrations. The failure to print and distribute electronic versions of the locally translated tools may be the primary reason for their absence at health posts. As a result, the fact that hard copies of the tools are not being sent regularly from the national level, as well as the lack of circular communication to print and use the soft copy formats, may have contributed to the tools' limited availability.\u003c/p\u003e \u003cp\u003eBecause the maternal death review, analysis, and response elements cannot function without them, recording and documentation are essential components of MDSR. Good documentation aids the review process by establishing action points and carrying out response actions, as well as selecting appropriate contextual strategies to prevent similar deaths. All health facilities, according to the national technical guideline for MPDSR, should record, document, or archive all notified or reported deaths [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. According to this assessment result, approximately three-fourths of implementing health facilities archived maternal death reports. Despite evidence that health facilities in Afar had a registration logbook, a PHEM weekly reporting format, and a means of communication to report to higher-level officials, the suboptimal practice of recording and archiving maternal death data is recorded.\u003c/p\u003e \u003cp\u003eFurthermore, implementing the MDSR system in health care facilities can improve documentation practices. Other studies in Ethiopia show that once the MDSR system was implemented, the level of documentation improved, resulting in better communication and organized care, and ultimately more buy-in from stakeholders [30].\u003c/p\u003e \u003cp\u003eIn terms of maternal death data communication infrastructure, 97.5 percent of health facilities have a communication means for reporting and receiving maternal death reports from their catchment areas. Furthermore, 92.8 percent of health posts reported having a method of communication for sending and receiving MDSR-related reports. This allows for the reporting of deaths to the next level and timely access to maternal health information, as well as the dissemination of feedback from a higher level. However, the majority of the MDSR implementing health facilities and health posts visited use a hard copy for service delivery registry and a combination of paper and phone (55.9%), with a paper-based one-fourth for information communication. Our findings contrast with those of another study conducted in Guinee, which discovered that all visited health facilities use electronic data communication and have maternal death databases [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This could be due to Ethiopia's lower level of attention to the issue, as well as a lack of funds and infrastructure in comparison to the indicated country.\u003c/p\u003e \u003cp\u003eIn terms of the overall readiness of the visited health facilities (hospitals and health centers) for maternal death identification and notification, about 90.0% of health centers and 80.0% of hospitals had no expected readiness to conduct the maternal death identification and notification process in their health facilities. Besides, among the MDSR system implementing health facilities visited, about 75.0% (23) had no required readiness to conduct the overall maternal death investigation and review process. Besides, this study also reveals that the overall readiness of health facilities for investigation and review varies across different regions in the nation. The disparities in detecting and notifying maternal deaths across regions may be due to a lack of trained human resources, a lack of training, a lack of guidelines and formats, work overload, and health care workers' negative attitudes toward maternal death detection and notification.\u003c/p\u003e \u003cp\u003eFurthermore, about 90.0% of MDSR system implementing health posts had no locally translated verbal autopsy formats to investigate maternal deaths in their catchment area. Additionally, the investigation of deaths at the community level didn\u0026rsquo;t follow uniform implementation at the national level as indicated by the HEWs response on who is responsible to investigate their catchment area. Based on this finding 36.4 percent of implementing health posts stated that the catchment health facility surveillance focal is in charge of investigating suspected maternal deaths that occurred in their catchment area, followed by health extension workers 56.8 percent.\u003c/p\u003e"},{"header":"5. Conclusions And Recommendations","content":"\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e5.1. Conclusions\u003c/h2\u003e \u003cp\u003eThis system evaluation profiled the MDSR system performance status at the health facility and community level across all regions and city administrations of Ethiopia. Findings of this evaluation suggested that the overall maternal death identification, maternal death data management, and evidence generation process for individual and programmatic response at health facility and community levels is suboptimal and may be resulted in a compromised evidence-based decision-making process at all levels significantly. Overall readiness of the health system to manage maternal death data and generate evidence for the decision-making process is very low as evidenced by the questionable availability and functionality of the current national-level MDSR system. It needs reasonable efforts for improvement in terms of the system\u0026rsquo;s core functions, supporting functions, and structure of the system. Even though there may be a long list of surrounding factors for this suboptimal achievement, the lower-level-level commitment of experts assigned to coordinate MDSR-related activities at the health facilities and health facilities\u0026rsquo; leadership commitment takes the greater portion. Additionally, findings on the community-level MDSR system implementation status uncover that a significant gap is observed in community MDSR systems in capturing and investigating community death. System implementation and performance in emerging regions were significantly lower in all surveillance system components.\u003c/p\u003e \u003cp\u003eBesides, the MDSR system coordinating bodies at health facilities was not satisfying. Even though most of the implementing health facilities established a committee in their respective institutions, a significant number of the committees were not functional as evidenced by the absence of routinely scheduled meetings to discuss on maternal death as per the guidance. In our attempt to describe the characteristics of core function, due to the shortage or absence of recording, reporting, notification, and investigation format and assigned trained focal person to coordinate MDSR-related activities at the health facility level, there may be a significant number of maternal deaths which are not recorded or reported. Moreover, the practice of routine data analysis was low, violating the surveillance\u0026rsquo;s goal and cannot proceed beyond the counting of deaths. Furthermore, the study indicates the gross variation among regions in implementing the MDSR system. For policymakers, this could imply that performance variation will ultimately affect the policy and strategy to be designed based on evidence generated by the system. Designing a strategy to address the stated gap is needed to effectively utilize the system for future planning and resource allocation.\u003c/p\u003e \u003cp\u003eThe evidence indicated above can lead to a conclusion that the system is not well-equipped to handle the very objective of the surveillance, which was to eliminate preventable maternal death by obtaining and using the information on each maternal death to guide public health action. On top of these, since maternal death is one of the priority public health problems of the nation and the system is operating integrated with the existing surveillance system the national PHEM system should accomplish several tasks to improve the system.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e5.2. Recommendation\u003c/h2\u003e \u003cp\u003eEven though the system is not working as expected, this system evaluation showed that the national-level MDSR system implementation in Ethiopia is partially satisfactory and encouraging. Significant progress has been made, but gaps remain, and upgrading the current system offers a unique opportunity to implement the necessary structural changes and exploit the system to its potential.\u003c/p\u003e \u003cp\u003eTo help the system achieve the settled objectives by the system, revitalization of the MDSR system at the national level and addressing all the components of the system is very critical. This revitalization should be well organized and designed by engaging all relevant stakeholders to address the critical issues found during the assessment. Having a well-prepared national-level roadmap for implementing the MDSR system with an implementation plan addressing all relevant stakeholders is critical. Besides, establishing a system to monitor the availability and functionality level of emergency coordination platforms and facilitate the system integration with other Public Health Emergencies (PHEs) under surveillance is vital.\u003c/p\u003e \u003cp\u003eAdditionally, reduction of the expected layers/process to be accomplished by the MDSR process at facility and community levels (a less relevant process) is required. Besides, establish sentinel sites as a comparative data platform for the already operating population-based surveillance system. Establishing a system that advocates for context-specific evidence-based preparedness and prevention of obstetric emergency-related maternal mortality using a vulnerability risk assessment and mapping approach should be designed for a programmatic response.\u003c/p\u003e \u003cp\u003eSpecific recommendations categorized under WHO building blocks are provided below.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e1. Leadership and governance\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eEstablishing a system to monitor emergency coordination platforms\u0026rsquo; availability and functionality at all levels with required advocacy is vital.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEngage professional associations, private sectors, and other relevant stakeholders in the MDSR system at all levels.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eConsidering the system as a \u0026lsquo;\u0026rsquo;flagship\u0026rsquo;\u0026rsquo; program to foster the implementation and monitoring and evaluation at the health facility and community level.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e2. Workforce\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eEstablish a system for routine capacity building, and gap filling, and provide refresher training for the assigned PHEM officers and review committee members at health facilities\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEnsure well integration of MDSR and PHEM at health facilities\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEnsure the integration of the current MDSR training module in the Health Extension Workers (HEW) Training Package and other health science pre-service training packages for sustainability\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e3. Health care financing\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eEnsure sustainable financial support for the system implementation, strengthening, monitoring, and evaluation.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e4. Health Information System for MDSR\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eEstablish well-organized data management system for the MDSR system integrated with the existing national PHEM\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEstablishing a system for routine data quality monitoring and data quality assurance integrated with the PHEM system\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDigitalization for real-time data collection, evidence generation, and sharing\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e5. Service delivery\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSystem should be designed to fit emerging regions\u0026rsquo; health service delivery to address implementation gap and monitoring and evaluation\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDesign a system for implementing repeated advocacy on MDSR at all levels of health system administrators / higher officials/politicians\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003e6. Logistics and supply\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSustainable system should be designed to provide required resources for maternal death identification, reporting, information generation, and sharing\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAvail pocket guide for health extension workers and health facility level MDSR review committee members\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAvailing computer and internet service for data management at health facilities\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe assessment protocol received ethical clearance from Ethiopian Public Health Institute, Scientific and Ethical Research Office (SERO). A support letter from EPHI was also written to all selected woredas, regional health bureaus, and selected health facilities and health posts indicating the objective and final aim of the evaluation. An individual informed consent was also sought from study participants by informing them about the evaluation\u0026rsquo;s purpose, significance, and contents. Each respondent was allowed consenting or refusing to participate in the study after receiving complete information about the study. All methods were performed in accordance with the relevant guidelines and regulations (e.g., Declaration of Helsinki).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors read the final version of this manuscript and approve for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used for this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFundings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis system evaluation is funded by UNFPA Ethiopia office.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProtocol preparation and literature review: AAE, TT. Data analysis and interpretation: AAE, TT: Drafting of the manuscript and revision of the manuscript: AAE, TT. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst and foremost, we would like to acknowledge UNFPA for the financial support to conduct this evaluation from the tool preparation, data collection, and report write-up period. We are also very grateful to study participants and experts who contributed a lot to the successful accomplishment of this study and other experts who participated from tool development to report write-ups. Health officials working at all health system levels and survey team members (data collectors, supervisors, regional and central coordinators) also deserve our deepest appreciation and gratefulness for their willingness and support during the study period.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHFs - Health Facilities; HPs - Health Posts; MCH - Maternal and Child Health; \u0026nbsp;MDSR - Maternal Death Surveillance and Response; MMR - Maternal Mortality Rate; ODK - Open Data Kit; PHEM - Public Health Emergency Management; PHEs - Public Health Emergencies; SDG - Sustainable Development Goals; SERO - Scientific and Ethical Research office; SNNPR - South Nation Nationality and Peoples Region; TWG - Technical Working Group; UNFPA - United Nations Population Fund; UNICEF - United Nations International Children\u0026apos;s Emergency Fund; WHO - World Health Organization.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e[1]\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;U. N. WHO, UNICEF, UNFPA, WORLD BANK GROUP and M. Mortality, \u0026ldquo;Trends in Maternal Mortality from 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division,\u0026rdquo; in \u003cem\u003eComposites in Infrastructure - Building New Markets\u003c/em\u003e, 2000, pp. ix\u0026ndash;xii. doi: 10.1016/b978-185617368-1/50001-5.\u003c/p\u003e\n\u003cp\u003e[2]\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;World Bank, \u003cem\u003eTRENDS IN MATERNAL MORTALITY 2000 to 2017 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division\u003c/em\u003e, vol. 2. 2019. DOI: 10.1111/padr.12033.\u003c/p\u003e\n\u003cp\u003e[3]\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;United Nations, \u0026ldquo;Transforming our world: the 2030 Agenda for Sustainable Development. United Nations Sustainable knowledge platform,\u0026rdquo; 2015. doi: https://sustainabledevelopment.un.org/post2015/transformingourworld.\u003c/p\u003e\n\u003cp\u003e[4]\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;WHO, UNFPA, and CDC, \u003cem\u003eMaternal Death Surveillance and Response Techincal Guidance\u003c/em\u003e. 2004.\u003c/p\u003e\n\u003cp\u003e[5]\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;S. Prasad, \u0026ldquo;Enhancing international accountability for maternal mortality and morbidity: The work of civil society at the United Nations Human Rights Council,\u0026rdquo; in \u003cem\u003eMaternal Mortality, Human Rights and Accountability\u003c/em\u003e, 2013, pp. 85\u0026ndash;110. doi: 10.4324/9780203684214.\u003c/p\u003e\n\u003cp\u003e[6]\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;WHO, \u0026ldquo;Maternal, newborn, child and adolescent health,\u0026rdquo; 2019.\u003c/p\u003e\n\u003cp\u003e[7]\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;W. H. Organization, \u0026ldquo;Reviewing maternal deaths and complications to make pregnancy safer Beyond the Numbers,\u0026rdquo; 2004.\u003c/p\u003e\n\u003cp\u003e[8]\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;C. for Disease Control, \u0026ldquo;Saving Mothers Giving Life: Monitoring and Evaluation Overview: Phase 1 Report, 2014,\u0026rdquo; 2014, [Online]. Available: https://www.cdc.gov/reproductivehealth/global/publications/pdfs/monitoringandevaluationoverview.pdf\u003c/p\u003e\n\u003cp\u003e[9]\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;S. M. 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Available: http://ovidsp.ovid.com/ovidweb.cgi?T=JS\u0026amp;CSC=Y\u0026amp;NEWS=N\u0026amp;PAGE=fulltext\u0026amp;D=mwic\u0026amp;AN=2016081714%5Cnhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS\u0026amp;CSC=Y\u0026amp;NEWS=N\u0026amp;PAGE=fulltext\u0026amp;D=mwic\u0026amp;AN=2016081714\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health System Readiness, MDSR, System Evaluation, Ethiopia ","lastPublishedDoi":"10.21203/rs.3.rs-2031541/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2031541/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: - \u003c/strong\u003eMaternal mortality remains a major health problem in Ethiopia. To generate contextual evidence, Maternal Death Surveillance and Response system was introduced in 2013. This assessment is conducted to describe the health system's readiness to avail evidence for decision-making through MDSR system in Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e - Cross-sectional study designed using the modified WHO framework for evaluating disease surveillance systems was used. Using a multistage sampling, 631 health facilities and 539 health posts were selected. Pretested survey questionnaires designed using ODK software were used. Trained field epidemiology residents were used for data collection from September 2019 to April 2020. Text descriptions, graphs, maps, and tables were used to present the study findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings: - \u003c/strong\u003eFinal study finding shows that 400 (77.1 percent) health facilities and 264 (71.5 percent) health posts claimed that they are implementing the MDSR system. Of the total implementing health facilities, 349 (87.3 percent) of them have a death review committee, and only 42 (12.4 %) were functional. About 89.4% of health centers and 79.4% of hospitals had sub-optimal readiness for maternal death identification and notification. Among implementing health posts, 39 (14%) and 231 (87.5%), of them had locally translated community case definitions and established mechanisms for receiving death reports from the community. Only 23 (6.96 percent) and 18 (26.47 percent) MDSR implementing health centers and hospitals had optimal readiness to investigate and review maternal deaths. Additionally, surveillance officers and HEWs at 6 (1.5 percent) and 24 (9.1 percent) systems implementing health facilities and health posts were engaged in data analysis and evidence generation at least once during 2019/20.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions and Recommendations: - \u003c/strong\u003eSub-optimal MDSR system implementation is registered. Revitalizing the system by addressing all system components is critical. Having a national-level roadmap for MDSR system implementation and mobilizing all available resources and stakeholders to facilitate this is vital. It is also critical to establish a system for routine data quality monitoring and assurance integrated with the existing PHEM structure. Having a system for routine capacity building, advocacy, and monitoring and evaluation of the availability and functionality of MDSR committees at health facilities are all critical.\u003c/p\u003e","manuscriptTitle":"Health System Readiness to Manage Maternal Death Data and Avail Evidence for Decision-Making Through Maternal Death Surveillance System in Ethiopia, 2020","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2022-10-03 17:37:59","doi":"10.21203/rs.3.rs-2031541/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-10-11T08:41:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-10-07T08:04:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5b95fe51-e702-41b3-8774-704feb06a49b","date":"2022-09-27T06:14:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-09-26T18:51:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-09-26T18:46:21+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-09-15T10:29:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-09-15T10:14:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2022-09-07T17:18:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eb504159-f7a4-4fde-a92b-e320903fdbd4","owner":[],"postedDate":"October 3rd, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T20:22:37+00:00","versionOfRecord":{"articleIdentity":"rs-2031541","link":"https://doi.org/10.1186/s12913-023-09321-x","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2023-03-31 20:16:09","publishedOnDateReadable":"March 31st, 2023"},"versionCreatedAt":"2022-10-03 17:37:59","video":"","vorDoi":"10.1186/s12913-023-09321-x","vorDoiUrl":"https://doi.org/10.1186/s12913-023-09321-x","workflowStages":[]},"version":"v2","identity":"rs-2031541","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2031541","identity":"rs-2031541","version":["v2"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}