Confidential audits contribute to reducing maternal mortality in the Republic of Moldova

A national workshop on analysing confidential audits of maternal mortality cases was organized on 15–16 April 2013 in the Republic of Moldova.

The workshop’s specific objectives were to:

  • present and discuss the maternal mortality situation in the Republic of Moldova and efforts to reach Millennium Development Goal 5 targets (related to improving maternal health);
  • discuss implementation of recommendations contained in the first (2010) report on confidential audits of maternal mortality that took place in the period 2006–2008;
  • present and discuss reform of perinatal care with regard to equal access to quality services for pregnant women across the country;
  • discuss possible revision and/or simplification of the confidential audit form.

The event was organized by the Ministry of Health with support from WHO and attended by approximately 50 representatives of the Ministry of Health, State Medical and Pharmaceutical University, National Institute on Mother and Child Health, and health care professionals and managers from across the country.

Current stage of implementation and recommendations for improvement

The ongoing reform of perinatal care services includes revision of emergency and intensive care for newborns and mothers, as well as implementation of the "making pregnancy safer" (MPS) and "beyond the numbers" (BTN) approaches. The general quality of health services also requires further analysis and improvement.

The workshop discussions pointed to the following areas in need of attention:

  • Dissemination of the CEMD (Confidential Enquiries into Maternal Deaths) report through the Ministry of Health and professional associations will influence improvement of the recommendations’ implementation, monitoring of the national protocol development and improvement of the quality of the offered care.
  • The undergraduate and continuous medical education core curriculum, including those for nurses and midwives, will benefit through the integration of the report’s recommendations and will contribute to decreasing maternal mortality rates. 
  • Strengthening of community mobilization is an important issue: women and their family members need to be informed about danger signs during pregnancy, about access to care during pregnancy and childbirth, the basic package of services and their reproductive rights – especially for migrants, the rural population and other disadvantaged groups.
  • Involvement of actors from various sectors (for example education, social affairs, finance, legal and justice) is needed to implement the report’s recommendations.

The workshop took place within the framework of the biennial collaborative agreement (BCA) 2012–2013 between the Government and WHO/Europe.

Next steps in improvement of the quality of care

The second CEMD report will cover the period of 2009–2011 and will present analyses of maternal mortality cases that occurred within the indicated period. The findings and recommendations will be presented to the Ministry of Health and will help raise awareness among medical professionals and the general population about the topic and the mechanisms currently in place to monitor implementation of the report’s recommendations.

Background of the confidential analysis of maternal mortality cases

The Republic of Moldova was selected as a pilot country for Making Pregnancy Safer (MPS) in the European Region, where the Initiative was launched in January 2002. In February 2003, the Ministry of Health of the Republic of Moldova, with support from WHO/Europe, established the National Working Group for Maternal Mortality Audit. The general recommendation of the group was to change existing practices in maternal mortality reviews to reflect the approaches contained in the WHO "beyond the numbers" tool. At the national level, it was felt that the most appropriate model would be the CEMD, and at facility level the "near-miss case review" (NMCR).