Enhancing Maternal Mortality Surveillance in Colombia
“This initiative has provided crucial support to the Colombian epidemiological surveillance program to achieve an important breakthrough in advanced data management and epidemiological surveillance. This allows decision-makers and health workers to improve the implementation of effective evidence-based interventions to prevent maternal mortality in the country" said Dr. Victor Hugo Alvarez, Public Health Epidemiological Surveillance group Coordinator, Ministry of Social Protection. Photo: Antioquia University/Joaquin Gomez
The fifth Millennium Development Goal (MDG) is to improve maternal health by reducing the maternal mortality ratio by three-quarters between 1990 and 2015. The United Nations states that it is complex to measure improvements in maternal deaths due to unreliable data. Most vital registration systems are generally insufficient for monitoring maternal mortality.
In the case of Colombia, a feasibility assessment conducted in September 2007 (PAHO/CDC) concluded that the country’s infrastructure provided a great opportunity for developing a web-based maternal mortality surveillance system. The country’s maternal mortality ratio is estimated at 73 maternal deaths per 100,000 live births. Colombia also ranks second in the World as having the highest number of internally displaced persons.
Since 2008, the Ministry of Social Protection (MSP) of Colombia, the National Institutes of Health (NIH), the Pan American Health Organization (PAHO), CLAP/PAHO, Georgia Tech, NACER/CALDAS of the University of Antioquia and Caldas in Colombia, WHO Geneva, the Centers for Disease Control and Prevention’s Division of Reproductive Health/WHO Collaborating Center, and the United States Agency for International Development (USAID) are collaborating in the implementation of a Web Based Maternal Mortality Epidemiological Surveillance System (WBMMESS). This will be a prospective, active and real time system to facilitate policy makers and program managers' decision making for improving maternal health outcomes.
This innovation aims to place urgency on reducing maternal mortality through active surveillance and guided by timely public health notification, investigation (clinical audit and family interviews), response and systems improvement. Critical to the implementation are epidemiologic and informatics principles, processes and tools for the elucidation of maternal health inequalities driven by health, social, behavioral, and community determinants.
The initiative operates in three Departments, including Antioquia, Caldas, and Valle del Cauca and Bogota District (capital of Colombia), and integrates strategies from the local to the national and PAHO regional levels. The initiative is guided by principles of consensus-building and collaboration across institutions for enhanced maternal mortality surveillance. Project beneficiaries include women of reproductive age and their families, including internally displaced women.
To date, phase one of the web-based maternal mortality surveillance system field test has been completed. Data collection tools and instruments have been developed for case ascertainment and analysis. Furthermore, technical requirements have been tested for designing and field testing the web-based maternal mortality platform. Another important objective of phase 1 was to strengthen the technical capacity of program managers at the municipal, departmental, and national levels in order to undertake the WBMMSS field test. To do so, a Community of Practice on maternal mortality surveillance was introduced in October 2008. Thus, the Community of Practice convenes groups of individuals who share information, insight, experience, and tools about maternal mortality surveillance. This effort aims to improve participant competencies through the systematic sharing and exchange of knowledge for improving the quality of the surveillance system.
Moreover, this project will enhance existing surveillance systems rather than creating a parallel system. This will be done through re-engineering, integration and standard policy application of the existing system. The lessons learned from the Colombian application will be disseminated for adaptation in other countries.