Pusponegoro, Arietta and Cahyanti, Ratnasari Dwi and Laksana, M.A.C. and Hidayat, Dini and Wardana, Gede Alit and Sianipar, Ellen Roostaty and Kadi, Fiva Aprilia and Saptanto, Agus and Kardana, I Made and Daisy, Lovely and Restianingrum, Mularsih and Marthatilova, Florentine and Sinaga, Nurlely Bethesda and Nanwani, Sandeep and Liyanto, Elvira and Syahrizal, Bobby Marwal and Kaptiningsih, Ardi and Silitonga, Alfrida Camelia and Rosari, Teresa Catalina and Amirah, Shakira (2025) Best practices and lessons learned from the implementation of maternal and perinatal death surveillance and response (MPDSR) in six Java-Bali Island hospitals: a mixed-methods study. Reproductive health, 23 (1). p. 29. ISSN 17424755

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Abstract

OBJECTIVES: MPDSR is one of the strategies to accelerate the reduction of preventable maternal and perinatal mortality. This study aims to evaluate the implementation of MPDSR in six selected Java-Bali hospitals and to identify enabling and barrier factors that influence its sustainability, providing evidence-based insights to improve the MPDSR system and support its scale-up across Indonesia. METHODS: This study evaluates the implementation of MPDSR in six Java-Bali hospitals before and after the MPDSR modeling. Barriers and enablers to sustainable MPDSR are identified through a mixed-methods approach, focusing on high-density regions with lower MMRs and IMRs. Quantitative and qualitative data collection include pre- and post-MPDSR modeling questionnaires and content analysis. RESULTS: After MPDSR modeling, improvements were observed in the organizational structure and management, and the implementation of the four steps of MPDSR, except for the percentage of identified and notified maternal deaths (decreasing from 100 to 69.6%). Approximately 57.9% of the generated action plans were SMART. Key barriers to MPDSR implementation include challenges in determining the cause of death per ICD-MM and ICD-PM, insufficient data for death review, technical issues in MPDN application, limited staff time and work overload, as well as inadequate feedback, monitoring, and evaluation of action plans. A significant enabler is the strong support from Hospital Directors, Quality Committee and Management, serving as the driving force for action plan implementation. CONCLUSION: The implementation of MPDSR in six Java-Bali Island hospitals improved after the MPDSR modeling. Best practices identified include the establishment of MPDSR steering committees, structured SOPs, strong leadership support, labeling of MPDSR cases in medical records, and integration with hospital quality improvement systems. These practices have contributed significantly to improving identification, review, and response processes. While some barriers remain, such as limited capacity and incomplete data, the study highlights practical strategies that can serve as models for scaling up MPDSR implementation nationwide.

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