Strengthening the system of Confidential Enquiry into Maternal Deaths (CEMD) in Lesotho

English: The purpose of this study was to describe through Appreciative Inquiry (AI), the strengths, opportunities and aspirations of all stakeholders involved in the Confidential Enquiry into Maternal Deaths (CEMD) system in Lesotho. This was done with an intention of supporting and strengthening the work of this system. The study was conducted using a qualitative descriptive design and Appreciative Inquiry as a research technique. AI draws from the principle of positivism, where by strengths base, rather than problems are a point of focus to resolve problems. The researcher was seeking to appreciate the best of what the system is, by discovering its strengths. The participants used their strength base to envision the best of what the system could be. They also drew strategies that will enable them to attain the envisaged future CEMD in Lesotho. Data collection along with primary data analysis was conducted in a one day AI workshop. The participants for the study were selected using non-probability selection and comprised of representatives of all stakeholders of CEMD in Lesotho. The sample size was 20 participants comprising of four (4) members of QMMH maternal mortality review committee, ten (10) Maternal Mortality Assessors each representing one of the ten districts in Lesotho and six (6) members of the LCCEMD, two of which also represented the MOH. The results of the study reflected five main themes that portray the strengths of the CEMD system in Lesotho; namely government commitment to CEMD, an effective feedback mechanism, strong communication system, a strong support system following maternal death and Maternal Death Review (MDR) and lastly an effective training and monitoring system. The participants used these strengths as the base to map out an envisaged ideal system of CEMD in five years, which was reflected in a collage form. The dream phase depicted more government commitment where a revolution against maternal deaths was declared, urging government to commit more resources to CEMD. Interlinks and integration of the efforts of other disciplines in curbing maternal deaths was encouraged. Strengthening communication, Advocacy for MDR and dissemination of key messages about safe motherhood are seen as crucial in strengthening CEMD in Lesotho. Participants lobbied for support of the carers of the diseased mother as well as those involved in MDR. They recommended a system of trust with an element of debriefing and counseling to avert psychological impact of MDR. Training and monitoring need to be more decentralized for capacity building on both MDR processes and skills acquisition in caring for pregnant mothers. During the design phase participants realized that with only one year to 2015, the target of reducing maternal deaths by 75 % may not be realized. They however realized that it is possible to prevent primitive maternal deaths; those that are avoidable. They drew a bold affirmative statement “Lesotho amazes the world: Primitive Maternal deaths down to zero by 2015”. A plan to realize this included: strengthening information sharing, improving the infrastructure for Maternal and child health (MCH) services, ensuring availability of Human resources and commodities. The researcher concluded that with the positive attitude, the stakeholders of CEMD in Lesotho were able to realize the strengths of the system and used them as a platform of improving it. An improved system is likely to yield recommendations that will enable Lesotho to improve maternal health and curb maternal deaths. The study was concluded with recommendations for clinical practice, pre-service and in-service education, research, the LCCEMD, and regulatory bodies for health professions.