Delta State Maternal and Perinatal Death Surveillance and Response (mpdsr) Law, 2022

DELTA STATE MATERNAL AND PERINATAL DEATH SURVEILLANCE AND RESPONSE (MPDSR) LAW, 2022

1. Short Title. This Law may be cited as the Delta State Maternal and Perinatal Death Surveillance and Response (MPDSR) Law, 2022

2. Interpretation. In this Law: "Care providers" include, but not limited to health workers; "Commissioner" means the Commissioner in charge of Health; "Committee" means Maternal and Perinatal Death Surveillance and Response (MPDSR) Committees; "Early Neonatal Death" means death of new born babies occurring after 28 weeks of gestation up to the first seven (7) days of extra-uterine life; "Health Facility Level" includes any institution, Primary Health Care Centers or Facilities where maternal and child healthcare is being provided; "Local Committee" means MPDSR Committee of a Community in the State; "Maternal Death" means the death of a woman while pregnant or within forty two days of termination of pregnancy, irrespective of the duration or state of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes; "Maternal and Perinatal Death Review" means a qualitative in-depth investigation into the cause of and circumstances surrounding maternal and perinatal deaths which occur in healthcare facilities; "MPDSR or Maternal and Perinatal Death Surveillance and Response" means a form of continuous surveillance that links health information system and quality improvement process from local to national levels, which includes the routine identification, quantification and determination of causes and avoidability of all maternal and perinatal deaths, as well as the use of this information to respond with actions that will prevent future deaths; "Medical Audit" means the systematic and critical analysis of quality of care which includes procedures for diagnosis, treatment, care and outcomes for patients; "Ministry" means Delta State Ministry of Health; "Perinatal period" means the period commencing at twenty-eight completed weeks of gestation and ending seven completed days after birth; "Perinatal death" means death that occurred 28 weeks of gestation up to the first seven (7) days of extra-uterine life; it includes still births and early neonatal deaths; "Pregnancy related deaths" means death of a woman while pregnant, irrespective of the cause of death; "Relatives" include husband, parents, siblings, children and the in-laws of a woman; "Scheme" means the Maternal and Perinatal Death Surveillance and Response (MPDSR) Programme; "State" means Delta State of Nigeria; "Stillbirth" means intrauterine death of a foetus after 28 weeks of gestation or foetus/baby that weighs 1kg at birth; "Verbal Autopsy" means method for determining individual's cause of death and cause- specific death fractions in populations that are without a complete vital registration system.

3. Establishment and Facilitation of MPDSR Scheme. (1) There is hereby established for the State a Scheme to be known as Maternal and Perinatal Death Surveillance and Response (MPDSR) Scheme in line with the policy of the Federal Government of Nigeria. (2) The Scheme shall be facilitated by the Ministry of Health and shall undertake the following: (a) Notification and collection of accurate data on all Maternal and Perinatal deaths in the State, including: (i.) notification of every Maternal and Perinatal death; (ii.) numbering, identifying and reporting all Maternal and Perinatal deaths; and (iii.) determining the cause of death, contributing factors and reviewing all Maternal and Perinatal deaths (using health facility records and/or verbal autopsies); (b) Analysis and interpretation of data collected in respect of: (i.) trends in Maternal and Perinatal death; (ii.) causes of death (medical) and contributing factors (quality of care, barriers to care, non-medical factors, health seeking behaviour, and Health Facility related constraint); (iii.) avoidable deaths, focusing on those factors that can be remedied; (iv.) risk factors, groups at risk and maps of Maternal and Perinatal deaths; (v.) demographic, socio-political and religious factors; (c) usage of data to make evidence-based recommendation(s) for action to reduce Maternal and Perinatal death; (d) dissemination of findings and recommendations to Civil Society Organizations, health personnel and decision/policymakers to increase awareness about the magnitude, social effects and prevention of Maternal and Perinatal death; (e) ensuring timely implementation of each recommendation by monitoring, evaluating and reporting the implementation of recommendations; (f) improving Maternal and Perinatal death statistics and moving towards attaining complete civil registration and vital statistics records; (g) guiding and prioritizing research related to Maternal and Perinatal death; and (h) improving Maternal and Newborn health.

4. Implementation. The Scheme shall be implemented by committees to be known as Maternal and Perinatal Deaths Surveillance and Response (MPDSR) Committees and shall operate at the State, all tiers of Health Facilities, and Community levels as provided in this Law.

5. Funding. The Scheme shall maintain a fund which shall consist of: (a) funds as shall, from time to time, be appropriated for in the budget of the State Ministry of Health; (b) funds donated to the scheme by local and international partners or organisations; and (c) all other funds accruing to the Scheme from time to time.

6. Establishment of the MPDSR Steering Committee. There shall be a Committee to be known as Delta State Maternal and Perinatal Death Surveillance and Response Steering Committee which shall be domiciled in the Ministry.

7. Membership of the MPDSR Steering Committee. (1) The Membership of the MPDSR Steering Committee shall include: (i.) a Chairman, who shall be an Obstetrician and Gynaecologist, with at least five (5) years experience; (ii.) a Co-Chairman, who shall be a Paediatrician, with at least five (5) years experience; (iii.) the Reproductive Health Coordinator in the State Primary Health Care Development Agency who shall be the Secretary and responsible for the day to day running of the Committee; (iv.) the Director, Public Health of the State Primary HealthCare Development Agency; (v.) the Director, Department of Planning, Research and Statistics of the Ministry; (vi.) the Director of Hospital Services/Chief Executive of the State Hospital Management Board; (vii.) the Executive Director, State Primary HealthCare Development Agency; (viii.) Executive Secretary, State Traditional Medicine Board; (ix.) the State Director of Pharmaceutical Services of the Ministry; (x.) a Histo-Pathologist; (xi.) a Haematologist/Head blood Transfusion Services; (xii.) the Chief Nursing Officer, Hospital Management Board; (xiii) a representative of the State Chapter of the National Council of Women Societies; (xiv) a representative of the Society of Gynaecology and Obstetrics of Nigeria (SOGON); (xv) a representative of the Nigerian Society of Neonatologist (NISON); (xvi) head, vital registry, National Population Commission, Delta State Office; (xvii) a representative of the State Ministry of Women Affairs, Community and Social Development; (xviii) the State Epidemiologist; (xix) the State Disease Surveillance and Notification Officer (DSNO); (xx) the Director Medical Services and Training of the Ministry; (xxi) the State Health Management Information System (HMIS) Officer; (xxii) a Nigerian Bar Association (NBA) representative from any of the branches in Delta State; (xxiii) a representative of Nigerian Medical Association (NMA), Delta State Branch; (xxiv) a representative of Nigerian Society of Anaesthetists (NSA), Delta State Branch; (xxv) a representative of Civil Society Organisations; and (xxvi) a representative of Private Medical Practitioners; (2) The Chairman and Co-Chairman shall be appointed by the Commissioner on the recommendation of the Permanent Secretary of the Ministry.

8. Tenure of Members of the MPDSR Steering Committee. (1) The Chairman and Co-Chairman shall serve a term of four years and may be re- appointed for a second term of four years and no more. (2) The Members, other than the Chairman, Co-Chairman and those holding statutory positions, shall be nominated by their respective Organisations/Associations and shall serve a term of four years and may be re-appointed for a second term of four years and no more.

9. Functions of the MPDSR Steering Committee. (1) The MPDSR Steering Committee shall perform the following functions: (a) be responsible for giving effect to the Scheme in the State; (b) track accumulated data on notifications on Maternal and Perinatal deaths; (c) appoint a technical sub-committee to analyze the reports in clinical depth and make recommendations; (d) appoint other sub-committees as deemed necessary; (e) appoint a Response Officer who will follow up and track the implementation of the Committee’s recommendations; (f) review the cases on an ongoing basis; (g) provide support for scaling up of MPDSR process to the whole State; (h) synthesize the data, interpret the results, make recommendations for action and prepare a report; (i) prepare an annual report and plan, and disseminate them; (j) make recommendations to the State Government and other stakeholders on ways to reduce avoidable Maternal and Perinatal deaths; (k) monitor implementation of recommendations and appropriate State responses to Maternal and Perinatal deaths; and (l) make quarterly reports to the Commissioner.

10. Powers of the MPDSR Steering Committee. The MPDSR Steering Committee shall have powers to: (i.) co-opt other members when necessary for purposes of carrying out its functions; (ii.) visit any health institution in the State for an on the spot assessment of factors leading to Maternal and Perinatal death in such institution; and (iii) report any person, who has breached any provision of this Law or any other relevant law to the Law Enforcement Agencies.

11. Meetings of the MPDSR Steering Committee. (1) The meetings of the MPDSR Steering Committee shall be convened by the Chairman and shall hold quarterly. The Chairman may convene an emergency meeting whenever the need arises. (2) The meetings shall be held at such a place and time as the Chairman may determine. (3) The Chairman shall preside over all meetings of the MPDSR Steering Committee and in his absence, the Co-Chairman, or in the absence of the Chairman and Co- Chairman, any other Member elected for that purpose by the Members may preside. (4) The quorum for meetings of the MPDSR Steering Committee shall be the presiding Officer and nine Members of the Committee. (5) The MPDSR Steering Committee shall have powers to regulate its own proceedings, subject to the provisions of this Law.

12. Sub-committees. The State MPDSR Committee shall have the following sub-Committees: (a) Technical sub-committee; (b) Advocacy sub-committee; and (c) Monitoring and Evaluation sub-committee.

13. Technical sub-committee. (1) The Technical sub-committee shall be composed of technical persons with experience and qualification from within and outside the MPDSR Steering Committee. (2) The Technical sub-committee shall hold its meetings as regularly as the Chairman may determine, provided that it shall hold a meeting one week prior to the quarterly meeting of the MPDSR Steering Committee. (3) The Technical sub-committee shall have the responsibility of analyzing accumulated data on notifications on Maternal and Perinatal deaths and review reports assembled from the Health Facilities and communities. (4) The Technical sub-committee shall make regular submissions/reports to the MPDSR Steering Committee at least once every quarter.

14. Establishment, and functions of Health Facility level and Community level MPDSR Committees. (1) There shall be established Maternal and Perinatal Death Surveillance and Response Committees at the Health Facility level and Community level. (2) The composition of membership of these committees shall be determined by the MPDSR Steering Committee in line with relevant MPDSR guidelines and taking into cognizance the practicability and peculiarities in the State. (3) The functions of these committees shall include: (a) tracking of all maternal and perinatal deaths in their facility and geographical areas; (b) reviewing of all maternal and perinatal deaths; (c) identifying direct cause of death and contributory factors to the death; (d) making recommendations to prevent future occurrence; (e) submitting reports to the relevant authorities including the MPDSR Steering Committee; and (f) other functions as specified by the MPDSR Steering Committee.

15. Notification and Conduct of Death Reviews. The process for death notification and conducting death reviews as documented in the National Guidelines for MPDSR and the developed National Tools shall be adopted and used in the State.

16. Duty to Report occurrence in Health Facility. (1) Where a Maternal or Perinatal death occurs within a Health Facility, the care provider(s) shall inform the MPDSR Desk Officers as soon as possible, but not later than 24 hours of such death and the MPDSR Desk Officers shall carry out their responsibilities as provided in Section 15 of this Law. (2) The Health Facility shall report any Maternal and/or Perinatal Death to the Local Government Disease Surveillance and Notification Officer not later than 48 hours of such death.

17. Duty to Report occurrence outside Health Facility. Where a Maternal or Perinatal death occurs outside a Health Facility, the relatives and birth attendant (where it occurs) shall, within 48 hours of such death, report the case to the Local Committee or any person representing the Community MPDSR Committee who shall ensure the death is reviewed.

18. Failure to Report. (1) Any person who conceals or fails to report any maternal and/or perinatal death within the stipulated time shall be guilty of an offence and shall be liable on conviction to a term not exceeding three months imprisonment or a fine of N100,000.00 (One Hundred Thousand Naira) or both. (2) Where a Health Facility fails to notify the Local Government Disease Surveillance and Notification Officer within the stipulated time, the head of the Health Facility shall be guilty of an offence and shall be liable on conviction to a term not exceeding three months imprisonment or a fine of N100,000.00 (One Hundred Thousand Naira) or both.

19. Accessory after the fact. Any person who becomes an accessory after the fact to concealment of a Maternal and/or Perinatal death and refuses or neglects to disclose such fact commits an offence and shall be liable on conviction to a term not exceeding three months imprisonment or a fine of N100,000.00 (One Hundred Thousand Naira) or both.

20. Confidentiality. (1) The identity of the deceased, the health worker and person who volunteers any information which may be useful in MPDSR shall be protected and such information shall be treated as confidential. (2) Any Member of the MPDSR Committees who breaches confidentiality shall be guilty of an offence and shall be liable on conviction to a term of one month imprisonment or a fine of N100,000.00 (One Hundred Thousand Naira) or both.

21. Obstruction. Any person who wilfully obstructs the Committees or any authorized Officer or person in the exercise of any powers or functions conferred on the Committees or person under this Law shall be guilty of an offence and shall be liable on conviction to a term of one month imprisonment or a fine of N100,000.00 (One Hundred Thousand Naira) or both.

22. Immunity. No Member of any MPDSR Committee shall when on duty be liable for any act validly undertaken by him in exercise of his duty and within the limit of the powers conferred on him by this Law or any applicable law.

23. Power to arrest. Any Member of a Law Enforcement Agency may arrest and charge any person who commits an offence under this Law.

24. Jurisdiction to try offences. A Magistrate’s Court or its equivalent shall have original jurisdiction to try offences created by this Law.