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2 Regional Meeting to Strengthen Capacity on Maternal and Perinatal Death Surveillance and Response, February 2016, Maldives South East Asia (SEA) participants composed of 11 countries; Bangladesh, Bhutan, DPR Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. The existing data of maternal mortality ratio (MMR), neonatal mortality ratio (NMR) and stillbirth rate in SEA, 2015 are showed in table 1. Table 1 maternal mortality ratio (MMR), neonatal mortality ratio (NMR) and stillbirth rate in SEA, 2015 India / Myanmar 53259/ Bangladesh / Timor-Leste 1133/ Nepal 27797/ Bhutan 754/ DPRKorea 24895/ Indonesia / Thailand Maldives 345/ Sri Lanka / Source: WHO/SEARO. Background Paper of the Regional Technical Advisory Group Meeting on Women's and Children's Health: Accelerating the Reduction in Newborn Mortality in South-East Asia Region. December New Delhi, India.

3 t The targets of MPDSR are followed by sustainable development goals (SDG) which are 3 indicators. 1. By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births. 2. By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births. 3. By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. MMR in Thailand 2015 is 20/100,000 live births. NMR in Thailand 2015 is 7/1,000 live births. Both indicators got target ofsdg already. However, Thailand MPDSR team set targets for 2018 that are following: Table 2 MPDSR target indicators ofthailand, Maternal mortality ratio (MMR) <15 Per 100,000 live births 2. Newborn and children under 5 year <4 Per 1,000 live births 3. Early antenatal care «12 wk.) >70 % 4. Pregnancy risk detection >5 % 5. 5 times quality ANC >70 % 6. Reduced postpartum hemorrhage (PpH) Y2 of % baseline 7. Labor room quality >70 % 8. Birth asphyxia <5 % 9. Low birth weight <7 % 10. Teenage pregnancy <50 Per 100,000 live birth

4 A plan for capacity building in MPDSR in SEA member countries 1. Understanding the concept ofmpdsr a. Definition: maternal death, stillbirth, newborn death, early neonatal death b. Way to carry out death surveillance at community and health facility c. Recording and reporting 2. Implementing MPDSR a. Geographic area, data collection and depth of death inquiry b. Nationallsubnational committee c. Recording and reporting d. Effective and efficient manner 3. Monitoring the implementation ofmpdsr a. Understanding on the indicators b. Desk review of reports c. Use of checklist and IT for rapid and accurate data collection 4. Linking MPDSR with civil and vital registration system and accountability ofmnh programme a. Joint efforts effectively and efficiently among relevant stakeholder Thailand conducts MPDSR following plan of WHO recommendation. And the challenges of Thailand are management of maternal death in community, maternal mobilization, teenage pregnancy, indirect cause of maternal death, unsafe abortion, newborn intensive care unit (NICU) in public sector and suing.

5 Conclusions 1. Member States commitment in MPDSR implementation: A strong commitment was evident for improving monitoring and accountability for maternal and newborn health in the Member States. The participants recognized the urgency to end preventable maternal-newborn deaths and stillbirths Member States have acquired experience in maternal death reviews (MDRs) and have progressively increased the scale of its implementation; however, the extent of implementation varies In transforming the MDRs into maternal and perinatal death surveillance and response (MPDSR), the elements ofsurveillance and response requires strengthening. Member States are committed to strengthen these elements and prepare for adding the reviews of stillbirths and newborn deaths Identification, notification that include zero reporting and triangulation ofmaternal-newborn deaths and stillbirths need to be strongly integrated into the existing HMIS, CRVS and integrated disease surveillance systems. These are the key elements of the "S" element ofthe MPDSR MPDSR will remain an integral part ofefforts to improve quality ofcare at all levels ofhealth care delivery system, which is key component of the "R" element of the MPDSR 2. Actions for implementing MPDSR. Member States agreed to strengthen the policy and legal framework for maternal-newborn death and stillbirth reporting and acting upon the findings so that corrective actions can be undertaken to prevent similar deaths in the future. Ministries of health would coordinate efforts of all partner agencies, professional associations, civil societies and WHO collaborating centres to harmonize MPDSR implementation and its scale up. Interprogramme and intersectoral collaborations are crucial both in surveillance of maternal-newborn death and stillbirths and response actions based on recommendations of death reviews. Member States will introduce the MPDSR in the preservice education and integrate it in the curricula of medical, nursing and midwifery education.

6 Partner agencies working in the Region attach a high priority to MPDSR. They would work with countries to build capacity and scale up the implementation. 3. Monitoring of MPDSR implementation. Availability of national policies, enabling legal environment and mechanisms facilitating MPDSR implementation, such as functional MPDSR committees at national and subnational are to be established if required, and monitored. Member States need to establish indicators for monitoring, and develop mechanisms for monitoring progress at various levels related to surveillance and response. The quality of data needs improvement, in terms of timeliness, completeness and accuracy, and use of standard defmition and terminologies related to MPDSR. Periodic monitoring of the system would contribute to scaling up ofmost cost effective and efficient and models for ensuring sustainability ofmpdsr. Effectiveness and efficiency in implementing MPDSR is to be monitored to ensure progress in achieving results as planned in an efficient manner. Recommendations 1. Member States: Finalize and implement systematically plans for MPDSR implementation at national and sub-national levels in collaboration with stakeholders, including partners, professional associations, civil societies, etc. Through the leadership ofministries ofhealth create an environment for collaboration among stakeholders and partners to work together for building capacity and scaling up of the MPDSR implementation. At all levels, empowerment and involvement of civil societies and communities should be considered.

7 To strengthen linkages between MPDSR approach and health management information system (HMIS) and civil registration and vital statistics (CRVS), as well as integrated disease surveillance system. This is to ensure the achievement ofresults, in terms ofprogress on the proportion of deaths reported and the proportion of deaths reviewed. To leverage MPDSR approach for strengthening the national systems for improving quality of care and to end preventable maternal-newborn deaths and stillbirths. This is to ensure the achievement of results, in terms ofprogress in implementing response based on the recommendations ofdeath reviews. To identify needed support that can be provided by UN agencies, professional associations, WHO collaborating centres, civil society and bilateral agencies in implementing and scaling up of MPDSR approach. Support professional associations in sensitization oftheir members in implementation ofmdsr in public and private sectors. 2. WHO and partner agencies: Provide required technical support for national capacity building on MPDSR and documentation of MPDSR implementation and scaling up. Share through available forum, such as South-to-South collaboration, as a learning platform to strengthen capacity and sharing experiences of the existing mechanisms and tools for strengthening the implementation and scaling up ofmpdsr. Documentation and dissemination ofbest practices in effective implementation and scale up of MPDSR in the Region. Support development oftools and materials on MPDSR for inclusion in pre-service curricula of medical, nursing and midwifery education.