Special Service Agreement to support (MPDSR) -(EMONC) - NO-C

1. Background

Eswatini remains committed to reducing maternal, newborn and child morbidity and mortality as part of its efforts to achieve Universal Health Coverage (UHC), the Sustainable Development Goals (SDGs), and national health sector priorities. However, preventable maternal and perinatal deaths continue to occur due to challenges related to quality of care, delays in identification and management of complications, inadequate referral systems, and limited use of mortality surveillance data to drive corrective actions.

Maternal and Perinatal Death Surveillance and Response (MPDSR) is a critical quality improvement approach that enables countries to identify, review and respond to maternal and perinatal deaths and near misses in order to prevent future deaths and adverse outcomes. In Eswatini, implementation of MPDSR has been guided by the National MPDSR Guideline developed in 2015. While progress has been made in establishing review processes, the current system requires strengthening to align with updated global recommendations, quality of care standards, and emerging digital health solutions. There is also a need to strengthen governance and accountability through functional MPDSR committees at national, regional and facility levels and to institutionalize quality improvement processes that ensure implementation of recommendations arising from death reviews.

At the same time, reducing maternal and newborn mortality depends on timely access to high-quality Emergency Obstetric and Newborn Care (EmONC) services. The country requires updated evidence on the availability, readiness and functionality of EmONC services to guide service optimization and investment decisions. Strengthening referral pathways and establishing an optimized national EmONC network are essential to ensuring timely access to lifesaving care, particularly for women and newborns experiencing obstetric and neonatal emergencies.

Despite significant progress in child survival interventions, routine immunization coverage in Eswatini remains below the national target of 80% for several antigens. Suboptimal vaccination coverage leaves children vulnerable to vaccine-preventable diseases and increases the risk of outbreaks that can reverse gains in child health and survival. Challenges contributing to low coverage include missed opportunities for vaccination, gaps in service delivery, inadequate defaulter tracking, supply chain constraints, vaccine hesitancy in some communities, and inequities in access to immunization services, particularly among hard-to-reach populations. Strengthening routine immunization and Vaccine preventable Disease surveillance is therefore critical to reducing child morbidity and mortality and ensuring that every child receives life-saving vaccines according to the national immunization schedule.

Rationale

To support these priorities, technical assistance from a qualified officer is required to provide specialized expertise in strengthening Maternal and Perinatal Death Surveillance and Response (MPDSR), improving Emergency Obstetric and Newborn Care (EmONC) referral systems, and enhancing routine immunization programme performance. The Officer will work closely with the Ministry of Health and relevant stakeholders to review and update the MPDSR guideline, support the design and institutionalization of the electronic MPDSR system, strengthen the national EmONC referral network and database, and assess and address barriers to routine immunization coverage. This support will contribute to strengthening the country's capacity to generate and use high-quality maternal, newborn and child health data, improve access to lifesaving maternal and newborn care, increase immunization coverage, enhance accountability, and ultimately accelerate efforts to reduce preventable maternal, newborn and child morbidity and mortality.

2. Deliverables

Overall objectives of the Special Service Agreement (SSA) are to:

· To strengthen the national Maternal and Perinatal Death Surveillance and Response (MPDSR) system through the review and updating of the National MPDSR Guideline, establishment and capacity building of MPDSR committees at all levels, integration of quality improvement approaches, and institutionalization of a functional electronic MPDSR (eMPDSR) platform for surveillance, response monitoring and accountability.

• To strengthen Emergency Obstetric and Newborn Care (EmONC) and referral systems through assessment of service availability and readiness, optimization of a national EmONC network, mapping of referral pathways, and development of evidence-based maternal and newborn health referral guidance.

• To strengthen routine immunization service delivery and programme performance through assessment of immunization coverage and equity gaps, identification of service delivery and community barriers, strengthening monitoring and data use systems, improving defaulter tracking mechanisms, and development of evidence-based strategies to increase routine immunization coverage towards and beyond the national target of 80%.

Scope of work

The Officer will provide technical assistance to the Ministry of Health and relevant stakeholders to strengthen maternal and perinatal death surveillance and response, improve access to quality emergency obstetric and newborn care, and enhance routine immunization programme performance. The assignment will focus on reviewing and updating the national MPDSR guideline, supporting the design and institutionalization of an electronic MPDSR system, strengthening the national EmONC referral network and database, and assessing and strengthening routine immunization systems to improve coverage and equity.

The SSA Officer will undertake the following key activities:

1. Review and update the national MPDSR guideline

• Conduct a comprehensive review of the existing 2015 MPDSR guideline, implementation experience, and relevant national policies and strategies.

• Assess the guideline against current WHO recommendations, global standards, and best practices for maternal and perinatal death surveillance and response.

• Consult with relevant stakeholders, including the Ministry of Health, health facilities, professional councils, development partners, and other key stakeholders, to identify gaps and areas requiring revision.

• Update the MPDSR guideline, including surveillance, notification, death review, data management, analysis, response, recommendation tracking, accountability, and feedback mechanisms.

• Develop or update relevant tools, standard operating procedures, reporting templates, and implementation guidance to support operationalization of the revised guideline.

• Facilitate stakeholder review, validation, and finalization of the revised MPDSR guideline.

2. Support the development and institutionalization of an electronic MPDSR system

• Assess existing MPDSR reporting processes, information flows, data requirements, and digital health platforms to identify opportunities for integration and digitization.

• Develop a functional framework and requirements for an electronic MPDSR system, including reporting, case notification, death review, recommendation tracking, dashboards, data analysis, and reporting functions.

• Ensure that the proposed system is aligned with national digital health architecture, data standards, interoperability requirements, and existing health information systems, where applicable.

• Support the development, configuration, or adaptation of electronic MPDSR tools and dashboards in collaboration with relevant technical teams.

• Develop data-flow processes, user roles, data quality requirements, and procedures for data management, reporting, and information use.

• Support pilot testing of the electronic MPDSR system in selected facilities and document lessons learned and recommendations for scale-up.

• Develop an implementation and scale-up plan, including capacity-building requirements and sustainability considerations.

3. Strengthen the EmONC referral network and national database

• Review the existing availability, functionality, distribution, and capacity of EmONC services and referral arrangements.

• Map and classify prioritized EmONC facilities and assess their linkages with referring and receiving facilities.

• Develop a national EmONC facility database, including key service availability, functionality, geographic location, referral capacity, and contact information.

• Review and/or develop evidence-based referral guidelines and standard operating procedures for maternal and newborn emergencies.

• Develop a functional referral network linking community, primary, secondary, and tertiary levels of care.