Cost of implementation and maintenance of maternal and perinatal death surveillance and response: a scoping review

Globally, most countries have policies and guidelines requiring maternal and perinatal death surveillance and response (MPDSR), a system that can reduce avoidable maternal and perinatal deaths. Economic studies of MPDSR help inform resources to implement and sustain MPDSR at subnational and national levels. This review aims to scope the range of economic studies available and examine types of costs incurred by LMICs to implement and maintain MPDSR.

We searched 11 electronic databases for key terms related to economics, maternal and/or perinatal death, health systems, surveillance, or audits/reviews. We included quantitative, qualitative, or mixed methods articles reporting costs of MPDSR, published in English, Spanish, or French during 2012-2023. Two independent authors screened titles and abstracts and extracted data. Costs were converted to the United States dollar price year 2024.

A total of 14,078 articles were systematically screened. Only 5 were included, as they reported costs of maternal and/or perinatal death surveillance and/or review. Of these only 3 reported itemized costs. None reported on costs of implementing recommendations. From the articles reporting itemized costs, in year 1 (start-up), the cost per death reviewed ranged from $113 to $5,758 and the cost per capita ranged from $0.40 to $1.11. In year 3, these declined to $86 to $577, and $0.26 to $0.66, respectively. The lowest cost per death was for conducting only maternal death reviews in health facilities. For community MPDSR, the lowest cost per capita was achieved by using a pre-existing functional household surveillance system to identify and investigate maternal and neonatal deaths. The highest cost was for establishing a new comprehensive death surveillance and review system, which investigated all deaths in women of reproductive age to identify maternal deaths only.

Comparability was challenging because available literature was sparse and economic methods and study designs were heterogeneous. The cost-benefit of community death surveillance and review, compared to facility-based death notification and review, has not been clearly established. Better understanding of MPDSR costs is needed to prioritize and integrate MPDSR in health planning across system levels.