1Mali and Senegal entered the second millennium with the unenviable record of the highest mortality rate from childbirth. In these countries, 800 women died every 100,000 deliveries, compared with 10 in France, for example. In most cases these were young women, aged 15 to 25, who did not survive the birth of their first child, due among other things to the poor quality of healthcare received. Hence the idea of the “Quarite” project, initiated by IRD and conducted in partnership with local health authorities.

Health centre in Benin.

2In 2007, researchers randomly selected 46 hospitals in Mali and Senegal and monitored their healthcare system for one year, as well as the mortality rate of women and children. The following year, they intervened in half of these hospitals, reminding teams of good practices and, more importantly, implementing “death reviews”. The purpose of these meetings was to piece together the history of the deceased patient, from her arrival to her death. The objective was to identify not so much the guilty parties but the problems that occurred, as well as solutions which could be tested to avoid a repeat performance, for example by facilitating access to certain medications and addressing work overload issues.

••• The implementation of “death reviews” helps lower mortality rates among women by 15% in the referral hospitals of Mali and Senegal ••• 

Mural painting at the entrance to the maternity ward of the Popenguine health centre, Senegal.

3In 2011, the assessment of these measures highlighted spectacular results: in the hospitals supported, the mortality rate for women dropped by 15% on average, and by 35% in rural hospitals, while the infant mortality rate decreased by 26%. This effect was so significant that Malian and Senegalese authorities immediately decided to expand the programme nationwide. And the WHO took up the idea in 2014: death reviews are now conducted in most African countries. Thanks to this type of initiative, the mortality rate from childbirth in Africa has been halved since 2007.

“As a result of the Quarite project, the quality of care is assessed more objectively, as it is based on standardised quality criteria. It has also prompted individual and collective questioning, as well as a readiness to change attitudes to encourage positive responses.” 
Sabine Liliou, gynaecologist, Bogodogo district, Burkina Faso