Table 1.

TOWS Matrix of the process of maternal death review in Malawi

	Strengths Having a task force (staff in maternity and female ward); Having standards to guide the Maternal Death Review Committee; Availability of data; Support from District Health Management Team; Availability of tools for maternal death review (review forms); Having financial resources for implementation; Having technical expertise; Knowing the evidence.	Weaknesses Fear of repercussions (blame); Other competing commitments; Some health care providers lack knowledge and skills; Inadequate resources (human and finances); Missing documentation (poor record keeping); Lack of transport to follow up at community level; Shortage of staff especially; senior staff such as Obstetricians & Gynaecologists; Shortages of drugs, supplies, blood etc.; Patients come from across the border or other districts.
Opportunities Technical assistance from international organisations; Support from the Ministry of Health; Having national safe motherhood protocols; Exchange visits to share ideas; Sharing experiences at workshops; Current high maternal mortality which provides the rationale to conduct maternal death reviews; Political will; Community support/involvement; Working with women's group.	SO Strategy Use standards and protocols to identify gaps in practice during maternal death reviews; Promote information documentation through the use of checklists and supportive supervision; Promote any forum of sharing experiences such as workshops and exchange visits; Involve senior management in maternal death reviews; Promote community involvement/support by working closely with women's group.	WO Strategy Use technical assistance from international organisations to improve knowledge and skills to conduct maternal death reviews; Promote forums for sharing experiences such as workshops and exchange visits; Use women's groups to advocate for more resources in maternal and neonatal health.
Threats Lack of openness on cultural practices; Threatening potential court case, Demotivation by the high maternal mortality; Political differences (parties); Communication problems and poor planning (district level reviews); Lack of political will; Shortages of supplies, drugs and blood; Shortages of human resources.	ST Strategy Promote community involvement by involving men and community leaders on maternity issues; Emphasize the principle of "no name, no blame" during maternal death reviews; Encourage the District Health Management Team to allocate resources for Maternal Death Reviews; Ensure proper stock inventory to prevent the frequent out-stocking of drugs, supplies and blood.	WT Strategy Promote community involvement by working with community leaders and women's group; Emphasize anonymity and confidentiality during maternal death reviews; Lobby for more staff from the Ministry of Health; Encourage districts to allocate resources for maternal and neonatal health when drawing their annual implementation plan.