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The journey to universal health coverage (UHC) is full of challenges, which to a great extent are specific to each country. 'Learning for UHC' is a central component of countries' health system strengthening agendas. Our group has been engaged for a decade in facilitating collective learning for UHC through a range of modalities at global, regional and national levels. We present some of our experience and draw lessons for countries and international actors interested in strengthening national systemic learning capacities for UHC. The main lesson is that with appropriate collective intelligence processes, digital tools and facilitation capacities, countries and international agencies can mobilise the many actors with knowledge relevant to the design, implementation and evaluation of UHC policies. However, really building learning health systems will take more time and commitment. Each country will have to invest substantively in developing its specific learning systemic capacities, with an active programme of work addressing supportive leadership, organisational culture and knowledge management processes. ispartof: BMJ GLOBAL HEALTH vol:4 issue:6 ispartof: location:England status: published

The prevalence of hypertension, diabetes, obesity, and chronic kidney disease (CKD) in an adult Arabic-Berber population was investigated according to 2012 KDIGO guidelines. A stratified, randomized, representative sample of 10,524 participants was obtained. Weight, height, blood pressure, proteinuria (dipstick), plasma creatinine, estimated glomerular filtration rate, and fasting glycemia were measured. Abnormal results were controlled within 2 weeks; eGFR was retested at 3, 6, and 12 months. The population adjusted prevalences were 16.7% hypertension, 23.2% obesity, 13.8% glycemia, 1.6% for eGFR under 60 ml/min/1.73 m(2) and confirmed proteinuria 1.9% and hematuria 3.4%. Adjusted prevalence of CKD was 5.1%; distribution over KDIGO stages: CKD1: 17.8%; CKD2: 17.2%; CKD3: 52.5% (3A: 40.2%; 3B: 12.3%); CKD4: 4.4%; CKD5: 7.2%. An eGFR distribution within the sex and age categories was constructed using the third percentile as threshold for decreased eGFR. A single threshold (under 60 ml/min/1.73 m(2)) eGFR classifying CKD3-5 leads to "overdiagnosis" of CKD3A in the elderly, overt "underdiagnosis" in younger individuals with eGFR over 60 ml/min/1.73 m(2), below the third percentile, and no proteinuria. By using the KDIGO guidelines in a correct way, "kidney damage" (confirmed proteinuria, hematuria) and the demonstration of chronicity of decreased eGFR

Objective In 2009, the Ministry of Health of Morocco launched a national confidential enquiry around maternal deaths based on the newly implemented routine maternal death surveillance system (MDSS). The objective of this paper is to show the importance of substandard care among the factors associated with maternal deaths. Methods The Moroccan National Expert Committee (NEC) organised an audit of maternal deaths identified by the MDSS to determine the medical cause, the preventability of the deaths and the type of substandard care involved. Results Three hundred and three cases of maternal deaths were analysed for the year 2009. Direct causes accounted for 80.8%. 75.9% were considered avoidable by the NEC. The three main factors were insufficient follow-up of care in 45.6% of cases, inadequate treatment in 43.9% and delay in seeking care in 41.3%. The auditors found that 54.3% of all maternal deaths could have been avoided if appropriate action had been taken at the health facilities. Conclusion The audit of maternal deaths in Morocco enabled a better understanding of the circumstances contributing to maternal deaths and pinpointed that more than half of maternal deaths were associated with substandard care in hospitals. Objectif En 2009, le ministere de la Sante du Maroc a lance une enquete nationale confidentielle sur les deces maternels, sur la base du nouveau systeme mis en œuvre pour la surveillance systematique de la mortalite maternelle (SSMM). L'objectif de cet article est de montrer l'importance des soins de qualite inferieure aux normes, parmi les facteurs associes a la mortalite maternelle. Methodes Le Comite National d'Experts (CNE) Marocain a organise un audit des deces maternels identifies par la SSMM pour determiner la cause medicale, le caractere evitable du deces et le type de soins impliques, inferieurs aux normes. Resultats Of 303 cas de deces maternels ont ete analyses pour l'annee 2009. Les causes directes representaient 80.8%. Of 75.9% ont ete consideres comme evitables par le CNE. Les trois principaux facteurs etaient: un suivi insuffisant des soins dans 45.6% des cas, un traitement inadequat dans 43.9% et le retard dans le recours aux soins dans 41.3%. Les experts ont constate que 54.3% de tous les deces maternels auraient pu etre evites si des mesures appropriees avaient ete prises au niveau des etablissements de sante. Conclusion L'audit des deces maternels au Maroc a permis de mieux comprendre les circonstances qui contribuent a la mortalite maternelle et a revele que plus de la moitie des deces maternels etaient associes a des soins de qualite inferieure aux normes dans les hopitaux. Objetivo En el 2009 el Ministerio de Salud de Marruecos lanzo una encuesta confidencial a nivel nacional basada en el recientemente establecido programa de vigilancia de muertes maternas (PVMM). El objetivo de esta publicacion es mostrar la importancia de cuidados subestandar entre los factores asociados con las muertes maternas. Metodos El Comite Nacional de Expertos de Marruecos (CNEM) organizo una auditoria de las muertes maternas identificadas mediante el PVMM con el fin de determinar las causas medicas, la posibilidad de prevenir las muertes y el tipo de cuidados subestandar involucrados. Resultados Se analizaron 303 casos de muertes maternas para el ano 2009. Las causas directas eran responsables del 80.8% de las muertes. Un 75.9% fueron consideradas como prevenibles por el CNEM. Los tres factores principales eran un seguimiento insuficiente en un 45.6% de los casos, tratamiento inadecuado en un 43.9%, y un retraso en la busqueda de cuidados en un 41.3%. Los auditores encontraron que un 54.3% de todas las muertes maternas podrian haberse evitado si en los centros sanitarios se hubiesen realizado las acciones apropiadas. Conclusion La auditoria de muertes maternas en Marruecos nos permite entender mejor las circunstancias que contribuyen a las muertes maternas y senalan que mas de la mitad de estas muertes estaban asociadas a unos cuidados hospitalarios subestandar.

OBJECTIVE: To describe the development of the maternal death surveillance system (MDSS) in Morocco and discuss the initial results. METHOD: The nationwide MDSS was implemented in 2009 with the involvement of health professionals and local authorities. It comprises (i) notification of all deaths of women of reproductive age (from 15 to 49 years); (ii) a preliminary survey to identify pregnancy-related deaths; (iii) a confidential enquiry into all pregnancy-related deaths. The information thus obtained describes socio-demographic characteristics of the women their obstetric and medical history the mode of delivery its follow-up and the medical cause of death. RESULTS: From 1st of January 2009 to 31st of December 2009 3814 deaths of women of reproductive age were recorded and a total of 436 pregnancy-related deaths were identified with 73.4% of those occurring in health facilities. Among the 313 reviewed records 80.8% were direct obstetric deaths and 13.5% were classified as indirect. Haemorrhage was the first direct obstetric cause of death (33%). Heart disease was the main indirect obstetric cause of death (39% of indirect causes). CONCLUSION: The Moroccan MDSS is a powerful tool for understanding the causes and circumstances of maternal deaths. However challenges remain regarding the full coverage of the system the decentralisation of the data entry and analysis and the completeness of medical records. (c) 2013 Blackwell Publishing Ltd.