Making Every Baby Count

4.1 The importance of review and response to deaths in the
community
In many countries, despite high average rates of antenatal care and increasing rates of
facility-based delivery, even in resource-limited settings, many births still occur at home,
without any contact with health-care facilities or providers. Therefore, many stillbirths and
neonatal deaths also still occur at home. Many of these families will have had contact with
a health-care facility or community health worker (CHW) during pregnancy and/or delivery.
Identification and review of these stillbirths and neonatal deaths occurring in the community
is needed to help complete the picture of why these deaths are occurring and how they
can be prevented. Identification and analysis of these deaths requires the facility-based and
district-level mortality audit committee and the community to be accountable to each other
for sharing information and enacting changes.
Factors contributing to stillbirths and neonatal deaths in the community may be different
from those contributing to facility-based deaths and may not be identified by the facilitybased
mortality audit process. For example, reviews of deaths occurring in the community
may identify barriers to care that may not have been faced by individuals who were able to
reach and receive care at health-care facilities.
Many stillbirths and neonatal deaths can be attributed, at least in part, to factors that occur
in the community, such as poverty and poor access to services, poor social and nutritional
status of girls and women, harmful practices around pregnancy and childbirth, and perceptions
about and use of health services. Yet everyone in the community wants healthy
children. Thus, whatever approach is used, it is important that the people whose lives will
be affected by the findings of the review process feel that their voices will be heard when
solutions are being developed.
The process of setting up a system for identifying, reviewing and responding to stillbirths
and neonatal deaths at the community level is also intrinsically valuable for the connections
it fosters among stakeholders in the community, at health-care facilities and within
the public health infrastructure.
4.2 Setting up the system
There are two primary additional roles that must be competently filled when setting up a
process for community mortality audits, including designated community-based “identifier-reporters”
and reviewers. In addition, a mechanism for transmission of information
must be in place. These three key components of the system for auditing deaths that occur
in the community are discussed below.
Identifier-reporters
Identifier-reporters are those who will be informed of or able to identify stillbirths and neonatal
deaths in the community as soon as they occur and then promptly relay information
about them to the health system. These could include CHWs (who may be volunteers or
salaried workers), community or village leaders, community representatives appointed or
elected specifically for this purpose, or individuals employed by another existing initiative
MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS
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