Making Every Baby Count

(e.g. individuals who conduct routine home visits during pregnancy and the postnatal
period). To facilitate their role as reporters, in order to effectively relay the information, they
should be formally connected to the health system through a primary health centre, hospital
or district office.
Where a public health system already has a network of CHWs in place, it may be effective
to train them to take on the identifier-reporter role. Many countries, however, do not have
unified networks of CHWs with sufficient coverage. Alternatively, identification/notification
programmes could be run through district or sub-district networks of identifier-reporters to
capture stillbirths and neonatal deaths in smaller areas. For example, in Cameroon, several
programmes have worked with village mothers’ associations or women’s associations to
assist community-level identification of programme-related outcomes.
It may be possible in some settings to integrate the reporting of stillbirths and neonatal
deaths within other existing public health surveillance efforts. Community-based maternal
death surveillance and response (MDSR) and integrated disease surveillance and response
systems may provide platforms for expansion to include perinatal deaths. In Indonesia, for
example, a training programme for professional midwives to be deployed in villages facilitated
the initiation of community-based perinatal death review (55).
Other public health programmes, including those outside maternal, newborn and child
health, may also provide these opportunities. For example, if a region has an ongoing
polio vaccination campaign to target remote communities, it may be possible to train the
community-based volunteers or campaign staff to identify stillbirths and neonatal deaths
in these communities and notify the health system of their occurrence. For example, the
“Reaching Every District” (RED) strategy was undertaken by a group of immunizationtargeting
partners of WHO in 2002 to improve surveillance by re-establishing outreach
services to communities in both urban and rural areas (56).
A variety of reporting mechanisms can be designed to successfully relay information from
community-based identifier-reporters to the public health system, as discussed in the section
on transmission of information, below.
Reviewers
Reviewers are community representatives who participate in perinatal mortality audits.
The composition and roles of the membership of facility-based or national-level steering
committees for these audits are described in Annex 5. There are a few additional considerations
that are particularly important to the community, including representation,
communication and advocacy.
The first consideration in the selection of reviewers of stillbirths and neonatal deaths in
the community is that of representation of the community perspective on these deaths.
Including a member of the community in the facility-based review committee may help
gather more complete information from the community’s perspective on what led to each
stillbirth or neonatal death. For example, a CHW participating in a review may be able to
contribute information on why a family did not seek care earlier or why transportation may
have been delayed.
44 MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS