Making Every Baby Count

Geospatial analyses may be very beneficial at the community level. Geolocalization of
deaths in the community may visually highlight areas without adequate access to care, or
may help characterize particular transportation barriers.
Step 4: Recommending solutions
Recommending realistic solutions to reduce deaths in the community is challenging. The
characteristics of high-quality recommendations are covered in Chapter 3, but there are
at least two aspects of recommending solutions that are worth addressing with particular
ramifications for the community: capacity and communication.
(i) Capacity to implement a recommendation
This is an extremely important consideration when formulating a recommendation that
impacts the community. If a recommendation is formulated in collaboration with community
leaders and in partnership with community members empowered to make the
recommended change, it can be powerful and effective. In contrast, however, if recommendations
that the community has no ability to enact are “handed down” to the community
from a perinatal mortality audit committee, they can cause distrust between the community
members and the health system.
(ii) Communication with the community
This is also of highest priority. Results and recommendations of perinatal mortality audits
must be disseminated in a way that communicates information effectively, sensitively and
via a medium that is accessible to all community members. Perhaps most important is the
principle of community-based dissemination: when communities of lay people are left out
of the plans for information dissemination, this represents a lost opportunity for enhancing
relationships and building capacity for positive change within the community.
Effective communication with the community can be enhanced early on in the process
through the selection of appropriate community representatives to participate in the perinatal
mortality audit committees. Communication and capacity can both be enhanced
by early involvement of community leaders, especially in formulating recommendations.
Lastly, communication is enhanced by using forms of media favoured by the community,
which may include radio, television, theatre and murals, in addition to written materials.
Steps 5 and 6: Implementing changes, evaluating and refining
Intentional, consistent involvement of the community in perinatal death audit can help
reduce perinatal deaths at both facility and community levels. Recommended solutions
are most likely to be implemented successfully when a community participates in perinatal
death review and in formulating the solutions, when the solutions are within the community’s
capacity to enact, and when the process is undertaken in an environment of consistent,
strong communication between the community and the local health-care facility.
Creating a mechanism of public accountability for implementing recommendations can
be a trust-building, empowering aspect of communication and can contribute to participatory
evaluation of changes, involving the community. For example, a perinatal death
52 MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS