Making Every Baby Count

4.3 The six-step mortality audit cycle from the community perspective. . . . . . . . . . . 46
Step 1: Identifying cases for review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Step 2: Collecting information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Step 3: Analysing information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Step 4: Recommending solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Steps 5 and 6: Implementing changes, evaluating and refining. . . . . . . . . . . . . . . . 52
Chapter 5. Creating an enabling environment for change 54
5.1 Creating an enabling environment to effect change . . . . . . . . . . . . . . . . . . . . . 55
5.2 Legal and ethical issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Legal protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Access to information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Use of the results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Ethical considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
5.3 Developing and disseminating policy and guidelines . . . . . . . . . . . . . . . . . . . . 57
5.4 Staff training, ongoing supervision and leadership . . . . . . . . . . . . . . . . . . . . . . 57
Chapter 6. Scaling up audit for quality and health care improvement 60
6.1 Moving from single facilities to regional and national levels . . . . . . . . . . . . . . . . 61
6.2 Collating data and linking to existing information infrastructure . . . . . . . . . . . . . 63
6.3 Ensuring appropriate resources and logistical support . . . . . . . . . . . . . . . . . . . 65
Conclusion 65
References 66
Annexes 70
Annex 1:
Stillbirth and Neonatal Death Case Review Form (and guidance
for completion) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Annex 2: Births and Deaths Summary Form (and guidance for completion). . . . . . . 82
Annex 3:
Minimum set of perinatal indicators to collect for all births and
perinatal deaths (and guidance for completion) . . . . . . . . . . . . . . . . . . 87
Annex 4: Approaches for classifying modifiable factors . . . . . . . . . . . . . . . . . . . . 92
Annex 5: Setting up a mortality audit steering committee . . . . . . . . . . . . . . . . . . 97
Annex 6: Sample audit meeting code of practice declaration . . . . . . . . . . . . . . . . 98
Annex 7: Sample calculations for reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Annex 8:
Stillbirth and Neonatal Mortality Audit – Meeting Minutes and Action
Items Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Annex 9: Steps for establishing a mortality audit for stillbirths and neonatal deaths . . .103
Annex 10: Verbal and social autopsy tool for stillbirth and neonatal death audits
in the community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105