Making Every Baby Count

In addition, review committee members should be instructed not to disclose any confidential
information about cases (including names of family or medical or other staff involved,
or any details of the discussions or findings of the review process) outside the review
group. Ideally, anyone with access to any information that contains personal identifiers
should sign a confidentiality agreement, stating that they will not disclose this information.
All records of the cases reviewed and any discussion should be kept secure; hard
copies of information should be kept in locked cabinets/offices, and electronic data kept
in password-protected files. In some types of review, such as confidential enquiries, complete
anonymity is the rule. However, in others, such as facility- and community-based case
reviews, the identity of both the deceased and the health workers involved in the care are
typically known, though care is taken to remove identifying markers in the notes as soon as
possible.
5.3 Developing and disseminating policy and guidelines
A clear, supportive policy has been one of the prerequisites for success in maternal mortality
audit (46, 51). In some cases this has also involved an enabling legal framework,
which may need to be in place before the process begins. Any fear of participation in such
audits can be removed by affording legal protection for assisting in such enquiries while
ensuring cases of gross malpractice will continue to be dealt with by the existing legal procedures.
National guidelines for how to set up an audit committee and conduct meetings,
clear guidance on information transmission, and standardized tools are also helpful. Clear
norms and practice standards for each level of the health system may facilitate a more
objective assessment of modifiable factors associated with each death (38, 63). These will
require periodic review and updating as new evidence emerges, as with the national clinical
guidelines. This process can be led by the national steering committee with ministry of
health guidance.
National guidelines for stillbirth and neonatal death mortality audit may mandate that particular
staff members are designated at various levels to oversee the system and that the
associated tasks and responsibilities are included in their job descriptions. In settings
where midwives provide the majority of care at birth and during the postnatal period, the
system should be developed in such a way that midwives can complete the process from
start to finish and provide leadership at all levels. If resources permit, an outreach person
or regional coordinator who is familiar with the tools and meeting structure can serve
as a liaison between clinical staff, senior management and district decision-makers. This
person can be a valuable resource, especially in ensuring that recommendations result in
actions that are followed up. This system has been one of the key drivers of institutionalization
and successful outcomes in South Africa (41, 47).
5.4 Staff training, ongoing supervision and leadership
District health staff, administrative staff, health workers and other relevant stakeholders
require training specific to their role in the audit process and the level of implementation
of the audit system. This training may be conducted by the ministry of health or through
professional associations. In Uganda, both the Association of Gynaecologists and Obstetricians
and the Uganda Paediatric Association have been involved in training on the national
MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS
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