Making Every Baby Count

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6 Scaling up audit for quality and health care improvement To facilitate wide-reaching change and promote accountability at all levels of the system, it is important for policy-makers to seize opportunities to create a standardized national mortality audit system. This chapter describes the creation of a mortality audit infrastructure and systems that link to existing data architecture and policy response beyond individual health-care facilities.
6.1 Moving from single facilities to regional and national levels Once local systems for comprehensive and systematic review of stillbirths and neonatal deaths have been institutionalized as routine practice with documented changes in practice and quality of care, other facilities, districts or health regions within a country may take note and explore the feasibility of adopting a similar approach. With some additional resources to coordinate this standardized system, data can be centrally collated, tracked and disseminated. A larger number of deaths enables a more detailed analysis to be undertaken with a broader population base, potentially enabling triangulation with other data sources such as CRVS and the HMIS. In some cases, a central (national-level) committee may just gather data from facility-based reviews and report broad trends, but in other cases a separate review process might also be put in place at a district or regional (subnational) level. One benefit of a regional-level review is that the forms can be made anonymous, and assessors from other facilities can review cases, providing an independent opinion and recommendations. At this level, general lessons may also be derived which reveal systemic bottlenecks and thus highlight a path towards broader changes. For example, the results may point to the need for regional review of pre-service training procedures or transport systems. If a decision is made to undertake a national audit programme with leadership from the central level, there are a number of factors to be considered in a phased approach (5), including: • Who leads? Will coordination take place at the national level or through regional committees, or both? Will it be governed by the ministry of health exclusively, associations of health professionals or a multistakeholder group that includes partners, civil society, community representatives, etc.? • Where are deaths identified? Does the system cover just public-sector health-care facilities or all facilities? Are deaths that occur in the community included? If so, how is information gathered about those deaths? How does the mortality audit system feed into or get information from the HMIS and/or CRVS? • What is the scope of implementation? Do single facilities conduct reviews on their own, or are they done within practice groupings or districts, or both? Is implementation mandated or voluntary? • What is the depth and breadth of the review process? Does the committee review a selected sample of cases, all deaths or all deaths and near misses? How does the committee decide which cases to review and how often? Figure 6.1 illustrates the dimensions of this phased introduction of mortality audits from single facilities to the national level. Experiences from high-income countries such as Australia (64, 65), New Zealand (66), the Netherlands (67–69) and the United Kingdom have shown the potential for sustained, widespread implementation when there is high-level national leadership. Where local drivers exist without an overarching national or regional coordinating body, national systems can still arise from the ground up, as seen in South Africa (13, 41). MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS 61
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Making Every Baby Count Audit and r
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Making Every Baby Count Audit and r
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4.3 The six-step mortality audit cy
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Acknowledgements The World Health O
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Foreword Pregnancy is a time of gre
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in the future. The process of routi
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Key messages of this guide • Audi
Page 16 and 17: 1 Getting started
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Page 28 and 29: application of ICD-10 to deaths dur
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Page 44 and 45: Possible actions include interventi
Page 46 and 47: Step 6: Evaluating and refining The
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Page 54 and 55: Step 1.2: Notification and reportin
Page 56 and 57: It may be easier for an information
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Page 60 and 61: 5 Creating an enabling environment
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Page 64 and 65: Maternal and Perinatal Death Review
Page 68 and 69: FIGURE 6.1. Dimensions of a phased
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Page 72 and 73: References 1. Maternal death survei
Page 74 and 75: 39. Bradshaw D, Chopra M, Kerber K,
Page 76 and 77: Annexes Annex 1 Stillbirth and Neon
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Page 96 and 97: 3) If there is no gestational age e
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Page 112 and 113: INFORMED CONSENT FORM (INTERVIEWEE
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SECTION 3. INFORMATION ON THE DECEA
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ASK THE RESPONDENT: What do you thi
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4.4.2 Before the woman became pregn
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4.16.2 During the last 3 months of
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5.5 How many hours or days passed b
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5.18 Would you say the baby’s siz
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5.33 Did the baby ever move, even a
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SECTION 6. NEONATAL ILLNESS HISTORY
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6.17 Did the baby have a swollen st
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SECTION 7. HISTORY OF INJURIES/ACCI
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8.7 What were the reasons the baby
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8.15.2 What difficulties did you ha
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SECTION 9. DATA ABSTRACTED FROM REC
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VA Supervisor comments and observat
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