MATERNAL DEATH REVIEW (Facility & Community Based) Govt of India – National Guidelines
National Guidelines for Maternal Death Review (MDR)
To establish operational mechanisms/ modalities for undertaking MDR at selected institutions and in community level
To disseminate information on data collection tools, data/information flow, analysis
To develop systems for review and remedial follow up actions
Key Points in MDR
Implementation of MDR should be supported by a State Govt Order
Notification of Maternal Deaths
Facility Based Maternal Death Review
Community Based Maternal death Review
All health functionaries have a role in MDR
District Collector ( DM) to conduct review meeting with the relatives of the deceased and service providers
No punitive action against service providers
MDR: Committees and Key Personnel at different level
State Task Force
State Nodal Officer
District MDR Committee
District Nodal Officer
- Facility MDR Committee
- Facility Nodal Officer
Block: Block Nodal Officer (BMOH)
- Block Investigation Team
Notifier of deaths
State Level Task Force
Members: Principal Secretary - Health and Family Welfare, Mission Director SHS, Senior Obstetrician/s of the Medical College Hospital, IMA. FOGSI and any other members nominated by Government.
STF will meet once in 6 months - to discuss the actions taken on the minutes of the last meeting and make recommendations to Government for policy and strategy formulations.
Every year an annual maternal death report for the state will be prepared and a dissemination meeting will be organized to sensitize the various service providers and managers.
State Nodal Officer
Identification of District Nodal officers
Organizes analysis of data collected from the districts and feed back to the district.
Organizes state level sensitization workshops
Convene state task force meeting
Facilitate preparation of annual maternal death report and dissemination meeting
MDR at District Level
Formation of MDR committee
Chairman: CMOH- roles and responsibilities
District Nodal Officer- roles & responsibilities
Monthly review meeting by MDR Committee
Quarterly review by DM
Quarterly review meeting with analyzed data and process indicators
FACILITY BASED MATERNAL DEATH REVIEW Activities to Initiate FB-MDR Identify & orient nodal officer(s) from selected facilities By State Nodal officer Constitution of MDR Committee at the facility By Principal /Superintendent of the facility Identification of facilities for MDR By State Director / Programme Manager
Facility Based Maternal Death Review: Steps-Process
Formation of facility level committee & identification of facility nodal officer (co-nodal officer) for each facility
Notification of maternal deaths by MO on duty within 24 hours to FNO ( Annex 6 )
FNO to inform district and state nodal officer within 24 hours telephonically and through Annex 6 .
Investigation within 24 hours using prescribed format ( Annex 1 ) by MO/Faculty/ ACMOH (for facilities other than MCH) & sending to FNO.
Preparation of case summary ( Annex 3 ) by FNO and sending copy of filled up format, summary and case sheet to facility MDR committee and DNO.
Maintain register of maternal deaths in the facility – line listing of maternal deaths ( Annex-4 )
Monthly review by the FBMDR committee headed by the Hospital superintendent/MSVP and sending minutes to DNO.
COMMUNITY BASED MATERNAL DEATH REVIEW Activities to Initiate CB-MDR Orientation of all ASHAs/ANMs/AWWs on reporting of women deaths and MDR Orientation/ training of block team on MDR programme at district level Identify & orient the District Nodal Officer for MDR at the state level.
Community Based MDR: Steps- Process
ASHA/Health worker: Notify all deaths of women between 15-49 years within 24 hours to block PHC MO – telephone and in the primary informer format ( Annex 6 ).
Block Medical Officer: Notify to district and state nodal officer within 24 hours of receipt of information and send the details in forma t ( Annex 6 ).
All suspected maternal deaths to be investigated by a team of 3 members (BPHN/PHN, ANM, LHV etc) with ‘verbal autopsy’ format ( Annex 2 ) within 3 weeks
Preparation of case summary ( Annex 3 ) by BMOH and sending to DNO along with filled up format ( Annex 2 )
CB-MDR: Steps- Process …..
MOH to maintain register of all deaths of women in the reproductive age group ( Annex 5 ) and line listing of all confirmed maternal deaths ( Annex 4 ) at block PHC.
- ASHA/ANM also maintain line listing of maternal deaths (Annex 4)
Feedback sharing with service providers at monthly meeting
District Level: DNO to receive both FBMDR and CBMDR formats and case summaries, prepare combined case summary if required and maintain line listing of all maternal deaths ( Annex 4 ).
COMMUNITY BASED MATERNAL DEATH REVIEW Process Flow Chart ASHA/Others Telephonically informs about the maternal death within 24hrs to Block MO PHC BLOCK DISTRICT STATE COMMUNITY Line listing of maternal deaths, submitted to Block MO PHC by ASHA ( monthly) Block MO PHC Telephonically informs DNO and SNO within 24hrs of receipt of information of maternal deaths Deploys investigation team (BPHN/ ANMPHN/Nurse to visit the deceased woman’s house and conduct verbal autopsy Confirmed death recorded at Block level and MO analyses and discusses the findings with the team Case summary sheet for every maternal death and format sent to the DNO Maternal death reports are reviewed by Dt MDR committee chaired by Dt CMO (monthly) DT. Collector’s/ Dt. Health Society DT Collector’s Monthly Review Meeting State Review 2 relatives of the deceased attend
Maternal death review at District level
Monthly district maternal death review by MDR committee chaired by CMOH:
All maternal deaths reported in the month – both FBMDR and CBMDR
Quarterly district maternal death review by DM:
All the maternal death reports compiled by the district MDR committee will be put up to the District Magistrate, who will have the option of reviewing a sample of these deaths, which will be representative of deaths occurring at home, at facilities and in transit .
District maternal death review by DM
To institute measures to prevent maternal deaths due to similar reasons in future
To sensitize service providers to improve accountability
To find out the system gaps to take appropriate corrective measures with time-line
To allocate funds from the district health society for the interventions
To monitor the implementation of the corrective measures
- at the community level
- at the facility level
- requiring state support
Maternal Death Review Process F1 F2 F3 Facility based review in each of the institution V1 V2 V3 ASHA ASHA BLOCK-1 ANM ANM CMO/DNO DM 2 3 1 1 BLOCK-2 BLOCK-3 Community based review