MATERNAL DEATH REVIEW (Facility & Community Based) Govt of India National Guidelines

National Guidelines for Maternal Death Review (MDR) Objectives  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 ‡ Feed back ‡ Remedial measures ‡ ‡ ‡ ‡ ‡ ‡

FACILITY BASED MATERNAL DEATH REVIEW

Activities to Initiate FB-MDR

Identification of facilities for MDR

Constitution of MDR Committee at the facility By Principal /Superintendent of the facility

Identify & orient nodal officer(s) from selected facilities By State Nodal officer

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.

FBMDR: Steps-Process«.. 
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.  Remedial measures

Stat Task o c

FBMDR -PROCESS
M ns o t ng ‡M ns, ‡Cas su
ay t ng asu s tak n Dt Magistrate d All MDs v onthly

State Nodal officers

CMO & DNO Dt MD R vi w Committee CBR &FBR ( onthly)

M ns o th t ng

‡M ns o ‡Co ct v

‡L n l st ng o MDs (Ann x- ) ‡App ov s FBMDR o at and ta ns a copy

Facility MD Review Committee Review of a MDs in the hospita (month y)

‡FBMDR format ‡Case sheet ‡Case summary Inform/send to NO (w th n 24hrs) ‡ MD over phone ‡Information report (Annex-6) ‡ FBMR format ‡Intimation on to FNO within 24hrs ‡Information report (Annex-6) ‡FB R done ,reported within 24hrs

Facility Nodal officer (FN0) Hosp tal
Medical Officer on duty MATERNAL DEATH IN THE HOSPITAL

COMMUNITY BASED MATERNAL DEATH REVIEW

Activities to Initiate CB-MDR

Identify & orient the District Nodal Officer for MDR at the state level.

Orientation/ training of block team on MDR programme at district level

Orientation of all ASHAs/ANMs/AWWs on reporting of women deaths and MDR

Community Based MDR: Steps- Process
Notification: 
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 format (Annex 6).

Investigation: 
All suspected maternal deaths to be investigated by a team of 3 members (BPHN/PHN, ANM, LHV etc) with µverbal 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

Line listing of maternal deaths, submitted to Block MO PHC by ASHA ( monthly)

COMMUNITY

Block MO PHC BLOCK
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

Case summary sheet for every maternal death and format sent to the DNO

DISTRICT

2 relatives of the deceased attend DT. Collector¶s/ Dt. Health Society

Confirmed death recorded at Block level and MO analyses and discusses the findings with the team

DT Collector¶s Monthly Review Meeting

Maternal death reports are reviewed by Dt MDR committee chaired by Dt CMO (monthly)

STATE State Review

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 Purpose«
‡ 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

DM
CMO/DNO

3

2

BLOCK-3

BLOCK-2
BLOCK-1
Community based review

1

ANM

ANM ASHA

1
ASHA

F1

F2

F3

Facility based review in each of the institution

V1

V2

V3

Orientation Training
At different levels
‡ National level: Sensitization and Training ‡ State level: Sensitization and Training ‡ District level: Sensitization and Training ‡ Facility level: Orientation ‡ Block level: Sensitization

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