Group 2: Care

Recommendation to increase ellaboration of team-work in

maternal health service
Community/facility level
■ Team meetings

■ Community meetings

■ Printed reports

■ Training programmes

■ Posters

Subnational or national level

■ Scientific articles

■ Statistical publications

■ Web-sites

■ Newsletters and bulletins

■ Fact sheets

■ Press releases

■ Training programmes

■ Professional conferences

■ Posters

■ Media
Community-based maternal death reviews
(verbal autopsies)
Facility-based maternal deaths review
Confidential enquiries into maternal deaths
Surveys of severe morbidity (near misses)
A method of finding out the medical causes of
death and ascertaining the personal, family or
community factors that may have contributed
to the deaths in women who died outside of a
medical facility.
Requires co-operation from the family of the
woman who died and sensitivity is needed in
discussing the circumstances of the death.
A qualitative, in-depth investigation of the
causes of and circumstances surrounding
maternal deaths occurring at health facilities.
Deaths are initially identified at the facility level
but such reviews are also concerned with
identifying the combination of factors at the
facility and in the community that contributed
to the death, and which ones were avoidable.
Requires co-operation from those who
provided care to the woman who died, and
their willingness to report accurately on the
management of the case.
A systematic multi-disciplinary anonymous
investigation of all or a representative sample
of maternal deaths occurring at an area,
regional (state) or national level. It identifies
the numbers, causes and avoidable or
remediable factors associated with them.
Requires existence of either a functioning
statistical infrastructure (vital records,
statistical analysis of births and deaths, human
resources, recording clerks, etc.) or nominated
professionals in each facility to regularly report
maternal deaths to the enquiry.
The identification and assessment of cases in
which pregnant women survive obstetric
complications. There is no universally
applicable definition for such cases and it is
important that the definition used in any survey
be appropriate to local circumstances to enable
local improvements in maternal care.
 Requires a good-quality medical record system,
a management culture where life-threatening
events can be discussed freely without fear of
blame, and a commitment from management
and clinical staff to act upon findings.

Clinical audit Clinical audit is a quality-improvement process

that seeks to improve patient care and
outcomes through systematic review of aspects
of the structure, processes, and outcomes of
care against explicit criteria and the subsequent
implementation of change. Where indicated,
changes are implemented at an individual,
team or service level and further monitoring is
used to confirm improvement in health care
delivery.

It must be possible to identify relevant cases

from facility registers and retrieve the case
notes. Health care personnel must feel able to
openly discuss case management and be willing
to envisage the application of revised protocols
for care.

Identification problem Recommendation Monitoring and PIC

evaluation