Community-Based System of Auditing Maternal and Newborn Deaths to Strengthen Collective Action and Demand for Accountability

Presenter: Samir Garg, State Health Resource Center Chhattisgarh

Background: Chhattisgarh is amongst the poorest states in India with indigenous tribes forming 32% of population. The maternal and newborn mortality indicators of Chhattisgarh are worse than national average. The state has a system of maternal and infant death audits conducted through Medical Officers. To augment it, Government initiated a community-based system of death audits.

Methodology:  Chhattisgarh has 19,100 Village Health Committees supported by a well-established network of 66,200 Community Health Workers called Mitanins, covering a population of 19 million. Since 2011, each village committee records deaths and discusses them in monthly community meetings. Verbal autopsies of maternal and newborn deaths were started in 2014 to enable community based death audits. 170 local facilitators were trained to conduct verbal autopsies of all recorded maternal deaths and 30% sample of newborn deaths each month. The information collected on each death is reviewed, summarized and coded by a technical team in discussion with the facilitators. The facilitators report back to community meetings.

Results: For year 2014, verbal autopsies and community audits were conducted for 402 maternal and 1,790 newborn deaths. Communities through Village Health Committees are able to conduct evidence based discussions on deaths and underlying gaps. It has helped them in demanding accountability from healthcare system through mechanisms like Public Hearings. Community level gaps in health-seeking are addressed through village health planning. Registration has improved with 45% increase in newborn deaths recorded. It has also yielded evidence of public health importance in form of medical causes and systemic gaps contributing to deaths. The information compiled is also shared with the government to seek necessary public health response.

Conclusion: Large-scale and cost-efficient systems of community-based death audits are feasible and can act as powerful tools of generating evidence and influencing community as well as government action to reduce maternal and newborn mortality.