Counting Every Stillbirth and Neonatal Death: Perinatal Audit Tools and Implementation for Improving Quality of Care Linked to Maternal Death Surveillance and Response

Session: Every Newborn Action Plan (ENAP): A Multi-Partner Measurement Improvement Roadmap

Presenter: Kate Kerber, Saving Newborn Lives, Save the Children
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Background: Previous meta-analysis suggests that small-scale perinatal audit programmes linked to action may reduce perinatal mortality rates by 30%. The Commission for Information and Accountability recommended scale up of maternal and perinatal mortality audit, yet whilst there has been major policy traction on the former, tools are lacking and progress limited for the latter. In the light of this, one of the Every Newborn Action Plan (ENAP) milestones is to develop perinatal mortality audit tools and promote use at scale.

Methodology: We assessed the status of policy and implementation for maternal and perinatal audit in low- and middle-income countries, reviewing evidence of effectiveness. Key challenges to completing the audit cycle and affecting change were identified along with solutions.

Results: Only 17 out of the 60 priority countries reporting maternal death notification in 2014 have a specific policy for auditing stillbirths and neonatal deaths. Maternal death surveillance is moving rapidly with many countries enacting policies and accountability mechanisms. Current evidence demonstrates that audit can improve birth outcomes when the whole cycle is completed. Lack of leadership and health information systems were found to be primary challenges and should be addressed to achieve effective audit systems. Functional audit requires a no-blame environment. Concurrent development and the use of clear guidelines and protocols also contributed to ensuring that the audit cycle is completed.

Conclusion: Health workers have the power to change what is in front of them, but wider change requires action at other health system levels, e.g., for human resources or commodity supply chains. Linking to wider change also requires a data management system including consistent cause of death classification, guidelines and especially leaders to champion the process, and to access change agents at other levels to address larger, systemic challenges. WHO perinatal audit tools are being developed based on these findings.