Integrated Community Engagement and Audit Systems

The goal of this implementation research project is to determine the feasibility of establishing and implementing an acceptable and robust audit system with community representation at secondary health facilities to improve maternal and perinatal outcomes. The implementation phases follow the standard World Health Organization (WHO) audit system. The initial step includes identifying death cases for review and subsequently collecting the detailed information on the near miss and adverse event history. A mixed methods data analysis will include both quantitative components, such as identification of trends in rates and causes of death and geographic location, and qualitative components, such as analysis of modifiable factors. The use of both types of data will provide a robust analysis of the problems and aid the audit team iin identifying and supporting priorities for action. The three-delay's model categorize the modifiable factors as the first delay (recognition of danger sign and care-seeking decision), second delay (identification and reaching health facility) and third delays (receiving adequate care and treatment at facilities). The audit team will make recommendations in collaboration with community representatives. The findings of the audits will be shared with the health facility authorities, program managers and community representatives to support policy and practice changes. A monthly monitoring cycle will be set up within the implementing facilities to ensure effective implementation of the audit systems.

Inclusion Criteria:Women aged 15-49 years who reside in the selected district. Secondary level public health facilities that offer obstetric and postnatal care, and respective catchment areas are supported by LHWs, included in the study. Data for all maternal 'near misses', perinatal and neonatal mortality and morbidity outcomes recorded for all women and newborns who deliver at home (through LHW monthly reports) and who contact the health facility within 42 days post-delivery, regardless of whether or not they delivered in the health facility.Exclusion Criteria:Women who are non- residents of the study district and who do not provide consent.