Increasing Awareness Increasing Awareness andand Empowering CommunitiesEmpowering Communities

Maternal and Perinatal Maternal and Perinatal Death Inquiry and ResponseDeath Inquiry and Response

MAPEDIRMAPEDIR

MAPEDIR’s purpose Increase awareness of maternal and

perinatal deathsMAPEDIR brings the deaths to light

Mobilizes communities to take local actionStimulates policy makers to improve health

services

MAPEDIR provides useful informationWhat caused local deathsSuggests ways to prevent similar deaths

MAPEDIR’s purpose Empower the community

Demystifies the causes of maternal and perinatal deaths and how to prevent them

Helps people understand they can take action to prevent deaths

Provides information to the community: To take effective local action To advocate for improved services

MAPEDIR’s purpose Inform the health system

Community death inquiries identify access issues and some quality of care problems Encourage community–health system

partnerships Facility-based death inquiries can

identify more quality of care problems

MAPEDIR’s context in India: The RCH II Program RCH II priorities (implemented by the

NRHM) Increase community (PRI, etc.) participation

in and demand for quality RCH services Evidence-based planning, resource allocation

and action to improve system quality and responsiveness

Strengthen the health system Institutional awareness, responsiveness and

accountability to improve RCH services

The MAPEDIR process

1a) Sensitize the communityPartner with NGOsMobilize the PRI, VHCs, SHGs, etc.Sensitize the community to maternal and

perinatal health issues: Birth preparedness / complication readiness Project purpose, and need to report maternal

deaths and conduct death inquiries Non-blaming, non-punitive approach

The MAPEDIR process

1b) Engage health officialsCreate a facilitating environment

Non-blaming, non-punitiveDevelop facility-based MAPEDIR

The MAPEDIR process

2) Identify maternal deathsBlock: expect 10-25 deaths / yearCurrently – most deaths not reported

Ways to increase death reportingSensitize the community to increase

awarenessKey informants (AWWs, TBAs, others)Health facility reports of deathsPregnancy registration and monitoring

The MAPEDIR process

3) Investigate the deaths (with verbal autopsy interviews)Biological causesSocial causes (careseeking delays and

reasons for the delays)

The MAPEDIR process

4) Analyze and interpret the dataQuantitative analysis – indicator levels

e.g., the percent of maternal deaths that did not seek any formal care

Qualitative analysis – the complete story of individual maternal deaths

Interpret – understand what are the most important causes and possible solutions

The MAPEDIR process

5) Share the data with the communityShare the analyses Interpret the data with the communityHelp the community:

Develop effective local interventions Advocate for improved services

The MAPEDIR process

6) Monitor interventionsContinue investigating maternal deaths

Are the interventions working? Are some women not being reached?

Modify the interventions as neededDevelop new interventions if needed