1. Study on Infant & Maternal Death Audit in Haryana Presentation prepared by Mr. Vivek Sharma Sr. consultant M&E, PHP HSHRC, Panchkula Dr. Meenakshi Gupta, Consultant M&E, HSHRC, Panchkula Date: 5 th April 2013 Venue: SIHFW, Panchkula Why is this study needed? What do you think? Is this study needed?

2.  Verbal autopsy is a research method that helps to determine probable causes of death in cases where there was no medical record or formal medical attention given.  Verbal autopsy offers a solution to the challenge of generating cause of death information.

3.  Verbal autopsy asks about signs and symptoms of the deceased person, risk factors and health care seeked prior to death, clarifying social, economic, behavioral, and health system issues that may have contributed to death.  This contextual knowledge is invaluable to health care managers, planners, communities, researchers, and policy & decision makers.

4. Line listing of all Deaths (reported by ANM/ASHA) Separation of women deaths aged between 15-44 years Screening of suspected Maternal Deaths (by MO) Community based MDR (Verbal Autopsy, of all MD) & or Facility based MDR Review of Maternal Death at Block and district level (monthly) Review of MD at state level (quarterly/bi- annually) Separation of deaths aged between 0-1 year Death audit of all infant Deaths IDR at block/district/state level

5.  Very little motivation of the service providers to conduct sincere audit  Case sheets are rewritten (facility based)  Supervisory officers tend to protect their subordinates  Reviews are more in favour of protecting the service providers rather than finding out the lapses in the provision of care

6.  Blame is often put on the field health functionaries  Non medical causes / contributory factors not identified  Timely conduct verbal autopsy at community and facility level  Compilation and analysis of verbal autopsy data and review of report at the facility, district, and state level  Action taken report

7. N = 294 Reported Maternal Deaths Source: Dept. of Health & Family Welfare, Haryana, 2012

8. Indicator India (Current) *SRS RGI Haryana (Current) *SRS RGI MDG2015 Infant Mortality Rate 4444<30 Maternal Mortality Rate 212153<100

9.  Find out challenges and gaps in process of MDR & IDR  Back check of existing review reports (verbal autopsies)  Corrective measures to conduct and review Maternal & Infant Deaths

10.  Avoiding maternal deaths is possible, even in resource-poor countries, but it requires the right kind of information on which to base programs  Knowing the level of maternal mortality is not enough; we need to understand the underlying factors that led to the deaths  Each maternal death or case of life-threatening complication has a story to tell and can provide indications on practical ways of addressing the problem  A commitment to act upon the findings of these reviews is a key prerequisite for success – and can be a health intervention itself – often leading to positive impact in service delivery

11. THANK YOU