Scaling best practices: Use of verbal & social autopsy tools

In 2016, the Ministry of Health in Kenya launched the national guidelines for Maternal and Perinatal Death Surveillance and Response (MPDSR). The guidelines outline a framework for establishing and maintaining a system for collecting, analysing and reviewing data on stillbirths, perinatal and maternal deaths and near-misses.

This is important for the health system, especially in a devolved system to ensure health workers identify lessons from unfortunate death of mothers and babies during pregnancy or childbirth to prevent future occurrences. MPDSR guidelines stipulate the roles of different stakeholders and how MPDSR should be implemented across all levels of care; national, county, sub county, facility, and community. Whereas MPDSR in other levels of care appear to have fairly picked up in Kenya, the community component significantly remains behind. Effective practice of community MPDSR (c-MPDSR) promotes verbal and social autopsies.

When doing verbal autopsy, healthcare workers and other committee members meet with the family of the deceased to discuss on the root causes of death. These discussions are not just within the medical parameters for cause of death, they also look at other related sociocultural and economic factors. As for social autopsy, community health units, facility representatives and other stakeholders as recommended by the MPDSR guidelines hold community forums to discuss recent cases. These forums agree on actions to prevent future deaths using data generated from verbal autopsy.

Significant milestone in Bungoma

Evidence for Action (E4A)-MamaYe has successfully piloted c-MPDSR in Kaduna State, Nigeria in previous years. The Kaduna pilot provides useful lessons to put c-MPDSR practice to scale.  For the Kenya context, E4A-MamaYe has built a partnership to support Bungoma County Department of health to launch c-MPDSR in Kanduyi sub county.

On February 15th, two c-MPDSR committees were successfully launched at Mayanja Dispensary. This facility has a vast catchment population covered by 5 Community Health Units; Kikwechi, Marakaru, Sitoma, Mayanja and Kabusasi.

The Mayanja c-MPDSR committees includes Assistant Chiefs, Community Health Extension Worker, facility clinician, Community Health Volunteers, Chair to Community Health Committees, Community mid-wife and representation of the civil society through the Bungoma RMNCAH Network.

Earlier this year, members of the committees were trained on use of verbal autopsy tool which already exists in the Kenyan context and the new social autopsy tool.  Notably, the social autopsy tool will facilitate ‘community self-diagnosis’ and identification of modifiable social and cultural factors that are attributable to the death of mothers and babies.

Continuous use of social autopsy has the potential not only for increasing awareness among community members, but also for promoting behavioral change at the individual and community level. Already E4A-MamaYe has revised the social autopsy tool to include a gender component, supporting communities to identify gender barriers and challenge gender stereotypes which put women and girls at risk.

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