Table 2

Framework for the functioning of maternal, neonatal and child death surveillance and response (DSR)

I. Surveillance process (What and How?)2 4–6
Elements of effective maternal, neonatal and child death surveillance and response2 4–61. Continuous surveillance (full cycle) integrating death auditing, review, communication and feedback mechanism (identify and notify; review, analyse and make recommendations; respond and monitor response)
2. Recommending cost-effective and evidence-based practices
3. ‘No naming, no blaming’ (confidentiality, non-punitive tone of the process)
4. Integrating learning and response from DSR into continuing professional development, quality improvement, health system strengthening and community education
5. Institutional support culture at all levels of the health system (management)
Actor participation (Who?)6 55
6. Driven by multidisciplinary teams (clinical, support, managerial)
7. Integration across levels from PHC facilities to hospitals, districts and higher levels
8. Involvement and commitment of the managers to act on the findings
9. Community participation in review and response (social and verbal autopsy)
II. Following a holistic approach to identifying modifiable causes
Three delays23First delay in deciding and seeking CareSecond delay in identifying and reaching a health facilityThird delay in receiving adequate appropriate care
III. Actions (proactive and reactive)
Provider levelCapacity building, in-service training
System levelHealth system improvement, provision of resources
Community levelCommunity education