Community Maternal and Perinatal Death Surveillance and Response (MPDSR) is a critical process in improving maternal, newborn, and child health outcomes in Kenya. By systematically reviewing deaths related to pregnancy, childbirth, and infancy within communities, health workers and stakeholders identify avoidable factors and implement corrective actions. Establishing a dedicated Community MPDSR committee ensures local ownership, timely response, and multisectoral collaboration, which are essential for reducing preventable deaths at the grassroots level.

4.1 Forming and training Community MPDSR committee

Forming and training a Community MPDSR committee is foundational to effective surveillance and response at the community level. The committee brings together diverse stakeholders who collectively contribute their expertise, local knowledge, and authority to investigate deaths and recommend interventions. In Kenyan community health practice, involving representatives such as the area assistant chief, community health personnel, clinicians, and civil society strengthens accountability and ensures multi-dimensional perspectives on maternal and newborn health challenges.

4.1.1 Area assistant chief

The area assistant chief plays a pivotal leadership role in the Community MPDSR committee by providing administrative oversight and facilitating coordination between the health system and the community.

Role and Responsibilities

• Community Leadership: The assistant chief acts as the government’s representative at the grassroots level, mobilizing community members and fostering trust in the MPDSR process.
• Facilitation of Meetings: They organize and chair MPDSR meetings, ensuring participation of all committee members and adherence to agreed procedures.
• Information Dissemination: The assistant chief communicates findings and action points from MPDSR reviews to the wider community and local leaders, promoting transparency.
• Conflict Resolution: In cases where sensitive issues arise during death reviews, the assistant chief mediates disputes to maintain a constructive environment.
• Resource Mobilization: The assistant chief advocates for community resources and support to implement recommended interventions, such as sanitation improvements or transport for emergency referrals.

Importance in Kenyan Context

The assistant chief’s involvement is critical in Kenyan rural and peri-urban settings, where local governance structures influence health behaviors and acceptance of interventions. For example, in a community near Kisumu County, an assistant chief effectively mobilized local transport providers to support emergency referrals after MPDSR identified delays in reaching health facilities.

Training Needs

• Understanding of MPDSR objectives and confidentiality principles
• Skills in community mobilization and leadership
• Basic knowledge of maternal and newborn health challenges
• Techniques for facilitation and conflict management within community groups

4.1.2 ACHO/CHA/CHO

The Assistant County Health Officer (ACHO), Community Health Assistant (CHA), and Community Health Officer (CHO) are frontline health professionals whose technical expertise and community engagement are vital to the MPDSR committee’s function.

Distinct Roles in MPDSR

• ACHO: Provides supervisory oversight and ensures integration of MPDSR activities with county health plans and policies.
• CHA: Acts as a liaison between households and health facilities, gathering data on deaths and supporting community sensitization.
• CHO: Coordinates community health units, facilitates training of CHVs, and leads technical discussions during death reviews.

Contributions to Committee Work

• Data Collection and Verification: CHAs and CHOs collect accurate information on circumstances surrounding deaths, often conducting home visits for verbal autopsy.
• Technical Analysis: The ACHO and CHO analyze contributory factors such as delays in seeking care or gaps in facility services.
• Action Planning: They guide the committee in developing evidence-based recommendations and linking them to health system responses.
• Capacity Building: CHOs train community health volunteers on MPDSR principles, ensuring sustainability.

Relevance to Kenyan Community Health Systems

In Mombasa County, CHOs have been instrumental in reducing perinatal deaths by training CHVs to identify danger signs early and report deaths promptly to MPDSR committees, improving the timeliness and quality of reviews.

Training Components

• Maternal, newborn, and child health clinical knowledge
• Verbal autopsy methodology and data quality assurance
• Community engagement and health education strategies
• Monitoring and evaluation of MPDSR outcomes

4.1.3 CHP from the village where the death has occurred

The Community Health Promoter (CHP) from the village where the death occurred offers unique local insight crucial for understanding contextual factors influencing maternal and newborn deaths.

Local Knowledge and Contextualization

• Cultural Practices: The CHP understands traditional beliefs and practices that may affect health-seeking behavior or care during pregnancy and childbirth.
• Social Dynamics: They identify household and community-level social determinants such as poverty, gender roles, and decision-making patterns.
• Environmental Factors: The CHP can report on infrastructural challenges like poor road access or lack of clean water that contribute to adverse outcomes.
• Community Networks: They facilitate engagement with local leaders, traditional birth attendants, and family members during death investigations.
• Support for Bereaved Families: The CHP provides psychosocial support and encourages acceptance of recommendations.

Role in the MPDSR Committee

The CHP participates actively in death reviews by presenting detailed accounts of the events leading to the death, which helps the committee identify avoidable factors. Their presence ensures that interventions address root causes specific to that community.

Kenyan Example

In a rural village in Meru County, a CHP highlighted how harmful cultural practices delayed referral for a mother with obstructed labor. This insight led the committee to design targeted community education campaigns that significantly improved timely facility deliveries.

Training Requirements

• Skills in community dialogue and sensitive communication
• Knowledge of maternal and newborn danger signs
• Basic counseling and psychosocial support techniques
• Understanding of MPDSR confidentiality and ethical considerations

4.1.4 Clinician from the health facility

A health facility clinician serves as the technical expert within the MPDSR committee, providing clinical perspectives on causes of death and health system gaps.

Clinical Expertise and Responsibilities

• Cause of Death Determination: The clinician reviews medical records and, where possible, conducts facility-based audits to establish medical causes.
• Identification of Health System Failures: They assess quality of care issues such as delays in diagnosis, treatment errors, or resource shortages.
• Technical Guidance: The clinician advises the committee on evidence-based interventions, clinical protocols, and referral pathways.
• Capacity Building: They support training of community health workers on clinical aspects relevant to MPDSR.
• Liaison Role: The clinician connects community findings with facility-level quality improvement initiatives.

Contribution to Kenyan Community Health

At a sub-county hospital in Nakuru, the clinician’s input into the MPDSR committee identified repeated delays in emergency caesarean sections, prompting the hospital management to improve anesthesia staffing and theatre availability.

Training and Competencies

• Advanced knowledge of maternal and newborn clinical care
• Skills in audit and quality improvement methodologies
• Effective communication with community stakeholders
• Familiarity with national MPDSR guidelines and reporting tools

4.1.5 Member of the civil society

Inclusion of a civil society member in the Community MPDSR committee enhances accountability, advocacy, and community representation in the surveillance process.

Roles and Contributions

• Advocacy: Civil society members champion maternal and newborn health rights and mobilize resources to support MPDSR activities.
• Community Voice: They represent marginalized groups and ensure that recommendations respond to community needs and social justice.
• Monitoring and Accountability: Civil society organizations often track implementation of MPDSR recommendations and report on progress.
• Capacity Building: They facilitate community awareness campaigns and support behavior change interventions.
• Linkage with National Programs: Civil society connects local MPDSR efforts with wider health policies and campaigns.

Impact in Kenya

An NGO member in Kisii County helped establish a community transport fund after MPDSR identified transport barriers as a major contributor to maternal deaths, illustrating how civil society can translate findings into concrete action.

Training Needs

• Understanding of maternal and newborn health rights and policies
• Skills in advocacy and community mobilization
• Knowledge of MPDSR framework and ethical considerations
• Networking and partnership development skills

Chapter Summary

This chapter covers the process of conducting Community Maternal and Perinatal Death Surveillance and Response (MPDSR), starting with the formation and training of a dedicated committee. Key members include the area assistant chief, community health officers, clinicians, and civil society representatives, each playing a crucial role in community-based surveillance. The chapter then details the essential MPDSR reporting tools such as the Perinatal and Maternal Notification form, MOH 519, and the verbal autopsy form, which are vital for accurate data collection. It highlights common causes of maternal and perinatal deaths including infections, anemia, childbirth complications, and other comorbidities that require careful investigation. The procedures for conducting maternal and perinatal death notifications and community verbal autopsies are explained to ensure timely and thorough information gathering. Finally, the chapter emphasizes the importance of documenting and reporting the outcomes of verbal autopsies and providing feedback to the community to foster learning and improve health outcomes.