Community Health professionals play a critical role in reducing maternal, newborn, and child mortality by actively participating in Maternal and Perinatal Death Surveillance and Response (MPDSR) processes. The establishment and effective training of community MPDSR committees ensures that deaths are systematically reviewed and appropriate responses are implemented at the grassroots level. In Kenya, where maternal and newborn deaths remain a public health challenge, community engagement through MPDSR committees fosters local ownership, timely reporting, and culturally sensitive interventions to improve health outcomes. This chapter focuses on the formation and training of community MPDSR committees, highlighting the key roles of various community stakeholders.

5.1 Forming and training Community Maternal and Perinatal Death Surveillance and Response (MPDSR) committee

A community MPDSR committee is a multidisciplinary team tasked with reviewing maternal and perinatal deaths occurring within the community, identifying preventable factors, and recommending actionable responses. The committee serves as a bridge between health facilities and the community, ensuring accurate death reporting and mobilization of local resources for health interventions. In Kenyan community health practice, the committee’s effectiveness depends on including representatives with diverse knowledge and influence, such as area leaders, health workers, and civil society members. Proper training equips committee members with skills in data collection, confidentiality, respectful communication, and response planning.

5.1.1 Area assistant chief

The area assistant chief is a vital community leader who plays a pivotal role in the MPDSR committee by linking government administrative structures with health initiatives. Being the government’s representative at the grassroots level, the assistant chief facilitates community mobilization, enforcement of health-related directives, and coordination of death reporting. Their involvement ensures that MPDSR activities align with local governance and legal frameworks, enhancing accountability and community participation.

Role of the Area Assistant Chief in MPDSR

• Community Mobilization: The assistant chief mobilizes local residents to participate in MPDSR meetings, ensuring that community voices are heard and that cultural barriers to reporting deaths are addressed.
• Death Reporting Facilitation: They assist in promptly reporting maternal and perinatal deaths to the appropriate health authorities, reducing delays that compromise response effectiveness.
• Coordination with Health Workers: The assistant chief liaises between health facility staff and community members, helping to resolve misunderstandings and promote cooperation.
• Enforcement of Health Policies: They support enforcement of public health regulations such as birth notification and safe delivery practices within their jurisdiction.
• Conflict Resolution: The assistant chief mediates disputes that may arise during sensitive death reviews, maintaining a constructive environment for committee deliberations.

Training Needs for the Area Assistant Chief

• Understanding MPDSR Objectives: Training must clarify the purpose and importance of MPDSR in reducing preventable deaths.
• Data Confidentiality and Ethics: Emphasis on maintaining confidentiality during death reviews to protect families’ privacy.
• Communication Skills: Developing skills to handle sensitive discussions and encourage community trust.
• Legal Frameworks: Familiarization with relevant Kenyan laws and policies related to maternal and perinatal death reporting.
• Leadership and Coordination: Techniques for effective community leadership and teamwork within the MPDSR context.

5.1.2 ACHO/CHA/CHO (Assistant County Health Officer / Community Health Assistant / Community Health Officer)

The ACHO, CHA, or CHO represents the formal health system within the community MPDSR committee and provides clinical expertise and technical guidance. Their role is crucial in verifying causes of death, interpreting medical information, and guiding appropriate health responses. Given their frontline position in community health service delivery, they ensure that the committee’s recommendations are evidence-based and feasible.

Functions of ACHO/CHA/CHO in MPDSR

• Verification of Death Causes: They review clinical records and verbal autopsy data to confirm the probable causes of maternal and perinatal deaths.
• Health Education: Provide health information to committee members and the community on prevention of maternal and newborn deaths.
• Technical Support: Facilitate proper documentation and data management for MPDSR activities.
• Referral Coordination: Advise on strengthening referral systems for complicated pregnancies and newborn care.
• Monitoring and Follow-Up: Participate in monitoring implementation of MPDSR recommendations at the community level.

Training Focus for ACHO/CHA/CHO

• Clinical Aspects of Maternal and Perinatal Deaths: Detailed understanding of common causes and prevention strategies.
• Data Collection and Analysis: Skills in conducting verbal autopsies, filling MPDSR tools, and interpreting data trends.
• Counseling and Communication: Techniques for sensitive interaction with bereaved families and community members.
• Multisectoral Collaboration: Training on working with non-health actors in the committee to address social determinants.
• Ethical Considerations: Upholding confidentiality and non-blaming approaches during death reviews.

5.1.3 CHP from the village where the death has occurred

The Community Health Promoter (CHP) from the village where the death occurred holds a critical grassroots perspective and direct knowledge of the social and environmental factors influencing maternal and perinatal health. Their inclusion ensures that the review process incorporates local context, cultural practices, and community dynamics that may affect health outcomes. The CHP acts as a liaison between the family, community, and the MPDSR committee.

Importance of the CHP in MPDSR

• Local Context Insight: Provides detailed information about the circumstances surrounding the death, including barriers to accessing care.
• Community Trust: Being a familiar face, the CHP facilitates honest communication and reduces stigma during death investigations.
• Data Collection: Assists in gathering information from families and witnesses for verbal autopsy.
• Health Promotion: Uses findings from MPDSR to educate the community on safe maternal and newborn practices.
• Advocacy: Represents community concerns and advocates for resources or interventions needed locally.

Training Requirements for the CHP

• Verbal Autopsy Techniques: Instruction on collecting accurate and respectful information from bereaved families.
• Confidentiality and Ethics: Emphasizing the importance of privacy and sensitivity in death investigations.
• Cultural Competence: Understanding how cultural beliefs impact maternal and newborn health and death reporting.
• Communication Skills: Training on active listening and non-judgmental engagement.
• Community Mobilization: Strategies to encourage community participation in MPDSR and uptake of recommendations.

5.1.4 Clinician from the health facility

Contributions of the Clinician to MPDSR

• Clinical Cause of Death Verification: Review of medical records and investigation of clinical management to identify gaps.
• Health System Analysis: Identification of facility-level barriers such as delays, resource shortages, or clinical errors.
• Capacity Building: Training other committee members on clinical aspects of maternal and newborn care.
• Implementation of Recommendations: Facilitating changes within the health facility based on MPDSR findings.
• Reporting and Feedback: Ensuring timely submission of death reports to sub-county and county health management teams.

Training Areas for the Clinician

• MPDSR Guidelines and Protocols: Familiarity with national MPDSR tools and reporting requirements.
• Clinical Audit Skills: Techniques for analyzing clinical care processes and outcomes.
• Interdisciplinary Collaboration: Working effectively with community members and other sectors.
• Communication and Sensitivity: Handling family interactions with empathy during death reviews.
• Quality Improvement: Applying MPDSR findings to enhance service delivery and patient safety.

5.1.5 Member of the civil society

The inclusion of a civil society member in the community MPDSR committee introduces an independent perspective focused on human rights, accountability, and community empowerment. Civil society organizations often have strong links to marginalized groups and can advocate for equitable access to maternal and child health services. Their presence enhances transparency and fosters a culture of shared responsibility for preventing maternal and perinatal deaths.

Roles of Civil Society Member in MPDSR

• Advocacy and Accountability: Ensures that MPDSR actions are community-centered and that authorities respond to identified gaps.
• Community Awareness: Mobilizes public support for maternal and newborn health initiatives.
• Resource Mobilization: Assists in linking the committee to funding or technical support from NGOs or donor agencies.
• Monitoring Implementation: Tracks progress of MPDSR interventions and reports challenges.
• Human Rights Promotion: Safeguards the rights of women and newborns in health service delivery and death investigations.

Training Priorities for Civil Society Members

• Understanding MPDSR Framework: Comprehensive knowledge of MPDSR objectives and processes.
• Human Rights in Health: Training on rights-based approaches to maternal and newborn care.
• Community Engagement Strategies: Skills in mobilizing and educating diverse community groups.
• Monitoring and Evaluation: Techniques for tracking implementation and reporting outcomes.
• Collaboration with Health Authorities: Building partnerships with government and health providers for effective response.

Chapter Summary

This chapter focused on the establishment and training of the Community Maternal and Perinatal Death Surveillance and Response (MPDSR) committee, highlighting the roles of key members such as the area assistant chief, community health officers, community health volunteers from the affected village, clinicians from health facilities, and civil society representatives. It described the essential MPDSR reporting tools, including the perinatal and maternal notification form, MOH 519, and the verbal autopsy form, which are critical for systematic data collection. The chapter explored the primary causes of maternal and perinatal deaths, emphasizing infections, anemia, childbirth complications, and existing comorbidities as key contributors. It detailed the procedures for conducting maternal and perinatal death notifications and the community verbal autopsy process, which involves gathering comprehensive information from families and community members. Documentation and reporting of the verbal autopsy outcomes were discussed as vital steps to ensure accurate records and inform interventions. Finally, the importance of providing feedback to the community on verbal autopsy findings was underscored to promote transparency and encourage collaborative efforts in preventing future deaths.