Karnataka Mid term Experiences - Infant Death Review


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Infant Death Review Mid-Term Experience from Pilot Districts:

Infant Death Review Mid-Term Experience from Pilot Districts Dr. Sudeep Shetty Senior Consultant ( Child Health -Karnataka) UNICEF Child health Workshop - The Capitol, Bangalore 23 rd Sept 2011


Background Unsatisfactory Trend of Infant Mortality GoK’s Commitment to reach NRHM Goal/MDG National IDR Consultation – Mar 2010 Field Testing of Primary tools Development of Guidelines & Final tools Need of support for operationalization 10/9/2011 Child Health Workshop 2

We are working Here:

We are working Here Raichur High IMR Lowest HDI Rank Weak Private Sector – predominantly Public Sector health facilities Low IMR Highest HDI Rank Dominant Private Sector – Seven Medical Colleges in District Dakshina Kannada 10/9/2011 Child Health Workshop 3


Objectives Main: Develop a replicable IDR model. Collateral: - Support the state in developing final guidelines & tools - To develop a Training Module on IDR implementation - Involvement of multiple stakeholders - To look in to the trend of IMR in 2 districts 10/9/2011 Child Health Workshop 4

UNICEF’s Support Components:

UNICEF’s Support Components National level IDR Consultation Develop tools, Field Testing & Refining the tools State/District level launch Capacity Building/Sensitization Printing & Supply of tools & IEC materials IDR SC Review & Analysis Feedback Dissemination & Advocacy at National level 10/9/2011 Child Health Workshop 5

IDR Process:

IDR Process First Information Report Verbal Autopsy Parallel Report from facilities IDR SC Review Meetings Factor Identification Frame (FIF) Feedback on individual death Data-entry & Analysis Periodic Reports & Feedback 10/9/2011 Child Health Workshop 6


FIR ASHA/AWW will report infant deaths telephonically to DHO (Cell # Raichur: 94492-39468, Dakshina Kannada: 9483503672) within 24 hours Followed by submission of FIR Form (Hard copy) to PHC. MO will retain copy with him/her for paying incentive to worker . Prepaid postal envelopes. FIR will be entered in FIR Register at DHO 10/9/2011 Child Health Workshop 7

IDR Community Poster:

IDR Community Poster 10/9/2011 Child Health Workshop 8

Facility Posters:

Facility Posters 10/9/2011 Child Health Workshop 9

Verbal Autopsy:

Verbal Autopsy 10/9/2011 Child Health Workshop 10

IDRSC Review:

IDRSC Review 10/9/2011 Child Health Workshop 11


FIF 10/9/2011 Child Health Workshop 12

Data Entry & Analysis:

Data Entry & Analysis 10/9/2011 Child Health Workshop 13


Feedback For individual reported deaths Highlights medical cause but focus on other factors identified & preventive measures To be sent after IDRC Review Prepaid post letters 10/9/2011 Child Health Workshop 14


Strengths Existence of Standard GoK Guidelines & Tools Very supportive experts from private sectors Sensitized Health System & other stakeholders IDR is so far perceived non-threatening by MOs of district Improved reporting - awareness among Health care workers on importance of reporting Mostly on time reporting, ASHA/AWW using mobile phone Committed District Health Authorities, Committed RCHO Regular IDR SC reviews Availability of required number of VAN & VAP forms Improved Feedback Mechanism 10/9/2011 Child Health Workshop 15


Weaknesses FIR : No uniformity in reporting Initial resistance to fill elaborate VA Formats MOs delegate Health workers to do Verbal Autopsy Poor reporting system, Incomplete, inconsistent data, Poor documentation which includes missing information, Not following ECS criteria Delay in reporting ~ 10% Poor reporting from even public hospitals No reports from Hospitals, No standard Facility Based Format Time for IDRSC & IDRC Reviews, Other competing priorities. Low priority to take IDR at DC meetings Poor availability/Non-availability of experts at district level? 10/9/2011 Child Health Workshop 16


Opportunities IDR is a Platform to discuss various child health issues with other stakeholders A platform to get confidence from other service providers Identifies facilities which implement/follow National or state New-born Care Protocols Opportunity for facilities to follow recommended protocols Identify gaps in clinical practice Use of MCTS in fetching baseline information. Government of India would like to adapt it for developing national guidelines 10/9/2011 Child Health Workshop 17


Threats Fear of Law suits for poor management at different level of care High IMR & High preventable IDs may lead to Under Reporting 10/9/2011 Child Health Workshop 18

Steps Ahead:

Steps Ahead Consolidating IDRC Reviews & Scale Up Distribution & Use of ACSM Materials Decentralized Data entry? Involvement of private facilities in reporting Capacity Building of DHA for analysis Supporting final development of guidelines & tools Developing IDR Training Module Documentation of processes, “Action Taken Reports”, and lessons learned. Evaluation of IDR Model and opportunities for quality scale-up 10/9/2011 Child Health Workshop 19

Final Output…:

Final Output… INFANT DEATH REVIEW – “KARNATAKA MODEL” 10/9/2011 Child Health Workshop 20



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