Practice of death surveillance and response for maternal, newborn and child health: a framework and application to a South African health district

There have been significant reductions in maternal, neonatal and child mortality in South Africa over the last decade, attributed principally to the prevention and treatment of HIV. However, despite a long history and institutionalised practice, there is little understanding of the role of Death surveillance and response (DSR) implementation and functioning in this mortality reduction. Clear guidance on how best to assess this functioning is also lacking; one study showed no association between consistent auditing and perinatal mortality rates.

Given the lack of standardisation and consensus on elements for assessing the functioning of DSR, this paper proposes an assessment framework using criteria drawn from the literature and then applies the framework to evaluate existing maternal, peri/neonatal and child DSR mechanisms in one South African district.

This paper thus seeks to answer the following question: Based on a comprehensive assessment framework, how functional are the district’s DSR mechanisms?