Maternal Death audit in Tamil Nadu: Its impact of health system

Background: Tamil Nadu state's progress in reducing maternal mortality is very rapid compared to India Tamil Nadu has introduced several innovations in maternal health services leading to the reduction of MMR from 380 in 1993 to 90 in 2007. One of the innovations is introduction of maternal deaths audit from 1994. Objective and methods: The objective of this paper is to describe how the system was developed and its working. The research was carried out through secondary literature review, interviews with key officials, presentations made by officials in various conferences and government reports. Results: An official order was issued in 2004 for compulsory reporting of maternal deaths within 24 hours in Tamil Nadu. The deaths are reported by community nurses, MOs, and hospitals. Investigations are carried out through community based and facility based maternal death review/clinical audits. Maternal deaths reported increased from 640 in 1995 to 1600 in 2001 followed by a decline. The reviews are placed on a monthly basis before the medical death audit committee chaired by district collector who issues orders for immediate corrective actions. The factors identified are shortage of staff, delay in transportation, multiple referrals, and facilities not ready for EmOC etc. These audit lead to improvements in the health system in-terms of greater accountability, better referral, improve preparedness of EmOC facilities. Learning's from maternal death audit reveal key management lessons for the health managers which should be instituted in all states of India and other developing countries.