Our mortality program aims to implement simple clinic-based mortality assessment for all deaths at the health center. 

Overview

The rationale for this program is as follows.  Every death in the catchment area, even if apparently not related to care provided at the clinic, should be reviewed by the staff team during weekly morbidity and mortality reports.  The reports of death will be compiled by staff members and by CHWs.  Deaths will be analyzed by their proximate causes, as well as their biological, structural, and societal precursors.   Additionally, at this meeting, any morbidity incurred by patients at the clinic itself (whether the clinic is at “fault” or not) will be discussed.   The goal is not to identify "mistakes" which implies personal culpability but rather "systems-level errors" which implies collective responsibility.

The fundamental rationale for these meetings is to understand the ultimate arbiter of epidemiological truth—death—among our community members.  Why did a death happen?  What was the immediate cause?  What role, if any, did or could have been played by CHWs? By clinic staff?  What are the underlying comorbid conditions suffered by the patient?  What are the underlying public health and socioeconomic conditions that coalesced to lead to the death?  What concrete steps can be taken to immediately help the families affected by the death?  What are some long-term solutions that we need to think about?  The main domains involve:

• hospital operations-- issues in patient flow, intake, processing or review of lab or pharmaceutical requests
• supply chain-- issues in obtaining a reliable supply of medicines, supplies, or equipment
• equipment/machinery-- issues in the functioning or quality of equipment, medical devices, and machines
• personnel-- issues pertaining to staff training, professionalism, management, or collaboration
• outreach-- issues in recruiting and engaging patients into timely and appropriate medical treatment
• societal/structural -- issues in gender, caste, economic, or other forms of discrimination; issues in roads, communications, educational facilities, and healthcare infrastructure

Further information is provided at the following blog post: http://blog.nyayahealth.org/2009/10/29/mortalityreview/

Data 

At the following link, we publish the the de-identified causes of death that have occurred at our clinic:  

http://spreadsheets.google.com/pub?key=p-TJjzE7A-O4wT-vh-N_0Rw&single=true&gid=10&output=html

Mortality Review Cases

These are discussion between Nyaya team members about mortality cases.  These are available for review at: 

http://docs.google.com/leaf?id=0B9ZQBHyI2oBYODQxMDI3NzQtZjAwMC00YmI3LTlmYmEtYjQ1NDIyYTIzYjVl&hl=en 

Nyaya members may edit via the following link: 

http://docs.google.com/a/nyayahealth.org/leaf?id=0B9ZQBHyI2oBYODQxMDI3NzQtZjAwMC00YmI3LTlmYmEtYjQ1NDIyYTIzYjVl&hl=en

Verbal Autopsies

For patients who die at home, our CHWs should undertake a mortality "verbal autopsy" as per http://www.who.int/whosis/mort/verbal_autopsy_standards2.pdf  This should accompany filling out the HMIS international death registry form.