Beruflich Dokumente
Kultur Dokumente
1 INTRODUCTION...............................................................................................................7
1.1 Objectives............................................................................................................................9
1.2 Target...................................................................................................................................9
1.3 Content Overview..............................................................................................................10
1.4 Scope and Limitation.........................................................................................................10
1.5 How to Use this Manual.................................................................................................... 11
MATERNAL AND NEONATAL DEATH REPORTING................................................. 11
2 SYSTEM........................................................................................................................... 11
2.1 MNDRS Objectives........................................................................................................... 11
2.2 Limitations.........................................................................................................................12
2.3 System Architecture...........................................................................................................12
2.4 System Components..........................................................................................................14
3 ORGANIZATIONAL STRUCTURE................................................................................15
3.1 Community Health Team Members...................................................................................16
3.2 Reporting Facilities (Hospitals/Health Facilities/Birthing Homes/RHUs/HCs)...............16
3.3 Municipal Health Office/City Health Office/Health Center..............................................16
3.4 Provincial Health Office/Provincial or City Review Team...............................................16
3.5 Centers for Health Development.......................................................................................17
3.6 Family Health Office.........................................................................................................17
3.7 National Epidemiology Center..........................................................................................17
3.8 Information Management Service.....................................................................................18
4 MNDRS POLICIES AND PROCEDURAL GUIDELINES.............................................18
4.1 Statement of Policies.........................................................................................................18
4.2 MNDRS Process Flows.....................................................................................................19
4.3 Reporting Frequency.........................................................................................................27
4.4 Security and Confidentiality Mechanism..........................................................................27
4.5 MNDRS Service Requirements.........................................................................................28
4.6 System Monitoring and Evaluation...................................................................................28
5 MNDRS OPERATIONS...................................................................................................29
5.1 MNDRS System Operations..............................................................................................29
6 REFERENCES..................................................................................................................31
MNDRS Manual 1
ACRONYMS
DOH WCFHC Department of Health Women Children and Family Health Cluster
DR Delivery Room
GP Gravidity Parity
HC Health Center
2 MNDRS Manual
MDRF Maternal Death Reporting Form
OR Operating Room
pregnancy outcome/result)
MNDRS Manual 3
DEFINITION OF TERMS
Antecedent Cause of Death : Fetal and/or maternal conditions giving rise to the immediate cause
of death.
Example:
Fetal Death : The death of the fetus aged 20 weeks and above prior to the complete
expulsion from the mother; the death is indicated by the fact that
after separation, the fetus does not breath or show any evidence of
life such as beating of the heart, pulsation of the umbilical cord or
definite movement of voluntary muscles.
Health Facility : Any facility that provides MNCHN services. These include hospitals,
lying-in clinics, BHS, and RHUs to name a few.
Immediate Cause of Death : Disease, injury or complication that led directly to death.
Example:
4 MNDRS Manual
Invalid Maternal Death Report: Reported as a maternal death case, but after validation, the report
did not pass the criteria to be considered as a maternal death case
Multiple Births : More than one fetus is being carried to term in a single pregnancy.
Examples of multiple births include twins, triplets etc.
Neonatal Death : Death of a liveborn infant within the first 28 days of life.
Non- Institutional Delivery : Childbirth occurring in a non-health facility (i.e. home, modes of
transportation, roads, commercial buildings, prisons etc.)
Obstetric Death, Direct : Maternal deaths resulting from obstetric complications (i.e.
hemorrhage, pregnancy related hypertension, infection and difficult
labor) of the pregnant state (i.e. pregnancy, labor and puerperium).
Commonly reported causes stem from intervention errors.
Obstetric Death, Indirect : Maternal deaths resulting from either previous existing diseases
or diseases that developed during pregnancy. Both are not due to
direct obstetric causes but aggravated by the physiologic effects of
pregnancy.
Operative Delivery : Any obstetric procedure in which active measures are taken to
accomplish delivery. Examples of operative deliveries are those
vacuum deliveries, forceps deliveries and caesarian section.
Parity : Number of times a woman has given birth to a fetus with AOG > 20
weeks, regardless whether the child was born alive or dead.
Preterm Births : Premature births: > 20 weeks but < 37 weeks AOG.
Preterm Neonate : Neonate born after 20 weeks AOG but before 37 weeks AOG.
MNDRS Manual 5
Term Deliveries : Term births: > 37 weeks AOG.
Underlying Cause of Death : Disease or injury that initiated the train of events leading directly to
death.
Example:
Valid Maternal Death Report : Reported and validated as a maternal death case by the Provincial or
City Review Team
6 MNDRS Manual
1 INTRODUCTION
One of the difficult undertaking that is being thoroughly and systematically addressed in
the Philippines is achieving its commitment to Millennium Development Goals of lowering
maternal mortality ratio and infant mortality rate. The target is to lower maternal mortality ratio
(MMR) to 52 deaths per 100,000 live births from 162 (NSO, 2006) and neonatal mortality rate
(NMR) to 10 per 1000 live births from 16 (NSO, 2008, NDHS) by 2015. Studies show that the
leading causes of these neonatal deaths are disorders related to short gestation and low birth weight.
This is much higher among infants whose mothers had no antenatal care or medical assistance at
the time of delivery (NSO, 2006; NSO, 2008; DOH, 2008).
In 2008, the Philippine Department of Health issued the guidelines on implementing Reforms
for the Rapid Reduction of Maternal and Neonatal Mortality (DOH, 2008) through effective
population-wide provision and use of integrated Maternal, Newborn, and Child Health and
Nutrition (MNCHN) services as appropriate to any locality in the country. The strategy changed
from a risk approach that ascertain and focusing only at pregnant women at risk of complications
to a model that considers all pregnant women at risk of such complications. The overall strategy
and interventions converged on addressing four risk factors of maternal and child health, namely
(DOH, 2008): Having untimed, unwanted, unplanned and unsupported pregnancy; Not securing
adequate care during the course of the pregnancy; Delivering without the care of skilled birth
attendants and/or not having access to emergency obstetric and neonatal care; and Not securing
proper post partum and post natal care.
The strategy aims to achieve the following intermediate results (DOH, 2009):
4. Every mother and newborn pair secures proper post-partum and newborn care with
smooth transitions to the women’s health care package for the mother and child survival
package for the newborn.
MNDRS Manual 7
Women are encouraged to give birth in conveniently located health facilities that are suitably
equipped to render basic emergency obstetric and newborn care (BEmONC). Complicated
pregnancies and those needing caesarian sections and blood transfusions are referred to higher
level facilities rendering comprehensive emergency obstetric and newborn care (CEmONC). This
network of basic and comprehensive emergency obstetric and newborn care provider facilities is
deployed in such a manner as to allow women to access the services they need within a timeframe
that ensures a safe outcome.
But, even if quality services are available, a major challenge is to facilitate utilization of clients
of these services especially among mothers that are hard to reach and unprotected from financial
risk. Likewise the geographic characteristics of the country and some cultural practices contribute
to the problem. Using ICT is a facilitating tool for health services given its pervasive use in
the country. Based on 2012 statistics, there are 86 mobile cellular phone subscriptions per 100
inhabitants (DOST-ICTO, 2012) and an average Filipino user sending an average of 600 messages
per month.
The Philippines has devolved it health services in 1991 such that Local Government
Unit-governed health system delivers the integrated maternal newborn child health and nutrition
service package which should be strengthened to ensure delivery of the integrated model more
responsive to the local situation. This strategy and the archipelagic characteristics nature as well
as the presence of many geographically isolated and disadvantaged areas (GIDAs) require among
others the use of information and communication technology. All BEmONC or CEmONC facilities
are required to be equipped with radio or telephone to facilitate contact with a designated higher-
level facility in cases of referrals.
The MNDRS is one response to problems on flawed and uncertain reporting of maternal
and neonatal mortalities. Underreporting of deaths among women and children is common
(Garces, 2009) especially in GIDAs and with Indigenous Peoples, and death reviews are done
only quarterly. The MNDRS tries to respond to these problems. The MNDRS functional design
supports MNCHN Strategy by capturing deaths at an early stage at various levels of the health
system and thus, tries to address underreporting and late reporting. This is envisioned to provide
a fairly complete estimation, and an immediate and efficient report of both maternal and neonatal
mortalities with the limitations of the routine registration system.
Republic Act No. 10354 otherwise known as the “Responsible Parenthood and Reproductive
Health Act of 2012,” in Section 8 requires health facilities to conductregular “maternal, fetal
and infant death reviews” to ensure something is learned from each circumstance and proper
interventions are put in place.
8 MNDRS Manual
This Manual of Operations highly takes into account the operational component of the
Maternal and Neonatal Death Reporting System to address the above situational health conditions.
It principally attempts to fill in the need for a reference guide for the employment of the system
for health workers. The document discusses the guiding principles, policies, and standards in the
adoption, implementation, management and integration of properly, completely, and adequately
reporting maternal and neonatal deaths in an MNDRS. As an overall management, it institutes
appropriate interventions on the gaps that lead to maternal and neonatal mortalities at various
levels in the health system.
The normative policies, standards and guidelines mentioned in this document are adoptions
from guidance documents from the WHO, DOH and Centers for Health Development and health
partners. The MNDRS architecture and implementation plans were developed from a series of
consultative workshops with various national and regional stakeholders, demonstration projects,
and local experiences on maternal and neonatal mortality reduction initiatives. The success of local
government units in implementing innovative strategies and achieving favorable health outcomes
provided inspiration and additional inputs in finalizing this document.
1.1 Objectives
1.2 Target
This MANOPS is principally intended for maternal and child health service providers
especially those involved in the prevention, monitoring, and management of maternal and
neonatal deaths at various levels of governance. Health service providers include those at
the primary health facilities and hospitals, both at the public and private sectors.
MNDRS Manual 9
1.3 Content Overview
This section introduces the objectives and target users of the manual, and gives an
overview of the contents.
This section briefly depicts the MNDRS objectives, system scope and limitations,
system architecture and components.
This section describes the various key stakeholders involved in MNDRS, with their
corresponding duties and responsibilities in the overall system implementation, supervision,
evaluation and sustainability.
This section describes the system policies and procedural guidelines in its rollout both
at the community and hospital level.
This section describes the step by step account of the four focal processes of the
MNDRS.
This MANOPS attempts to provide the minimum standards needed for the overall
implementation of MNDRS. It also offers a comprehensive amalgam of salient and
vital information to guide health providers especially those at the local level on the
operational management of the system. This manual remains a work in progress.
10 MNDRS Manual
1.5 How to Use this Manual
This manual is intended for health service providers at all levels of health service
delivery system. Here are suggestions on how the manual is to be used:
b. Read sections 4 and 5 for specific procedural guidelines on the systems operation
of the MNDRS.
The Maternal and Neonatal Death Reporting System (MNDRS) is a mechanism for reporting
of maternal and neonatal deaths using internet and SMS technology. It is the DOH’s response
in support to addressing the increase and incomplete and uncertain reporting of maternal and
neonatal mortalities, along with the inadequate and late maternal review.
The functional design of the system commits deeply to the MNCHN Strategy which strongly
integrates “more innovative ways to deliver cost-effective and sustainable interventions” focusing
on the major causes of maternal and newborn death in the short term period (2008-2015).
The technical design, in contrast, primarily intends to add in Short Message Service (SMS)
applications to the current health data reporting system. If properly implemented, this program can
provide the agency not only a fairly complete estimation, but also an immediate and efficient report
of both maternal and neonatal mortalities in the absence of a reliable routine registration system;
subsequently, better concerted efforts can be taken to promote timely, effective and preventive
interventions.
c. To provide the necessary reports at all levels for proper monitoring, development of
program interventions, policies and protocols
MNDRS Manual 11
2.2 Limitations
The MNDRS covers all data reported after the occurrence of maternal and/or neonatal
deaths. However, this initiative will not settle on comprehensive analysis of the reported
deaths, as well as on pregnancy tracking. These concerns will be addressed broadly in
separate systems.
a. Reporting begins at the designated reporting unit – either at the community or the
healthcare facility where the deaths happen. Registered MNDRS reporters – either
a midwife in the community or a designated health service provider in a healthcare
facility - gather all pertinent data surrounding the event. They then transfer the
data into appropriate e-MNDRS forms, according to the place of occurrence of
death, and send the report either through SMS submission via the SMS gateway or
through online submission via web-based technologies.
b. The MNDRS Central Database System located at the DOH Central Office in Manila
receives the reports sent.
i. For reports sent via text messaging, only correctly formatted reports are
integrated into the online system for updating. For reports to be sent via
online, in contrast, the designated reporter can directly fill out and supply
all the required data on the online MNDRS report form. After which, these
reports are made accessible to all designated recipients, namely the Municipal
Health Officer (MHO)/City Health Officer (CHO), Provincial Health Officer
(PHO), Center for Health Development (CHD) and DOH Central Office (CO)
at all levels of health governance through the MNDRS website. However, the
viewing rights and access levels of these recipients differ, depending on their
designated responsibility, and area of jurisdiction.
ii. For the SMS and online reporting, the MNDRS likewise sends Immediate
Notification Alerts to the mobile phones of designated recipients alerting
them that a mortality report has been submitted and requires appropriate
and immediate action. Similarly, for every validation or review made on the
reports, these designated recipients are further notified via text messaging.
12 MNDRS Manual
iii. In addition, the National Statistics Office and the Office of the Local Civil
Registrar shall also receive monthly reports for validation of congruity of
statistical reports between agencies.
c. In the MNDRS website, tables and graphs can be generated from which statistical
trends and distribution patterns of the mortalities can be analyzed. Furthermore,
tables outlining the actions – validation or review of these reports - taken by the
designated recipients on the submitted reports will also be shown; thereby, providing
the CHD and DOH CO a vantage point of the work performance of these units
within their jurisdiction.
MNDRS Manual 13
2.4 System Components
The key feature of the MNDRS is the SMS reporting functionality, enabling a
rapid and alert reporting to all concerned health workers at various levels parallel to the
accomplishment and submission of forms, triggering immediate investigation and review,
and development of appropriate and immediate interventions, if applicable.
a. Alert System
This is the key component of MNDRS that enables sending of advanced notification
related to or regarding the deaths as they occur, thereby allowing for fast and real time
reporting, particularly during emergency setting, and conduct of necessary investigation,
validation and development of immediate intervention, if applicable. However, this
also has its limitation given the purpose it serves: the data included in the actual reports
are short and limited, and the report submitted has yet to be confirmed and validated.
Another key characteristic of the MNDRS is the generation of reports that can be used
by the DOH Program Managers for health planning. It dwells mainly on the management
decision and interventions vis-à-vis statistical trends and distribution patterns (i.e. gender,
age, cause-specific deaths, geographical location etc.) of the mortality reports. Findings from
the reports will serve as basis for the formulation of general policies, budgeting protocols
and development of counteractive interventions to support better decision-making.
14 MNDRS Manual
Figure 2. The MNDRS System Components
3 ORGANIZATIONAL STRUCTURE
MNDRS Manual 15
As shown in Figure 3, the Department of Health is the principal agency in ensuring the successful
and smooth implementation of MNDRS. The Women Children and Family Health Cluster
(WCFHC) and the Information Management Service (IMS) with the National Epidemiology
Center (NEC) shall spearhead the operations of this project.
The duties and responsibilities of the various key stakeholders involved in MNDRS are as
follows:
b. Encode validated data in the Maternal and Neonatal Death in the MNDRS website
b. Validate the data then encode the reported maternal/neonatal death in the MNDRS
website
e. Conduct community and facility based data collection and analysis of the deaths
within their area of jurisdiction
b. Conduct the review process for decision-making, planning for interventions and
policy development
16 MNDRS Manual
3.5 Centers for Health Development
a. Learn current software operations of the MNDRS and further updates on the system
b. Conduct orientation and training on Maternal and Neonatal Death Reporting System
c. Review reports submitted by the Provincial Health Office or City Review Team and
assist the PRT/CRT in the maternal and neonatal death reviews
h. Consolidate and submit all maternal and neonatal death review reports submitted
by the PRT/CRT, to FHO
i. Assess and analyze statistical trends and distribution patterns of maternal and
newborn mortalities in the region to guide in decision-making for interventions and
policy development
j. Oversee and supervise day to day operations and ensure efficient and effective
implementation of the system
e. Maintain network and database operations 24 hours a day, and 7 days a week
f. Establish, maintain, and regularly update backup and restore procedures for servers,
application system, and database
l. Provide regular feedback to all end-users on the technical operations of the MNDRS
m. Oversee and supervise day to day operations and ensure efficient and effective
implementation of the system
b. The WCFHC, NEC and IMS shall oversee the overall management and
implementation of MNDRS.
c. The Center for Health Development shall oversee and regularly monitor the
submission of data on maternal and neonatal death reporting or review cases.
18 MNDRS Manual
4.2 MNDRS Process Flows
ii. The midwife-accomplished CHT MDR form then submits to the MHO/
CHO for validation as to the veracity and reliability of the data on
the death report. An Immediate Notification Alert will also be sent to
the MHO/CHO and other authorized health personnel, alerting them
of the submitted report requiring immediate and appropriate action.
MNDRS Manual 19
iii. Once the report has been fully validated, the MHO/CHO encodes other
relevant data gathered from the report into the online system and mark the
report “validated.” Consequently, the MHO/CHO has to sign the CHT MDRF
and accomplishes the death certificate.
iv. Accomplished death certificate is forwarded to the LCR for registration. Once
registered, a copy of death certificate with the DCN is given to the MHO/
CHO. The DCN is affixed to the accomplished online maternal death record.
vi. Reviewed reports from the PRT/CRT are submitted to the respective CHD
for further assessment and analysis, such as statistical trends and distribution
patterns of the maternal mortalities within the region.
vii. Consolidated maternal death reports from the PRT/CRT at the CHD level are
forwarded to DOH CO in a quarterly basis. Findings and recommendations
drawn from the reviewed reports are taken into account for the planning and
development of responsive program interventions, policies and protocols.
20 MNDRS Manual
b. Maternal Death – Facility Reporting System
ii. If the report is deemed complete and accurate, the designated reporter sends
the report either through SMS, or by directly filling out the online form
and mark the report “validated.” Consequently, the reporter has to sign the
FMDRF, accomplish the death certificate and submit this to the MHO/CHO
for signature.
iii. Accomplished death certificate is forwarded to the LCR for registration. Once
registered, a copy of death certificate with the DCN is given to the reporting facility.
The DCN is then affixed into the accomplished online maternal death record.
MNDRS Manual 21
iv. Signed FMDRF and registered death certificate is submitted to the PRT/CRT.
The PRT/CRT Secretariat conducts the initial review of the submitted reports
for accuracy, completeness and soundness of the data. If deemed accurate
and valid, reports are compiled and consolidated for comprehensive review
by the PRT/CRT. The review includes analysis of findings and formulation
of appropriate plans of actions relative to the gaps, issues and problems that
comes out or is extracted from the review of maternal and neonatal deaths
v. Reviewed reports from the PRT/CRT are submitted to respective CHD for
further assessment and analysis of statistical trends and distribution patterns
of the maternal mortalities within the region.
vi. Consolidated maternal death reports from the PRT/CRT are forwarded to
DOH CO in a quarterly basis. Findings and recommendations drawn from
the reviewed reports are taken into account for the planning and development
of responsive program interventions, policies and protocols relative to the
gaps, issues and problems that comes out or is extracted from the review of
maternal and neonatal deaths.
i. If the maternal mortality occurred in transit, the referring facility health team
leader or the sending RHU physician shall be responsible to establish the
cause of death, and in gathering other pertinent data surrounding the event,
followed by transferring these data into the FMDRF, assessment of the report
for accuracy and completeness of information and signing the form.
ii. If the report is deemed complete and accurate, the designated reporter sends
the report either through SMS, or by directly filling out the online form.
Submission of accomplished FMDRF to the PRT/CRT, MHO/CHO and
FHSIS unit proceeds after. An Immediate Notification Alert is submitted to
the designated recipients, alerting them of the submitted report that requires
their appropriate action.
iii. The MHO/CHO validates the data as to its veracity and reliability and if deemed
valid, the MHO/CHO encodes other relevant data gathered from the report
into the online system and marks the report as “validated.” Consequently, he
accomplishes the death certificate.
iv. Accomplished death certificate is forwarded to the LCR for registration. Once
registered, a copy of death certificate with the DCN is given to the MHO/CHO.
The DCN is then affixed into the accomplished online maternal death record.
22 MNDRS Manual
v. Signed FMDRF is submitted to the PRT/CRT. The PRT/CRT Secretariat
conducts the initial review of the submitted reports for accuracy, completeness
and soundness of the data. If deemed accurate and valid, reports are compiled
and consolidated to be subjected to comprehensive review by the PRT/CRT.
The review includes analysis of findings and formulation of appropriate
plans of actions relative to the gaps, issues and problems that come out or are
extracted from the review of maternal and neonatal deaths.
vi. Reviewed reports from the PRT/CRT are submitted to respective CHD for
further assessment and analysis of statistical trends and distribution patterns
of the maternal mortalities.
vii. Consolidated maternal death reports from the PRT/CRT are forwarded to
DOH CO on a quarterly basis. Findings and recommendations drawn from
the reviewed reports are taken into account for the planning and development
of responsive program interventions, policies and protocols relative to the
gaps, issues and problems that comes out or is extracted from the review of
maternal and neonatal deaths.
ii. The midwife-accomplished CHT NDR form is submitted to the MHO for
validation of the veracity and reliability of the data on the report. An Immediate
Notification Alert is also sent to the MHO, alerting him of the submitted report
that requires his appropriate action.
iii. The MHO/CHO validates the veracity and reliability of the data on the
submitted report online. Once deemed valid and veritable, the MHO/CHO
then now encodes other relevant data gathered from the report into the online
system and marks the report “validated.” Consequently, the MHO/CHO has
to sign the CHT NDRF and accomplish the birth and death certificates.
iv. Accomplished birth and death certificate are forwarded to the LCR for
registration. Once registered, a copy of death certificate with the DCN is
given to the MHO/CHO. The DCN is then affixed into the accomplished
online neonatal death record.
v. The signed CHT NDRF and registered death certificate is submitted to the PRT/
CRT. The PRT/CRT Secretariat conducts the initial review of the submitted
reports for accuracy, completeness and soundness of the data. If deemed
accurate and valid, compilation of said reports for comprehensive review by
the PRT/CRT ensues, followed by analysis of findings and formulation of
appropriate plans of actions.
vi. Reviewed reports from the PRT/CRT are submitted to respective CHD for
further assessment and analysis of statistical trends and distribution patterns
of the neonatal mortalities.
vii. Consolidated neonatal death reports from the PRT are forwarded to DOH CO
quarterly. Findings and recommendations drawn from the reviewed reports are
taken into account for the planning and development of responsive program
interventions, policies and protocols.
24 MNDRS Manual
e. Neonatal Death – Facility Reporting System
ii. If the report is deemed complete and accurate, the designated reporter now
sends the report either through text messaging, or directly filling out the online
form and mark the report “validated.” Consequently, the MHO/CHO has to
sign the FNDRF and accomplishes the birth and death certificate.
iii.
Accomplished birth and death certificate are forwarded to the LCR for
registration. Once registered, a copy of death certificate with the DCN is
given to the reporting facility. The DCN is then affixed into the accomplished
online neonatal death record.
MNDRS Manual 25
iv. The signed FNDRF and registered death certificate is submitted to the PRT/
CRT. The PRT/CRT Secretariat conducts the initial review of the submitted
reports for accuracy, completeness and soundness of the data. If deemed
accurate and valid, compilation of said reports for comprehensive review by
the PRT/CRT ensues, followed by analysis of findings and formulation of
appropriate plans of actions.
v. Reviewed reports from the PRT/CRT are submitted to respective CHD for
further assessment and analysis of statistical trends and distribution patterns
of the neonatal mortalities.
vi. Consolidated neonatal death reports from the PRT are forwarded to DOH CO
quarterly. Findings and recommendations drawn from the reviewed reports are
taken into account for the planning and development of responsive program
interventions, policies and protocols.
i. If the neonatal mortality occurred in transit, the referring facility health team
leader or the sending RHU physician is designated to obtain birth and maternal
history and gather other pertinent data surrounding the event, followed by
transferring these data into the FNDRF, assessment of the report for accuracy
and completeness of information and signing the form.
ii. If the report is deemed complete and accurate, the designated reporter can
now send the report either through text messaging, or directly filling out the
online form. Submission of accomplished FNDRF to the PRT, MHO and
FHSIS unit proceeds after. An Immediate Notification Alert is submitted to
the designated recipients, alerting them of the submitted report that requires
their appropriate action.
iii. The MHO/CHO validates the veracity and reliability of the data on the
submitted report online. Once deemed valid and veritable, the MHO now
encodes other relevant data gathered from the report into the online system
and mark the report “validated.” Consequently, the MHO/CHO accomplishes
the birth and death certificate.
iv. Accomplished birth and death certificate are forwarded to the LCR for
registration. Once registered, a copy of death certificate with the DCN is
given to the MHO/CHO. The DCN is then affixed into the accomplished
online neonatal death record.
vi. Reviewed reports from the PRT/CRT is submitted to respective CHD for
further assessment and analysis of statistical trends and distribution patterns
of the neonatal mortalities.
26 MNDRS Manual
vii. Consolidated neonatal death reports from the PRT/CRT are forwarded to
DOH CO quarterly. Findings and recommendations drawn from the reviewed
reports are taken into account for the planning and development of responsive
program interventions, policies and protocols.
The reporting frequency for the CHT, Facility-Based and MHO/RHU is dependent
to the frequency of death cases – as the death occurs or at a daily basis, if applicable.
For the CHD and PHO/PRT/CRT, the maternal and neonatal death tracking report
is to be accomplished quarterly.
ii. Protection against known threats or hazards to the security and integrity of
such information and processes; and
iii. Protection against unauthorized access to or use of the information that could
result in substantial harms or inconvenience to any of the stakeholders.
b. The DOH CO has created respective MNDRS accounts, along with setting of
appropriate viewing rights and access levels for all designated MNDRS recipients
(i.e. RHU, MHO/CHO, PHO and CHD), contingent on their area of jurisdiction.
Moreover, each reporting facility is also designated with a unique facility code, an
indication of data ownership sent via SMS.
c. The CHD and NCDPC in collaboration with IMS shall assign the appropriate
username and password for each facility. However, the assigned password has an
expiry date to prevent inadvertent and unauthorized use, in case the user is no longer
connected with the respective health facility. The IMS sets the window period for
the password prior to expiration.
MNDRS Manual 27
4.5 MNDRS Service Requirements
To ensure smooth operations of the MNDRS system, the following conditions must be met
by the concerned units:
a. At the community and facility level, any mobile phone capable of basic SMS for
sending and receiving MNDRS report.
b. At the higher management level, the following prerequisites shall be in place prior
to installation of the system:
2) Hardware maintenance
4) ISP connection
iv. Full time human resource to operate or take care of the MNDRS
v. Issuances on:
To evaluate the progress and congruity of the system with the program objectives, a concurrent
audit and inspection of the MNDRS system both at the grassroots and top management level
shall be conducted. Specific objectives of the system audit encompass assessment of system
performance, adherence to established standards and guidelines, common issues and challenges
encountered, and software review.
28 MNDRS Manual
5 MNDRS OPERATIONS
There are four focal steps in the Maternal and Neonatal Death Reporting System, namely:
Registration of all designated reporters and validation officer/s must commence prior
to the respective reporting and validation process.
i. The DOH CO/CHD creates respective MNDRS account, along with setting
of appropriate viewing rights and access levels of all designated MNDRS
recipients, namely: Health Facilities, Municipal Health Officer (MHO), City
Health Officer (CHO), Provincial Health Officer (PHO), Center for Health
Development and DOH Central Office depending on their area of jurisdiction.
Moreover, each reporting facility is also designated with a unique facility
code.
ii. The RHU officer/MHO/CHO registers profiles and cellular phone numbers of
all the midwives within their jurisdiction. The system automatically generates
their MNDRS account and their corresponding log in details on the website.
The MNDRS account is vital in the registration of these phone numbers to be
used for reporting.
1) Upon registration of profiles of all the midwives, the Rural Health Unit
(RHU) officer/MHO/CHO registers their respective phone numbers to
be used for the reporting, and consequently informs them that the SMS
reporting can now commence from their end.
Reporting of maternal and neonatal death cases begins at the designated reporting unit
– either at the community or the healthcare facility where the deaths happen.
MNDRS Manual 29
i. Registered MNDRS reporters gather all pertinent data surrounding the event.
They then transfer the data into appropriate MNDRS forms, according to the
place of occurrence of death – facility based death or non-institutional death.
The MNDRS Reporter must always fill out appropriate number of copies of
the paper form before submitting the report. The paper forms not only serve
as backup files for the reporting unit, but are also prerequisites for the conduct
of validation and review, respectively.
ii. The reporting unit has two options of reporting the mortalities: either through
SMS submission via the SMS gateway or through online submission via web-
based technologies.
1) For reports sent via text messaging, only correctly formatted reports are
integrated into the online system for updating.
2) For reports sent via online, in contrast, the designated reporter can directly
fill out and supply all the required data on the appropriate online MNDRS
report form.
i. All correctly formatted reports sent via SMS, and online reports are made
accessible to all designated recipients (i.e. MHO/CHO, PHO, and CHD) at
all levels of governance through the MNDRS website. However, the viewing
rights and access levels of these recipients differ, depending on their area of
jurisdiction.
ii. For both SMS and online reporting, the MNDRS likewise sends Immediate
Notification Alerts to the mobile phones of designated recipients (e.g. MHO,
PHO, CHD) alerting them that a mortality report has been submitted and
requires appropriate action. Similarly, for every validation or review made on
the reports, these designated recipients are further notified via text messaging.
1) First level validation is done by the system for verification of the submitted
report for any duplication.
4) Fourth level validation is at the CHD level, tasked not only to verify
the reports submitted by the PHOs/PRTs/CRTs, but also to draw up
conclusions and appropriate interventions at the regional level.
30 MNDRS Manual
d. Generation of Statistical Reports
In the MNDRS website, tables, and graphs can be generated from which statistical
trends and distribution patterns of the mortalities can be analyzed. Further, tables outlining
the actions – validation or review - taken by the designated recipients on the submitted
reports will also be shown; thereby, providing the CHD and DOH CO a clear picture of the
work performance of these units within their jurisdiction.
6 REFERENCES
Department of Health (DOH) 2007. Maternal Death Reporting and Review System: A Guide for LGU
User, Manila: Women’s Health and Safe Motherhood Project 2.
DOH 2008. Administrative Order No. 2008-0029 ‘Implementing Reforms for the Rapid Reduction of
Maternal and Neonatal Mortality,’ issued on September 22, 2008, Manila.
DOH 2011. MNCHN Strategy Manual of Operations, 2nd Edition, Manila: National Center for Disease
Prevention and Control, Department of Health.
DOH, Maternal and Neonatal Deaths Reporting System Project Proposal, Project Briefs, Documentations
and Presentations, 2011-2013
Department of Science and Technology, Information and Communication Technology Office (DOST-
ICTO), 2012 Mobile cellular telephone subscriptions per 100 inhabitants by Year in Philippine ICT
Statistics Portal http://phicts.icto.dost.gov.ph/
Garces, R.G 2009. Reproductive Age Mortality Studies: Community-based Case Control Study on
Maternal Mortality Risk Factors, Manila
NSO, Philippines, and ICF Macro 2009. National Demographic and Health Survey 2008. Calverton,
Maryland: National Statistics Office and ICF Macro
MNDRS Manual 31