Community Participation in Maternal and Perinatal Death Surveillance and Response (MPDSR) in Kenya

Community participation in Maternal and Perinatal Death Surveillance and Response (MPDSR) is expected to support the aims of the MPDSR process by generating data for quality improvement and resource mobilisation. The policy guidelines and literature do not articulate the theoretical underpinnings and practical realities of implementing community participation in MPDSR. This thesis adopts a critical approach to understand how community participation works in practice. I conceptualised the collaborative processes expected between community members and health workers during MPDSR sessions as knowledge co-production. I conducted this qualitative study in two counties in Kenya. I used in-depth interviews, observation of MPDSR sessions, focus group discussions and facilitated a co-production workshop with MPDSR participants. The participation process is characterised by rhetoric, contradictions between what MPDSR participants say and what happens. Rhetoric is created by challenges in the health system and the wider context in which MPDSR is implemented. Health workers talk about the importance of community participation but also about the lack of competence and credibility of community members as knowledge producers. This results in the exclusion of community knowledge from the MPDSR process. Despite health workers’ discourse of no blame in the MPDSR process, health workers and community members associate MPDSR participation with scrutiny of their actions. Health workers avoid scrutiny by re-engineering’ MPDSR reports, while community members avoid MPDSR sessions where ‘bad’ deaths are reviewed. This makes it difficult to co-produce knowledge for quality improvement. The MPDSR policy puts a lot of faith in community representatives’ capacity to mobilise resources for MPDSR implementation with little regard for the socio-political context that MPDSR is implemented. Examining MPDSR participatory spaces uncovers the disconnections between the policy expectations and the practical realities of implementing MPDSR. These findings could strengthen the global policy and our understanding of community participation in quality improvement and resource mobilisation.