Clinical Audit programmes


Three mortality audits exist in South African; Saving Mothers, Saving Babies and Saving Children, which offer a review of the healthcare provided to mothers, babies, and children. These reports synthesize information to help guide priority setting for the National Department of Health and all levels of health service delivery.


MaMMAS Maternal Morbidity and Mortality Audit System

In 1998 the National Committee for Confidential Enquiry into Maternal Deaths (NCCEMD) was established specifically to tackle the high maternal mortality rate which became notifiable by law the previous year. The recording and analysis of maternal deaths is efficient, allowing trends in maternal deaths to be identified promptly. The  Maternal and Infant Health Care Strategies Research Unit created the database which is used to generate the Saving mothers reports,  Prof RC Pattinson has edited all reports to date. This programme currently covers 80% plus births in the public sector, it has been adopted as the National Department of Health as a critical audit tool.




PPIP Perinatal Problem Identification Programme

The  Maternal and Infant Health Care Strategies Research Unit has also been pivotal to the generation of saving babies reports from PPIP data. PPIP is a mortality audit tool, developed by Johan Coetzee. The last Saving Babies report of 2014-2016 was produced by the National Perinatal Mortality and Morbidity Committee based on PIPP data. Technical support is provided to registered users via email, while extensive logistic and training support is provided by the Medical Research Council Unit for Maternal and Infant Health Care Strategies. PPIP has been adopted by other African countries to audit perinatal deaths.





Child PIP Child Problem Identification Programme 

The Child Healthcare Problem Identification Programme (Child PIP) is a mortality review process that assesses the quality of care children receive in the South African health system. Child PIP originates in the idea that as individual health workers in South Africa we care about what we do, and because we care, we reflect on what we do. When we reflect we are faced with the challenging question, ‘Is this the best I can do?’ Child PIP enables a process for reflecting on the way we care for children, for weighing and measuring the quality of care we give and identifying ways to bring about change where it is needed.

Child PIP was first developed in 2004, building off the Perinatal Problem Identification Programme and the Confidential Enquiry into Maternal Deaths, and has since become a firmly established tool for in-hospital child death review. Child PIP’s death review track record covers more than 15 years, including the period when South Africa’s HIV pandemic peaked. Child PIP is currently implemented by healthcare practitioners in over 280 hospitals across all nine provinces and in 49 out of 52 districts.


Child PIP is led by the Executive Committee, a small team of experienced Child PIP users including the developers of Child PIP, and a National Department of Health (NDOH) representative. The Technical Task Team (Provincial Coordinators and representatives from all nine provinces) supports the Executive Committee and provides ongoing implementation support to facilities.

Child PIP was one of the 2015/16 winners of the international Healthcare Innovation Award.



  • NDOH
  • GSK (Child PIP)


Lavin T, Pattinson RC , Kelty E, Pillay Y, Preen DB. The impact of implementing the 2016 WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience on perinatal deaths: an interrupted time-series analysis in Mpumalanga province, South Africa. BMJ Global Health. 2020 Dec 1;5(12):e002965.

Gebhardt GS, Rhoda N, Westwood A, Pattinson RC. Recommendations for the management of birth at the margins of fetal viability-a practical approach for South Africa. In Obstetrics and Gynaecology Forum 2020 Dec 1 (Vol. 30, No. 4, pp. 31-36). In House Publications.

Cebekhulu SN, Pattinson RC. Maternal deaths due to sepsis: a slow but steady decline. In Obstetrics and Gynaecology Forum 2020 Dec 1 (Vol. 30, No. 4, pp. 24-25). In House Publications. 

Moodley J, Fawcus S, Pattinson RC. 21 years of confidential enquiries into maternal deaths in South Africa: reflections on maternal death assessments. In Obstetrics and Gynaecology Forum 2020 Dec 1 (Vol. 30, No. 4, pp. 4-7). In House Publications.

Lavin T, Preen DB, Allanson E, Pattinson RC. Why correctly identifying maternal condition in perinatal death classification systems is crucial: a commentary. BJOG: An International Journal of Obstetrics & Gynaecology. 2020 May;127(6):668-70. (A COMMENTARY)


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