The South African Child Death Review Project - effective intersectoral collaboration

Child Death Reviews (CDRs) use an intersectoral approach to understand and prevent child deaths.  We piloted the first South African CDR in 2014 in collaboration with Prof Lorna Martin from the Division of Forensic Medicine, UCT; the Department of Health, Western Cape; and the Forensic Pathology Services, Department of Health, KwaZulu-Natal. This project was developed as an outcome of the first national child homicide study by the South African Medical Research Council and UCT.  

The CDR teams aim to facilitate a coordinated response from the police, forensic pathology services, prosecution authorities, paediatricians, and social services. In 2014 we tested the efficacy of this model in the South African setting through a process evaluation at the Salt River Mortuary in the Western Cape and Phoenix Mortuary in KwaZulu-Natal. This multiagency approach brings together evidence in a way that enables more effective identification of child abuse and neglect. It helps identify system failures within departments and opportunities to strengthen communication and coordination between them. 

The CDR pilot demonstrated how a multi-agency approach can enhance reporting and enable a real-time response to ensure children are safer in their homes. The value of making joint decisions also took the burden off the forensic pathologist and police as investigating child deaths in the home is incredibly difficult, particularly when there is a suspicion of a non-accidental injury at the hands of someone close to the child. Social services investigations have also proved crucial in identifying families in distress who require ongoing support to prevent further negative outcomes to the remaining children in the family. Importantly, the 2014 evaluation found that CDR teams were effective to strengthen the health and child protection response systems.

The project has been adopted by the Department of Health in the Western Cape as a ‘best practice model’ and has been integrated into the routine practice of Forensic Pathology Services with the other partners: South African Police Service, DSD, National Prosecuting Authority of South Africa and various role players from the Department of Health (including district paediatricians, neonatologists, and epidemiologists). The project has expanded throughout the Western Cape and CDR teams were trained across the province. The Western Cape had five operational CDR teams based at Salt River; Tygerberg; Paarl; George; and Worcester mortuaries but drawing in the broader health district.

Furthermore, the National Prosecuting Authority of South Africa is using the CDR cases to develop jurisprudence on the prosecution of child murder in the country.

Findings from the CDR project has highlighted failures in the child protection system (with an emphasis on child murders) and was used in engagements with civil society as well as with the Premier and DSD in the WC. Data from the project informed the Provincial Child Murder Planned adopted by the provincial government in November 2018.  The project is now focussed on expanding the model in Kwa-Zulu Natal and to standardise the model further through the establishment of a provincial steering committee. 

For queries about this project contact: Prof Shanaaz Mathews – shanaaz.mathews@uct.ac.za or Lucy Jamieson -lucy.jamieson@uct.ac.za

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[1] Mathews S, Abrahams N & Martin LJ (2013) Child death reviews in the context of child abuse fatalities – learning from international practice.  A briefing paper. Cape Town: Children’s Institute, UCT, The Gender and Health Research Unit, South African Medical Research Council, and the Division of Forensic Medicine and Toxicology, University of Cape Town.

[2] Mathews S, Martin L, Scott C, Coetzee D & Lake L (2015) Every child counts: Lessons learned from the South African Child Death Review pilot. A research brief. Cape Town: Children’s Institute, University of Cape Town.

[3] Mathews S, Martin L, Coetzee D, Scott, C, Naidoo T, Brijmohun Y & Quarrie K (2016) The South African child death review pilot: a multi-agency approach to strengthen healthcare and protection for children. South African Medical Journal, 106(9): 895-899.

[4] Mathews S and Abrahams N (2018) Developing a an Understanding of Filicide in South Africa. In: Brown T, et al. (eds) (2018). When Parents Kill Children. Cham: Springer International Publishing AG. https://doi.org/10.1007/978-3-319-63097-7_3

Further reading

• Mathews S, Martin LJ (2016). Developing an understanding of fatal child abuse and neglect: Results from the South African child death review pilot study. South African Medical Journal 2016;106(12):1160-1163. DOI:10.7196/SAMJ.2016.v106i12.12130
• Mathews S, Martin LJ, Coetzee D, Scott C, Brijmohun Y (2016). Child deaths in South Africa: Lessons from the child death review pilot. South African Medical Journal 2016;106(9):851-852. DOI:10.7196/SAMJ.2016.v106i9.11382
• Abrahams N, Mathews S, Lombard C, Martin LJ, Jewkes R (2017) Sexual homicides in South Africa: A national cross sectional epidemiological study of adult women and children. PLoS ONE 12(10): e0186432.
  https://doi. org/10.1371/journal.pone.0186432
• Abrahams N, Mathews S, Martin LJ, Lombard C, Nannan N & Jewkes R (2016) Gender Differences in Homicide of Neonates, Infants, and Children under 5 y in South Africa: Results from the Cross-Sectional 2009 National Child Homicide Study. PLoS Medicine, 13(4), e1002003.
• Dawson M, Mathews S, Abrahams N & Campbell J (2017) Death Reviews in the Context of Domestic Homicide in Low- to Middle-Income Countries: South Africa as a Case Study. In: Dawson M. (eds) Domestic Homicides and Death Reviews. Palgrave Macmillan, London.
• Mathews S, Abrahams N, Jewkes R, Martin LJ, & Lombard C (2013) The epidemiology of child homicides in South Africa. Bulletin of the World Health Organization, 91(8), 562–568.
• Mathews S & Martin L (2016) Developing an understanding of fatal child abuse and neglect: Results from the South African child death review pilot study. South African Medical Journal, 106(12), 1160-1163.
• Mathews S, Martin L, Coetzee D, Scott C & Brijmohun, Y (2016) Child deaths in South Africa: Lessons from the child death review pilot. South African Medical Journal, 106(9), 851-852.
• Mathews, S., Martin, L., Scott, C., Coetzee, D., & Lake, L. (2015). Every child counts: Lessons learned from the South African Child Death Review pilot. A research brief.