A/HRC/14/20/Add.2 addressed, albeit in the light of the adequacy of systemic issues, such as training, supervision and working conditions. Nonetheless, individuals must never become scapegoats when the fault really lies with a failing health system or elsewhere. 74. The Special Rapporteur strongly recommends that all states introduce, as a matter of urgency, a system of maternal death review. Following a transparent, participatory process (that is not confined to health professionals), each state should choose its preferred form of maternal death review. However, the preferred form must encompass all maternal deaths, i.e. those occurring in public and private facilities as well as those not occurring in any facility. Adequate resources, training and supervision must support the preferred system. 75. The “plus”: an independent body. It is extremely important that once the individual reviews are complete they go to an independent body responsible for submitting an annual report to the state’s legislature. Based on an analysis of all the reviews, this public report should identify systemic and institutional trends, draw conclusions and make specific recommendations regarding law, policy and practice. The annual report should name neither individual women nor health workers. The independent body should publicly report whether or not its earlier recommendations have been acted upon. It may also be granted certain powers, for example, to compel a health facility to take specific measures. The Government of India must urgently establish an appropriate independent body that is responsible for using the maternal death reviews to hold the authorities accountable (the “plus”). One institutional option is briefly introduced in subsection 5 below. 3. Emergency obstetric care indicators – “plus” 76. Indicators for EmOC are essential to identify needs, monitor implementation and measure progress and enhance accountability. 77. In 1991, UNICEF asked Columbia University to design a new set of indicators for EmOC. After testing, six indicators were published by UNICEF, WHO and UNFPA in 1992 as the Guidelines for Monitoring the Availability and Use of Obstetric Services; a revised second edition was published in 1997. Ministries of health, international agencies and programme managers in over 50 countries around the world, including in India (such as in Rajasthan and Maharashtra), have used these indicators. 78. In 2006, an international panel of experts participated in a technical consultation to discuss modifications to the existing indicators in the light of 10 years’ wealth of experience. The agreed changes, including two new EmOC indicators, were published in 2009 by WHO and other organizations as Monitoring Emergency Obstetric Care: A Handbook. 79. Today, not only is there an international consensus that EmOC is a cornerstone intervention to reduce maternal mortality, but also the Handbook reflects an international consensus on how such care should be measured. The indicators should be included in countries’ health information systems to track progress at district, regional and national levels. Building on India’s experience with the Guidelines, the Special Rapporteur strongly recommends that all relevant district, state, national and international bodies in India use the eight indicators set out in the Handbook. 80. Integrated into a situational analysis or needs assessment, the indicators can provide a baseline from which progressive realization can be measured. In contrast to a maternal mortality rate or ratio, they can be used to measure performance in a small area and over a short period. As the Handbook explains, the data generated by the indicators will often signal the need for supplementary studies. While the indicators may expose, for example, a low met need for EmOC (indicator 4), they will not signal where all the problems lie. 18 GE.10-12866