Abstract
BackgroundIn the developed world, information on vital events is routinely collected nationally to inform population and health policies. However, in many low-and middle-income countries, especially those in sub-Saharan Africa (SSA), there is a lack of effective and comprehensive national civil registration and vital statistics system. In the past decades, the number of Health and Demographic Surveillance Systems (HDSSs) has increased throughout SSA. An HDSS monitors births, deaths, causes of death, migration, and other health and socio-economic indicators within a defined population over time. Currently, the International Network for the Continuous Demographic Evaluation of Populations and Their Health (INDEPTH) brings together 38 member research centers which run 44 HDSS sites from 20 countries in Africa, Asia and Oceana. Thirty two of these HDSS sites are in SSA.DiscussionThis paper argues that, in the absence of an adequate national CRVS, HDSSs should be more effectively utilised to generate relevant public health data, and also to create local capacity for longitudinal data collection and management systems in SSA. If HDSSs get strategically located to cover different geographical regions in a country, data from these sites could be used to provide a more complete national picture of the health of the population. They provide useful data that can be extrapolated for national estimates if their regional coverage is well planned. HDSSs are however resource-intensive. Efforts are being put towards getting them linked to local or national policy contexts and to reduce their dependence on external funding. Increasing their number in SSA to cover a critical proportion of the population, especially urban populations, must be carefully planned. Strategic planning is needed at national levels to geographically locate HDSS sites and to support these through national funding mechanisms.SummaryThe paper does not suggest that HDSSs should be seen as a replacement for civil registration systems. Rather, they should serve as a short- to medium-term measure to provide data for health and population planning at regional levels with possible extrapolation to national levels. HDSSs can also provide useful lessons for countries that intend to set up nationally representative sample vital registration systems in the long term.
Highlights
In the developed world, information on vital events is routinely collected nationally to inform population and health policies
Summary: The paper does not suggest that Health and Demographic Surveillance Systems (HDSSs) should be seen as a replacement for civil registration systems
HDSSs can provide useful lessons for countries that intend to set up nationally representative sample vital registration systems in the long term
Summary
How can HDSSs help to build national vital registration systems HDSSs can help to build CRVSs by providing experience in vital registration operational techniques. HDSSs can help in building and retaining capacity on technical skills pertaining to data collection, management, quality control, archiving and retrieval, analyses and dissemination when other capacity building programmes seem to face challenges This will enhance the use of the data in active research, and networking of national experts working on similar issues. Integration of the HDSS geographic information system data further demonstrated that the decentralisation of services to peripheral health facilities improved the benefits for remote communities [49] This provides strong support for the public health approach to antiretroviral therapy (ART) delivery advocated by WHO [51], and the data were used to support renewal of Global Fund awards to Malawi, further funding the ART roll-out programme. A full-fledged HDSS can be operated within or around the SVR in order to collect more detailed information such as migration patterns, health and disease burdens, and several other socio-economic factors. A detailed investigation of the merits and demerits of this combination needs to be carried out find out the most cost effective and efficient approach
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