Abstract
BackgroundAccurate and timely cause of death (COD) data are essential for informed public health policymaking. Medical certification of COD generally provides the majority of COD data in a population and is an essential component of civil registration and vital statistics (CRVS) systems. Accurate completion of the medical certificate of cause of death (MCCOD) should be a relatively straightforward procedure for physicians, but mistakes are common. Here, we present three training strategies implemented in five countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne (UoM) and evaluate the impact on the quality of certification.MethodsThe three training strategies evaluated were (1) training of trainers (TOT) in the Philippines, Myanmar, and Sri Lanka; (2) direct training of physicians by the UoM D4H in Papua New Guinea (PNG); and (3) the implementation of an online and basic training strategy in Peru. The evaluation involved an assessment of MCCODs before and after training using an assessment tool developed by the University of Melbourne.ResultsThe TOT strategy led to reductions in incorrectly completed certificates of between 28% in Sri Lanka and 40% in the Philippines. Following direct training of physicians in PNG, the reduction in incorrectly completed certificates was 30%. In Peru, the reduction in incorrect certificates was 30% after implementation and training on an online system only and 43% after training on both the online system and basic medical certification principles.ConclusionsThe results of this study indicate that a variety of training strategies can produce benefits in the quality of certification, but further improvements are possible. The experiences of D4H suggest several aspects of the strategies that should be further developed to improve outcomes, particularly key stakeholder engagement from early in the intervention and local committees to oversee activities and support an improved culture in hospitals to support better diagnostic skills and practices.
Highlights
Accurate and timely cause of death (COD) data are essential for informed public health policymaking
Monitoring of country progress towards the Sustainable Development Goals (SDGs) will be impossible without reliable mortality and COD data provided by civil registration and vital statistics (CRVS) systems: 7 goals and 17 of their corresponding indicators require cause-specific mortality data, the optimal source of which are functioning CRVS systems [3]
Population-based, cause-specific mortality statistics are generated from information provided on individual medical certificates of cause of death (MCCOD)
Summary
Accurate and timely cause of death (COD) data are essential for informed public health policymaking. Medical certification of COD generally provides the majority of COD data in a population and is an essential component of civil registration and vital statistics (CRVS) systems. Accurate and timely data on cause of death (COD) is perhaps the most critical information source for guiding health programmes and policies [1]. Population-based, cause-specific mortality statistics are generated from information provided on individual medical certificates of cause of death (MCCOD). Routine and correct application of the World Health Organization (WHO)-recommended international MCCOD form, as well as coding the data to ICD-10 standards, is essential for the production of reliable mortality statistics that are comparable between countries, for national and subnational populations, and for specific population groups over time [5]
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