Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations

Gay Bronson,Erin Nichols,Robert Jakob,Nicolas Maire,Daniel Cobos Muñoz,Osman Sankoh,Peter Byass,Ties Boerma,Frank Odhiambo,Raj Mitra,Carla Abouzahr,Ian Riley,Don De Savigny,Sonja Firth,Alan D Lopez,Daniel Chandramohan,Philip Setel,Sam Notzon

doi:10.1080/16549716.2017.1272882

Abstract

ABSTRACTBackground: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death.Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance.Conclusions: Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems.

Highlights

Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals
The United Nations (UN) and World Health Organization (WHO) standards for mortality statistics require the recording in the civil registry of all deaths, by age, gender, date and place of occurrence, along with medical certification of the cause of death (COD) by trained physicians according to the International Classification of Diseases (ICD)
Verbal autopsy (VA) is an imperfect tool for ascertaining COD, but it is the only alternative in the absence of medical certification [29,33,34,35,36,37]

Summary

Introduction

Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. There has been growing momentum to strengthen CRVS systems in recent years [1,2,3,4], it will still be some time before the routine CRVS systems currently present in low- and lowermiddle-income countries will be able to ensure physician-certified COD for a significant proportion of deaths. This is especially so for those that occur in rural or remote areas, owing to the lack of trained physicians and the fact that at least two-thirds – and often more than 80% – of deaths occur at home. Summary COD statistics available in such countries are often biased since they derive mainly from deaths

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