Strengthening Cause-of-death Information
in countries through
Africa Programme on Accelerated Improvement
of Civil Registration and Vital Statistics System
(APAI-CRVS)
Workshop on the Principles and Recommendations for a Vital Statistics Systems
2-5 December 2014
United Nations Economic Commission for Africa
Outline
• Why Cause-of-death (CoD) matters
• The state of CoD information in Africa
• Challenges in the collection of CoD
information in Africa
• Proposed strategies for improvement
• Regional resources for improvement of CoD
information
Why Cause-of-death matters
• “…..One of the best ways to
help the living is by counting
the dead-Prabat Jha”
• Helping the living however, cannot stop at
counting the dead. We must proceed to
establish who died and what person the died
of.
Why Cause-of-death matters:
1. Reliable knowledge on the mortality and
Cause-of-death (CoD) of a population is
critical for policy making and planning .
2. Mortality and CoD data are foundation for
health planning, monitoring and evaluation:
this includes MDGs and national health
plans.
Why Causes-of -death matter:
cont..
Cause-of- death data from vital records:
– Identify emerging diseases and conditions and
track changes in the burden of disease in different
groups;
– Monitor and evaluate health system performance
and the impact of policies and programmes;
– Guide priorities for intervention programme and
allocate and distribute health sector resources
– Contribute to health research and the generation
of evidence
The state of CoD information:
• “Only around one-third of all the deaths in
the world are recorded in civil registries with
the cause-of-death information”…(WHO,2012).
• In Asia and Africa where the largest number of
deaths are reported to occur, capturing causeof-death information remains a big challenge
Quality of globally available
information on CoD (2000-2008)
Source: WHO,2012
The state of CoD information in Africa:
Source: WHO,2012
• South Africa, Egypt, Mauritius and Seychelles
are the only countries where nearly all the
dead are counted with their respective cause
of death information.
• The remaining countries have such data only
for very limited areas or parts of their
population
The challenge
• Only a minority of deaths in Africa occur in medical
institutions where there is a physician able to issue a
medical certificate including CoD
• Verbal Autopsy (VA) is not an established practice for
the derivation of CoD for non-institutional deaths
Common challenges in collecting CoD
for deaths in health facilities
1. The law:
–
does not make it mandatory for the medical
institutions to record CoD;
– does not recognize the use of WHO’s
conventional standard in assigning CoD
2. Practice:
– CoD not completed using International Form of
the Medical Certificate of CoD.
– Poor quality of CoD assignment by doctors
– No clear business process for flow and
compilation of data
Common challenges in collecting CoD
for deaths outside health facilities
– Deaths are not registered
– No systematic process is in place for recording
and compiling CoD for death outside health
facilities
– The use of VA in collection of CoD has been
limited to a few experimental areas or through
special surveys in selected countries
Proposed strategies for improving CoD
information for institutional deaths
1.
Constitute a core team to implement the strategies and
plan of action for improvement of CoD information.
2.
Review existing death certificates and related forms and
modify as required to ensure alignment with international
standards
3.
Collaborate with hospital administrators and physicians to
develop an action plan for the training of physicians in
medical certification.
4.
Collaborate with universities and medical training
institutions to incorporate ICD training in medical curricula
Proposed strategies for improving CoD
information for non-institutional
deaths
1. Decide on the steps to implement verbal autopsy
(Recommend use of WHO VA standards, forms and
tools)
2. Test the tools and process (from collection to
compilation) through pilot studies
3. Based on the results of the pilot and tool testing
exercise, re-design the business process
4. Plan and conduct regular training of lay
interviewers in verbal autopsy processes
5. May need to start on a sample basis
Regional resources for improving CoD:
Assessment tool on CoD
Objective: The tool is developed to help countries
understand their systems –what works and what doesn’t
work and to develop country specific strategies for
improvement
Why Cause-of-death handled separately:
(i) Need for increased focus in the area in view of its poor
state of performance in most of our countries.
(ii) Operations relating to Cause-of -death are unique and
different as compared to those followed in the registration
of vital events
Immediate next steps
Develop a clear set of strategies in improvement of causes of
death collection and compilation – this may also include a clear
action plan for five years
Dual approach in the plan
Institutional deaths
– clear set of action plans
Non- institutional deaths
– plan for operational research on verbal autopsy to test the full
process – two years (only selected countries?)
-move to a nationally representative sample – third year onward
Develop a regional pool of experts on death registration, causes
of death including verbal autopsy who can be assigned to
countries on demand
Thank you