T2005/2/9
Task Force Proposal 3
Improving monitoring of vital events
Current situation
Measurement of vital events in populations is the cornerstone of health and population
information upon which evidence-based and results-oriented health programmes and
systems should be built. Vital registration, comprising notification of deaths by sex and
age and the attribution of cause of death through medical certification, has been
extremely useful in western countries for the identification of major mortality trends and
differentials. Currently, however, fewer than one in four deaths (or births) in developing
countries are registered. And even where deaths are registered, the attribution of causes of
death – essential for assessing the overall burden and pattern of disease – is often weak
or non-existent. Paradoxically, the countries with the highest estimated mortality levels
are often characterized by a complete lack of vital events monitoring systems.
When full coverage of vital registration systems is not yet feasible other solutions have to
be sought. Sample vital registration with lay reporting of cause of death (SAVVY) in
areas with poor medical coverage may present a viable way of collecting essential
information. . Such systems include identification of the main causes and correlates of
death assessment of household characteristics, risk factors and simple physical
measurements and follow-up of mortality and disability in the household.
More recently, demographic surveillance systems in selected communities - mainly
coordinated through the INDEPTH network - have been a cost effective way of
generating essential information for health programmes. While several of these studies
have been successful in shifting health priorities at national levels (e.g. TEHIP in
Tanzania), many of these studies have not been large enough to transform national
programmes.
There is an urgent need to promote and facilitate the implementation of vital registration
systems and cause of death attribution with additional health and economic data
collection in countries.
Why a role for HMN?
The resources required for establishing and maintaining a functioning vital registration
system would not normally be borne by the health sector alone. The reporting of births,
deaths and other vital events, is generally the responsibility of the civil administration and
the national statistics office. However, the health sector has a primary interest in the
output of the vital registration system and bears the main responsibility for cause of death
attribution. Strengthening such systems inevitably requires significant resources. It is
therefore necessary for the Health Metrics Network (HMN) to collaborate with other
interested partners and to advocate a global strategy to ensure that all countries have
accurate, unbiased data sufficient for calculating population birth and death rates
(including perinatal events) by age and sex within the next 10 years using a variety of
practical and cost-effective tools. This top priority should be closely linked to the
establishment of accurate and unbiased knowledge in each country on the cause of death
using validated ‘verbal autopsy’ (VA) methods (see below) to complement and correct
for biases in facility-based mortality data, and include additional information as deemed
appropriate.
These goals can be accomplished by supporting the following technical objectives:
(1) Creating an enabling environment for enhanced efforts to register births and
deaths and attribute cause of death;
(2) Improving analytical methods for evaluating and adjusting data from vital
registration systems, and to guide necessary expansion of routine vital
registration;
(3) Actively promoting sample registration systems for the vast majority of countries
that currently lack any comprehensive and regularly updated information on vital
events;
This ‘critical path’ to better vital events data systems will only yield sustainable results if
it is taken hand in hand with existing national and district-level information strategies,
governance structures and social development monitoring agendas. Vital registration
needs to be part of a national health information system. In improving the measurement
and monitoring of vital events the health sector cannot go it alone. The link between
statistical and health constituencies in country and at regional and global levels are key.
Strategy
In line with the recommendations made by the Health Metrics Network issues group on
vital events monitoring1, the Task Force will focus on improving systems of complete
vital registration (e.g. enhancing linkages between the different constituencies, improving
completeness and coverage), promoting sample registration systems and integrate vital
registration systems into health information systems, and facilitate R&D work on
improving routine vital registration systems.
1
Improving systems for monitoring and measurement of vital events. Issues paper prepared for the Health
Metrics Network. Compiled by Philip Setel, Osman Sankoh, Colin Mathers. November 2003.
2
Much of the in-country promotion of and support to strengthening or developing
registration systems will have to be done through the country health information system
reform work of HMN. The Task Force on Vital Event Monitoring will however
contribute significantly to this process: advocacy, development of tools and methods,
provision of seed money and technical assistance and supporting capacity building.
Areas of work may include:
 Promotion of work to ascertain on causes of death and morbidity / disability in
different age groups and different settings - support to country studies, technical
meeting on validity of verbal autopsy, morbidity and disability measurement
 Organization of an international conference on 'Count the dead' that brings
together experiences and methods in different parts of the world and comes up
with recommendations on how to scale up and improve vital events monitoring
 Development of training network on household measurement of disease and
death, including collaborating institutes in India (those involved in the sample
registration system) and selected INDEPTH sites and train leaders in vital events
monitoring from various countries.
3