Monitoring HIV/AIDS using
Sample Vital Registration with
Verbal Autopsy
Gregory Kabadi
on behalf of SAVVY partners
Outline
• SAVVY Overview
• Technical aspects for SAVVY
• Implementation plan
• SAVVY’s facilitation with RITA
SAVVY Overview
‘SAVVY’ = Sample Vital Registration with Verbal Autopsy
• A sample demographic surveillance system built around
vital events monitoring
• Purpose is to provide improved monitoring and
measurement of vital events
• Not available from vital registration systems, household
surveys, etc.
• SAVVY will include cause of death ascertainment
• Supplemental information from periodic surveys “nested”
within system
• SAVVY will consolidate and adapt “best practice” in
• Sample and demographic surveillance techniques
• Survey sampling methods
• Validated ‘verbal autopsy’ methods
SAVVY’s ORGANISATIONAL STRUCTURE
• National Level:
• Technical Staff at MOHSW, Other Gov Depts,
Development Partners. SAVVY’s Implementing
Partners: IHI & NIMR Mza
• District Level:
• DMO and CHMT, SAVVY’s District Coordinator
• Community Level
• Census Supervisors, Enumerators and Key
Informants
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Sentinel Panel of Districts (SPD)
SPD central
District Medical Officer
FBIS District
Coordinator
SAVVY District
Coordinator
Facility I/C
KIs & Census
Enumerators
FBIS = Facility-Based Info System
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Why SAVVY?
• Several millennial commitments to ‘do better’ with
investments in population health and development
• Few reliable sources of information on mortality rates
and causes of death- especially HIV/AIDS
• Strengthen the capacity of the Ministry of Health &
Social Welfare to collect and use surveillance data to
manage programs
SAVVY Sample Selection - NBS
Zones
Districts
• 7 zones (western, northern,
central, S highlands, lake,
eastern, southern)
•
Probability Proportional to Size
•
Enumeration area and households
from Tanzania Mainland
• Probability sample ~21
districts, ~3 per zone
• 208 EAs in total
•
National estimates
•
Stratified by rural-urban & gender
•
Target population is adults 18-59
• 30 households per EA
Households
SAVVY Sampled Districts
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What are the technical aspects?
Censuses
• Conduct baseline census followed by periodic updates
• Deaths and births reported
Mortality Surveillance System
• Deaths followed-up with ‘verbal autopsy’
• Substantial and growing literature on the reliability and
validity of this technique
• Provides accurate cause of death data at community
level by age and sex
Nested studies
• Behavioral, service satisfaction, health equity, SES
Implementation plan
• Sensitization and Govt buy-in
• Signing of MOU with NIMR
• Signing of MOU with NBS
• List of names of the sample districts including EAs
from NBS Statistical Master Sample
• Plan/set up Financial & A/C reporting
• SAVVY staff recruitment
•
•
•
•
So far, 2 hired at IHI, 3 at NIMR Mwanza
Pending, 4 – 6 at IHI & NIMR Mwanza (all, fulltime)
Pending 23 District Coordinators (District-based, fulltime)
District-based, KIs + Census enumerators (abt 270, temp)
• Office set up, procurement of utilities + cars
Implementation Plan… cont’d
• Phased-in implementation of SAVVY
• 4 Pilot districts – 2010: Kinondoni, Bagamoyo, Geita &
Kahama
• 12 districts by 2011; ALL by – 2012
• Identification of key members in selected districts to
organize district work and VA interviews
• Preparation of SAVVY field manuals, guidelines and
SoPs
• Develop and pilot test data for census and VA both on
Tablet PCs
• Training of field teams on data collection using Tablet
PCs
• Write and submit Feasibility Study
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Implementation Plan…..cont’d
• Establish vital events reporting system in pilot
districts
• Train community Key Informants on recording &
reporting of vital events
• Conduct baseline census in the first 4 SAVVY
districts & Conduct verbal autopsy interviews
• Conduct supervision and quality assurance of
baseline census
• Data management and analysis of baseline
census, write report of baseline census
• Identification and training of physicians for coding
of Verbal Autopsy data
• Set up of Steering Group (high level) & TWG
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REGISTRATION OF BIRTHS & DEATHS, RITA I
RITA = Registration, Insolvency & Trusteeship Agency
(Ministry of Justice and Constitutional Affairs)
• To register a birth or death event (birth within 90 days,
death within 30 days):
• Birth or Death notification:
• B1 or D1 for a birth or death at a health facility resp
• B2 or D2 for a birth or death in communities resp
• Certificate, TShs. 3,500/= (about US $ 3)
• A birth/death event after the period recommended, more
evidence will be needed, fee + penalty!
• A birth certificate: Given a name, Citizenship, know own
parents and to be cared for, Retirement, Higher education
• A death certificate: Inheritance, Evidence to being an
orphan, Sponsorship by Gov
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REGISTRATION OF BIRTHS & DEATHS, RITA - II
• SAVVY will monitor and register all live births and
deaths in its communities (SAVVY districts)
• RITA promised to issue SAVVY its notification registers
(B1/B2 and D1/D2) that it will be distribute to Village
Executive Officers (VEO)
• SAVVY’s KIs inform the SAVVY District Coordinator of
vital events in their communities
• SAVVY Coordinator verifies events and collects data,
registers them at the VEO (RITA’s registers)
• SAVVY Coordinator / VEO send the notification
registers to the RITA’s District Officer for issuance of
certificates
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SAVVY’s Key Informants, Attributes
• A SAVVY’s KI should be appointed by community
leadership (Ward or Village) for having the following
attributes/qualifications to be able to report on vital
events:
- Be a resident of the community
- Approved of by the community
- Confidentiality
- Of good rapport
- Be able to read and write
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WORKING TOOLS
• Key Informant
• A Bicycle
• A Simple phone (within network coverage)
• Incentive: for each birth or death reported
• Census Enumerators/Supervisors
• A Tablet PC
• Transport during census
• SAVVY District Coordinator
• A Tablet PC
• Transport
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Conclusion
• Very powerful information platform to generate
population-based demographic, health & mortality
data
• NBS-endorsed, national sample; results stratified by
residence & zone
• Provides economical, quality platform for detailed
programme Monitoring & Evaluation
• Provides opportunity for fundamental & operational
research
• Comparability over time: trend analysis
• Included in the MOHSW’s HMIS project for
sustainability in the near future
ASANTENI