Everyone should count. Yet about 40% of deaths are still not registered—and even when they are, many have vague causes assigned such as “stopped breathing” or “heart failure,” or no cause at all.
Civil Registration and Vital Statistics (CRVS) is at the root of good governance. The civil registration of births deaths, including cause of death, offers basic benefits to both individuals and governments. For individuals, birth registration establishes one’s legal identity. This unlocks access to a host of rights, protections and services unavailable to those whose legal identity has not been established. Death registration benefits individuals by protecting survivors’ rights and legitimating inheritance.
For governments, reliable, complete and timely vital statistics derived from registration records are fundamental to setting health and social priorities, policies, and impact measurement. They are also central to the monitoring of several of the Sustainable Development Goals (SDGs) adopted by the United Nations. The U.N. recognizes the importance of addressing under-registration and has set targets of universal birth registration and 80% death registration by 2030.
“CRVS is unique in its power to benefit every individual and inform public policy simultaneously.”
—Romain Santon, CRVS Deputy Director for Asia
It is now possible to count every human life, even in remote areas. Vital Strategies’ CRVS Program collaborates with governments to ensure that everyone is counted, and that high-quality data are available to policymakers.
We have supported governments in 29 countries to implement many of these advances through the Data for Health Initiative, funded by Bloomberg Philanthropies and the Australian Government’s Department of Foreign Affairs and Trade. Our technical assistance includes strengthening CRVS governance and system design; improving notification and registration of vital events; increasing the quantity and quality of cause of death data; and supporting the production of high-quality vital statistics.
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#CountingEveryone
Millions of people around the globe live without the rights, protections and benefits afforded by a legal identity, and die without any proof of existence. Without inclusive and high-quality birth, death and cause of death data that come from registration records, governments in many low- and middle-income countries are ‘flying blind’ in their efforts to practice evidence-based policymaking.
It’s time to start #CountingEveryone.
A new campaign from Vital Strategies and our partners in the Bloomberg Philanthropies Data for Health Initiative highlights dynamic leadership and close coordination for improving civil registration and vital statistics systems.
Join us: vitalstrategies.org/CountingEveryone
Our Results
- Bangladesh has scaled nationally a model of registration developed with Vital Strategies support, leading to a 98% increase in births registered and a 112% increase in deaths registered between 2015 and 2020. In addition, Bangladesh has begun implementing WHO standards in certifying and coding causes of death and the scaled application of verbal autopsy as part of its CRVS improvement program.
- In Brazil, we partnered with the Data Impact Program to support the National Council of Health Secretaries (CONASS) to publish measures of excess mortality during the COVID-19 pandemic. These data are, among other uses, being cited by media to combat misinformation about the impact of the pandemic and assess racial inequalities in mortality.
- To assess the mortality impact of COVID-19, support for rapid mortality surveillance helped enable 17 countries in Africa, Asia and Latin America to count over five million deaths by sex, age and place of death in just over two years.
- With Vital Strategies support, Rwanda has updated its CRVS legal framework and is rolling out a decentralized and more digitized registration system nationwide. Birth registration has risen from 26% to 86%, and death registration from 5% to 30%. The first-ever vital statistics reports have also been produced for 2019 and 2020, and all deaths occurring in hospitals are certified and coded to ICD standards.
- Support from Vital Strategies and the Global Health Advocacy Incubator led to an updated legal and regulatory framework for CRVS in Tanzania. One in ten deaths nationally now have a properly certified cause of death, and that proportion will climb. Certification training has also been integrated into medical school curricula and is now mandatary for medical re-licensure. In addition, a nationally representative verbal autopsy system, with additional support from the Global Fund, is starting to scale.
Areas of Technical Assistance
Governance, System Design and Processes: We partner with governments to create solutions tailored to their needs. This may entail supporting a national CRVS committee or Registrar General’s office or helping establish a national mortality subcommittee. We also offer support in the application of a CRVS business process improvement framework, as well as legal and regulatory technical assistance in partnership with the Global Health Advocacy Incubator.
Notification and Registration of Birth and Death: The CRVS team works with governments to ensure they have the capacity to count every human life. Our technical assistance in this area builds local capacity to improve completeness of notification and registration of health facility and community births and deaths. We accomplish this through guidelines for better collaboration and coordination of the health sector and civil registrar to report and register vital events; sample standard operating procedures (SOPs) and data-sharing memoranda of understanding (MOUs); training; ensuring the interoperability of data systems; and building public awareness.
Assigning Causes of Death in Health Facilities: Vital Strategies provides tools and trainings to build capacity of government to generate a reliable picture of leading causes of death. This means ensuring that medical certification adheres to global standards and that medical personnel understand how to properly certify and code cause of death. We provide support for adoption of the WHO international standard medical certificate of cause of death (MCCD); training in how to properly certify cause of death; manual and automated coding of mortality data using the most recent version of the International Classification of Diseases (ICD); and the introduction and scaled application of MCCD and ICD quality assurance and improvement.
Understanding Community Causes of Death: The “verbal autopsy” method is a way to determine patterns of mortality in places where there is no doctor in attendance at the time of a person’s death; in some countries this can reach 80% of all deaths. Verbal autopsy is a structured interview conducted with the caregivers of the deceased about signs and symptoms observed before death. The patterns of responses to these questions leads to an assignment of the most likely cause of death. When applied to a nationally representative sample of sites, a complete picture of the mortality burden can emerge. Vital Strategies supports the establishment of scaled, representative verbal autopsy systems integrated with the CRVS system; trains verbal autopsy master trainers at the country level using the most recent standards set by the WHO; and builds institutional capacity to undertake necessary secure data storage, management, cause of death assignment processing and quality control.
Vital Statistics Production and Use: Vital Strategies’ CRVS and Data Impact Teams support government partners to produce vital statistics reports and provide training to journalists in the use of CRVS data.
About the Data for Health Initiative
The Data for Health Initiative is a global effort supported by Bloomberg Philanthropies with additional support from the Australian Department of Foreign Affairs and Trade and Bill & Melinda Gates Foundation. The Initiative provides technical and financial assistance to low- and middle-income countries worldwide to improve public health data.
Vital Strategies serves as an implementing partner in the Initiative, with several programs related specifically to data improvement and public health intelligence: The Civil Registration and Vital Statistics (CRVS) Program assists governments in strengthening their systems for counting every birth and death and for monitoring the causes of death; the Data Impact Program supports governments to maximize the use of data to enhance public health policymaking and decision-making; the Cancer Registries Program provides assistance to governments in establishing and strengthening population-based cancer registries; and the Global Grants Program provides funds to government and local experts to implement discrete projects focused on data for public health decision-making.
The various Data for Health programs support country partners to strengthen data systems including a focus on gender equity, and all have worked in collaboration to produce guidance and technical assistance on COVID-19 for government partners, enabling them to better measure the scale of the crisis within their borders and execute a data-driven response.
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