Strengthening Cause-of-death Information

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• 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

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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

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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.

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Why Cause-of-death matters

• Reliable knowledge on the mortality and
  Cause-of-death (CoD) of a population is critical
  for policy making and planning .
• Mortality and CoD data are foundation for health
  planning, monitoring and evaluation this
  includes MDGs and national health plans.

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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

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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
  cause-of-death information remains a big
  challenge

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Quality of globally available information on CoD
(2000-2008) Source WHO,2012
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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

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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

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Common challenges in collecting CoD for deaths in
health facilities

• The law
• does not make it mandatory for the medical
  institutions to record CoD
• does not recognize the use of WHOs conventional
  standard in assigning CoD
• 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

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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

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Proposed strategies for improving CoD information
for institutional deaths

• Constitute a core team to implement the
  strategies and plan of action for improvement of
  CoD information.
• Review existing death certificates and related
  forms and modify as required to ensure alignment
  with international standards
• Collaborate with hospital administrators and
  physicians to develop an action plan for the
  training of physicians in medical certification.
• Collaborate with universities and medical
  training institutions to incorporate ICD training
  in medical curricula

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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

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Regional resources for improving CoDAssessment
tool on CoD

• Objective The tool is developed to help
  countries understand their systems what works
  and what doesnt 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

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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

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• Thank you