When civil registration is inadequate: interim methods for generating vital statistics

Comprehensive guidelines and tools to help countries rapidly improve their vital statistics systems, based on international best practice are now available. For many countries, however, attainment of timely, accurate statistics on births and deaths and causes of death will require years of strategic and prioritized investment, with technical assistance from WHO, the United Nations, and academia. In the meantime, however, countries will need accurate and unbiased data in order to measure progress with their health programs and broader development goals, such as the MDGs and the growing crisis of non-communicable diseases. This article has introduced some interim strategies that can yield adequate vital statistics and cause of death data as countries work to strengthen their civil registration systems. These methods mirror the skills, practices and advantages of complete and functioning civil registration and vital statistics systems, but for a sample of the population. They are based on the principle of rigorous and continuous data collection for a defined and manageable part of the population. Doing "smaller, representative" populations well rather than "larger populations poorly" will reduce the biases that would otherwise occur from missing data, incorrect application of data management procedures, poor data quality checking and lack of medical certification of causes of death. A critical component of this strategy is to routinely apply verbal autopsy methods to collect essential cause of death data. When properly applied, VA can yield population-based cause of death data of comparable quality to what is typically collected in hospitals in developing countries. Moreover, with the availability of automated methods to diagnose causes of death, it is now possible to obtain accurate cause of death data routinely, cheaply and quickly in resource-poor settings. The long-term goal of strengthening civil registration and vital statistics systems is to ensure that every birth and death is properly registered, and that causes of death are accurately certified. Stakeholders wishing to establish sentinel surveillance or sample registration should work in collaboration with national and local authorities responsible for civil registration and should support and promote the formal registration of births and deaths whenever possible. In addition, sentinel or sample registration systems should help strengthen the capacity of the health system to correctly certify the causes of death for each decedent.