title: Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations.
abstract: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death. Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance.
  
  
  
  Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems.
authors.affiliation: a Department of Epidemiology and Public Health , Swiss Tropical and Public Health Institute , Basel , Switzerland.|b University of Basel , Basel , Switzerland.|c Melbourne School of Population and Global Health , University of Melbourne , Carlton , Australia.
authors.forename: Don
authors.initials: D
authors.lastname: de Savigny
authors.affiliation: c Melbourne School of Population and Global Health , University of Melbourne , Carlton , Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Riley
authors.affiliation: d Department of Disease Control , London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
authors.affiliation: e African Field Epidemiology Network (AFENET) , Kisumu , Kenya.
authors.forename: Frank
authors.initials: F
authors.lastname: Odhiambo
authors.affiliation: f National Centre for Health Statistics , Centres for Disease Control and Prevention , Hyattsville , MD , USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Nichols
authors.affiliation: f National Centre for Health Statistics , Centres for Disease Control and Prevention , Hyattsville , MD , USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Notzon
authors.affiliation: g CAZ Consulting , Geneva , Switzerland.
authors.forename: Carla
authors.initials: C
authors.lastname: AbouZahr
authors.affiliation: h Africa Centre for Statistics , United Nations Economic Commission for Africa , Addis Ababa , Ethiopia.
authors.forename: Raj
authors.initials: R
authors.lastname: Mitra
authors.affiliation: a Department of Epidemiology and Public Health , Swiss Tropical and Public Health Institute , Basel , Switzerland.|b University of Basel , Basel , Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cobos Muñoz
authors.affiliation: c Melbourne School of Population and Global Health , University of Melbourne , Carlton , Australia.
authors.forename: Sonja
authors.initials: S
authors.lastname: Firth
authors.affiliation: a Department of Epidemiology and Public Health , Swiss Tropical and Public Health Institute , Basel , Switzerland.|b University of Basel , Basel , Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Maire
authors.affiliation: i INDEPTH Network , Accra , Ghana.|j School of Public Health , University of Witwatersrand , Johannesburg , South Africa.
authors.forename: Osman
authors.initials: O
authors.lastname: Sankoh
authors.affiliation: k Vital Strategies , New York , NY , USA.
authors.forename: Gay
authors.initials: G
authors.lastname: Bronson
authors.affiliation: k Vital Strategies , New York , NY , USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Setel
authors.affiliation: l WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden.|m MRC-Wits Rural Public Health and Health Transitions Unit (Agincourt), School of Public Health , University of Witwatersrand , Johannesburg , South Africa.
authors.forename: Peter
authors.initials: P
authors.lastname: Byass
authors.affiliation: n Department of Health Statistics and Information Systems , World Health Organization , Geneva , Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Jakob
authors.affiliation: n Department of Health Statistics and Information Systems , World Health Organization , Geneva , Switzerland.
authors.forename: Ties
authors.initials: T
authors.lastname: Boerma
authors.affiliation: c Melbourne School of Population and Global Health , University of Melbourne , Carlton , Australia.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Lopez
mesh_terms: D001344:Autopsy / Q000592:standards*; D002423:Cause of Death; D006078:Government Programs / Q000458:organization & administration*; D063025:Health Information Management / Q000592:standards*; D006801:Humans; D038801:International Classification of Diseases / Q000592:standards*; D007391:International Cooperation; D011159:Population Surveillance / Q000379:methods*; D011203:Poverty / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014798:Vital Statistics
keywords: Mortality surveillance; Sustainable Development Goals; cause of death; health information systems; information technology; international classification of disease; process mapping; systems integration