International Technical Assistance on CRVS

ISP is committed to playing a key role in the improvement of CRVS systems in developing countries. In addition to expertise available within CDC and NCHS, ISP and NCHS maintain multiple collaborations with CRVS partners including: The World Health Organization’s Department of Health Statistics and Informatics of the Innovation, Information, Evidence, and Research Cluster; and U.S. state vital statistics offices through the National Association for Public Health Statistics and Information Systems (NAPHSISExternal). Additionally, NCHS coordinates the International Collaboration Effort on automating mortality statistics.

In March 2015, Bloomberg Philanthropies, in partnership with the Australian government, launched a Data for Health (D4H) initiativeExternal that seeks to provide countries with tools to better collect and use health-related data. The program aims to assist 20 low- and middle-income countries across Latin America, Asia, and Africa to strengthen data collection and data use. Countries will then be better able to prioritize, deploy resources, shape public health policies, and measure the success of interventions. The D4H initiative is a partnership of the University of Melbourne, the CDC Foundation, Union North America, Johns Hopkins University, and the World Health Organization. The initiative has three areas of focus: improving country civil registration and vital statistics (CRVS) systems as the best source for vital statistics data; developing new mechanisms for conducting public health surveys to monitor major risk factors for early death including non-communicable diseases; and assisting governments in translating data into actual policy change. The ISP is a key partner in the first area of focus—the CRVS component.

Drawing from the CRVS expertise available from these sources, international technical assistance in the form of training and demonstration projects is provided to select countries to address the unique combination of CRVS deficiencies and barriers found in each country.

Training opportunities available through ISP’s CRVS improvement effort include:

• Medical certification of cause of death for physicians
• Manual coding and identification of underlying cause of death
• Use of automated software for coding and identification of underlying cause of death (IRISExternal)
• CRVS staff training at local and national levels
• General CRVS training (see FETP CRVS curriculum)

Countries participating in the CRVS improvement effort include:

• Kenya

  Since 2013, ISP has worked with the Civil Registration Department (CRD) and the Ministry of Health to implement a demonstration project in Homabay County. The demonstration project aims to improve registration coverage through active reporting by health workers and to improve quality of information on cause of death through medical certification of cause of death and verbal autopsy. Efforts in Kenya are being conducted with support from the Kisian Kenya Medical Research Institute (KEMRI)/CDC Field Research Station and other CRVS partners operating in Kenya, including the World Health Organization/Health Metrics Network and their Monitoring of Vital Events through the use of Information Technology (MOVE-ITExternal) initiative.. The project also collaborates with CDC’s Global Immunization Division, which recently received GAVI funding to improve data quality through use of electronic birth and immunization registries.

• South Africa

  Although a specific demonstration project has not been deemed necessary in South Africa, ISP has provided technical expertise to Statistics South AfricaExternal, the Department of Home Affairs, and the Medical Research Council in efforts to: improve completeness of death registration, identify techniques for improving the estimation of registration completeness, produce training manuals for Home Affairs staff, provide physician training on cause-of-death certification and ICD–10 coder training, improve the processing and automated coding of the death notification form, install the IRISExternal automated coding system, improve the analysis and reporting of vital statistics data, establish operating procedures, conduct a quality assessment of the National Population Register and evaluate the Western Cape mortality surveillance system. ISP also is providing assistance to enable South Africa to serve as a regional leader and support center on CRVS.

Countries supported through the Bloomberg Data for Health (BD4H) Initiative include:

• Malawi

  In collaboration with Malawi’s National Registration Bureau, Ministry of Health, and the CDC/USAID President’s Emergency Plan for AIDs Relief (PEPFAR) Malawi team, since 2012, ISP has supported efforts to strengthen Malawi’s vital statistics system, which currently lacks a full-fledged civil registration system. With BD4H support, ISP will augment current improvement efforts by providing technical assistance to: support a comprehensive assessment of the CRVS system; develop a strategic CRVS system plan and monitoring and evaluation plan; conduct staff training; coordinate registration activities in tandem with the implementation of a Sample Vital Registration with Verbal Autopsy (SAVVY) system; establish three demonstration projects to test district-level CRVS system infrastructure; produce regular vital statistics publications and support data use; augment mortality and natality components of existing facility-level electronic Health Management Information Systems; and develop public-awareness campaigns.

• Morocco

  ISP is providing technical assistance to support a demonstration project in Morocco that focuses on the City of Rabat and calls for careful coordination between the Ministry of Health and the Ministry of Interior regarding their joint responsibilities for event registration and cause-of-death reporting. The Morocco project includes a review of current CRVS legislation; a review of the online death registration system; a training course for physicians on the proper certification of causes of death; verbal autopsy administered electronically using mobile devices; training on cause-of-death coding and selection of underlying cause of death; and development of a national center for coding causes of death using IRISExternal, an automated system for coding and selecting underlying cause of death. Once these activities are firmly established in Rabat other Moroccan cities will be invited to participate.

• Zambia 

  ISP will collaborate with the Ministry of Home Affairs/Department of National Registration and Ministry of Health to improve coverage of birth and death registration, to introduce electronic transfer of birth and death notifications from hospitals to the national registration system, to implement a national curriculum for medical certification and coding of cause of death using the International Classification of Disease (ICD) system, and to integrate existing Sample Vital Registration with Verbal Autopsy (SAVVY) activities with the civil registration system. The project will also collaborate with CDC’s Global Immunization Division on a GAVI-sponsored project to improve data quality through use of electronic birth and immunization registries.

• Mumbai, India 

  In collaboration with the CDC/India Epidemic Intelligence Service (EIS) Program, the Municipal Corporation of Greater Mumbai, and the Government of Maharashtra State, ISP is providing technical assistance to improve mortality surveillance through medical certification and coding of cause of death using the International Classification of Disease (ICD) system, as well as training on the analysis of cause of death data. The collaboration is supporting the development of a comprehensive system of monitoring and evaluation.