Potential and Principles for Health Sector Actions to Strengthen Civil Registration and Vital Statistics Systems

Transcription

1 Potential and Principles for Health Sector Actions to Strengthen Civil Registration and Vital Statistics Systems Discussion Paper This paper was prepared by WHO with inputs from Canada, UNICEF and USAID as a discussion paper for a meeting on health sector contributions to strengthening civil registration and vital statistics systems in Geneva, December The paper provides background information and introduces for discussion a set of good practices and principles for the health sector actions in order to maximize the benefits for strengthening country civil registration and vital statistics systems. Contents Civil Registration and Vital Statistics... 2 Strengthening CRVS... 2 The Links between Health and CRVS... 3 Potential and Principles for Health Sector Actions to strengthen CRVS... 4 Maternal, Newborn and Child Health... 6 Causes of Death... 7 Generating vital statistics from CRVS and related systems... 7 Annexes... 9 Annex 1: Health Statistics by Region... 9 Annex 2: CRVS Regional Programmes and Progress Annex 3: Snapshot of progress in 75 countries

2 Civil Registration and Vital Statistics Civil registration is defined as the continuous, permanent, compulsory and universal recording of the occurrence and characteristics of vital events (live births, deaths, marriages and divorces) and other civil status events pertaining to the population as provided by decree, law or regulation, in accordance with the legal requirements of each country. A vital statistics system processes and tabulates the vital events data recorded by the civil registration system with the-purpose of creating statistics. 1 A well-functioning civil registration and vital statistics system (CRVS) registers births and deaths, issues birth and death certificates, and compiles and disseminates vital statistics, including cause of death information. It provides important documentation on legal identity and family relationships for individuals and generates vital statistics on population, fertility and mortality. The unique value of CRVS lies in the achievement of universal and continuous reporting: that is, that all birth and all deaths (with causes of death) are registered on an ongoing basis. This ensures that all citizens can access legal documentation on vital events and that vital statistics are accurate, based on a complete data collection. The information generated is of critical importance for policy and planning in many sectors, and is of particular importance the health sector in relation to fertility, maternal and child health, and age, sex and disease-specific mortality. The registration of vital events involves multiple sectors, including registration and health sectors, local authorities, and departments of justice, security and the interior. Other actors may play a role, for example religious and funereal institutions, civil society groups, and agencies involved in the protection of migrants and refugees. 2 The national statistics office plays a key role in compiling and disseminating the statistical information contained in the registration records. Despite the well-documented benefits of CRVS, many countries do not have adequate systems in place. The Millennium Development Goals highlighted the paucity of quality data and the urgent need for reliable, continuous and comparable vital statistics 3. The births of one in three of children are known to be unregistered every year 4, and more than half of WHO Member States currently produce either no data on mortality and cause of death or data of poor quality that are of little value for public health policy and planning. It is estimated that two-thirds of deaths globally are never registered and are thus not counted in the vital statistics system 5. The weakness of CRVS systems has been described as the scandal of invisibility 6. Strengthening CRVS Awareness of the importance of CRVS systems is growing: countries are increasing their investments in CRVS, regional UN agencies are mobilizing governments and providing technical guidance, and increased global attention is reflected in political declarations and calls for the inclusion of civil registration in the post-2015 development agenda. 7 In Africa, 8 the Eastern Mediterranean 9 and the Pacific, 10 regional strategic plans have received ministerial level endorsement and ministerial support for the regional plan in the Asia-Pacific region, home to two-thirds of the world s population, most of whom are unregistered, is planned for Political commitment in the international community is higher than ever before with a Global Call for Partner Action on CRVS. 12 2

3 Global and regional partners are working together to mobilize resources, align support to countries, develop common approaches and technical guidance, 13 and facilitate cross-country learning. Annex 2 provides a summary of the status of current regional initiatives. Strengthening of country CRVS systems comprises several key components: Political commitment: Coordination: National improvement plan: Implementation support: The known value of CRVS as a system providing legal identity as well as valuable data for evidence-based decision-making can underpin political commitment. The intersectoral nature of CRVS requires high-level political commitment as well as domestic investment in CRVS. In addition to commitment on the part of senior policy-makers it is essential to ensure the collaboration and active participation of the public and civil society to ensure that all individuals participate fully in the system and are aware of its potential benefits. A national steering committee, chaired by a high-level government officer, should have multisectoral representation including, where appropriate, development partners, civil society, and academia. The improvement strategy should be based on a multisectoral assessment and planning process, should address the need for a supportive policy and legal framework and include a strategic improvement plan with prioritized and costed activities, mobilization of national investments, and a monitoring and evaluation strategy. Innovative approaches can be used to strengthen various aspects of CRVS including notification, recording, registration and certification, enhancing coverage of birth and death registration, improving the quality of data, and, if appropriate, alignment of partners in their support to the implementation. Information and communication technologies (ICT) have the potential to accelerate improvements in CRVS effectiveness and efficiency. Several projects introducing ICT are currently being piloted and assessed for possible scale-up and sustainability. Technology can be viewed as an enabling factor to improve business processes for notification and registration of births and deaths as well as to improve and speed up the compilation of vital statistics. The Links between Health and CRVS Many functioning CRVS systems draw on information from the health sector for the notification and confirmation of births and deaths. In some countries the civil registration law designates health institutions as informants of births and deaths occurring in health facilities. Sometimes a detached civil registry office is located in each facility making the notification process simple and straightforward. Alternatively, notifications are forwarded to the registry directly. In some settings, the law allows for certain civil registration activities to be carried out by designated health facility staff. The health sector also relies on CRVS systems and information. Detailed information on births and deaths by age, sex and cause are needed to identify emerging health challenges and monitor the impact 3

4 of health policies and programmes. For example, information on maternal deaths and on infectious or vector-borne disease and mortality is critical to developing appropriate responses and monitoring. The unique advantages of CRVS are the universality and continuity in the recording of all births and all deaths with causes of death. Complete information on births is critical for planning of supplies such as vaccines, and assessment of programme performance through estimation of coverage rates. Complete information on deaths enables accurate mortality counts at the population level as well as by specific causes of death. Fertility trends, disease-specific and all-cause mortality, life expectancy, burden of disease and many other health indicators are derived from CRVS systems and used to underpin health policies, programmes and planning as well as health monitoring, measurement and evaluation. Moreover, the civil registration system collects information on vital events by local administrative area, thus permitting disaggregation of vital rates by urban/rural and geographic area. This detailed data is essential for identifying and targeting health and other policy interventions to marginalized groups. Potential and Principles for Health Sector Actions to strengthen CRVS Investments and innovations in the health sector have the potential to contribute to strengthening of CRVS systems overall. For example, new ways of tracking the health of mothers, newborns, and children, ascertainment of cause of death, and analysis of mortality data can contribute to both more complete capture of vital events and improved quality of vital statistics. The use of automated methods for coding causes of death to ICD statistical categories helps improve both accuracy and efficiency. The possible contributions of the health sector, particularly in relation to mortality and cause of death registration and the generation of vital statistics are outlined in Figure 1. Figure 1: Health Sector Contributions to CRVS System Strengthening As part of broader efforts for CRVS improvement, the health sector actions can contribute in multiple 4

5 ways: HEALTH SECTOR POTENTIAL AND PRINCIPLES: GOOD PRACTICES Advocacy: Play a role in advocacy for political mobilization for CRVS; Use strong links to civil society and local community to raise awareness of the importance of registration of births and death National engagement: Capacity strengthening: Participate in the CRVS national steering committee; Participate in the comprehensive CRVS assessment and national plan development, and ensure that the health sector role and responsibilities are well defined. Support health workers and medical professionals in understanding their roles and responsibilities in the notification of vital events; Build skills of medical professionals with regard to the ascertainment and certification of cause of death. Innovation: Use innovations developed to facilitate identification of births and deaths as part of a cohesive CRVS system overall rather than as isolated projects; Create and support the dissemination and use of innovative approaches to improving cause of death ascertainment, such as automated ICD coding and verbal autopsy for non-facility deaths. At an operational level, health sector contributions to CRVS can include the following components: a) Notification from the health facility or community health worker of a birth or death, provided both to families and the appropriate registration authorities; b) Issuance of a Medical Certificate of Cause of Death by the health facility/medical doctor to the family and the appropriate registration authority; c) The completion of a Verbal Autopsy to determine causes of death In settings where medical certification is not possible; d) The creation of a health record of the occurrence of vital events (births, deaths) and associated characteristics; e) Where the legal framework is supportive, formal registration of vital events in collaboration with the civil registration system; f) Where designated by the law, issuance of certificates of birth and/or death to the family members in collaboration with the relevant registration authorities; g) Compilation, analysis and interpretation of health-related vital statistics in collaboration with national statistical agencies The use of health system entry points for strengthening registration, such as immunization services (which reach well over 90% of target populations in many countries) to identify and retrospectively register children, is also being explored. Table 1 in the Annex shows coverage of health service interventions that could offer entry points for improving both registration of vital events and compilation of statistics. Other health programmes that can be used to strengthen CRVS systems include maternal, newborn and child health, efforts to monitor cause-specific mortality, and interventions 5

6 aimed at strengthening routine health information systems that can contribute to the generation of vital statistics. The following section explores linkages between these areas and strengthening of CRVS. Maternal, Newborn and Child Health Recent innovations in the health sector include the development of ICT interventions to track individual information on service use across the Continuum of Care from pre-pregnancy to delivery and the immediate postnatal period, as well as services for infants and children from the delivery through to childhood. Good practices for linking to CRVS include: HEALTH SECTOR ACTIONS IN THE CONTEXT OF MNCH: GOOD PRACTICES In health facilities Promoting mechanisms to ensure that all births that occur in health facilities are formally recorded in the health system and notified to the civil registration authorities securely and confidentially. Using childhood immunization services, as well as other child or family services, as occasions to promote and encourage families to register hitherto unregistered children. Using birth registration to improve access to health care. Ensuring that all deaths of children occurring in health facilities are recorded and medically certified using the international form of medical certificate of cause-of-death and duly notified to the civil registration authorities. Building upon systems designed to identify pregnant women and maternal and perinatal deaths (maternal/perinatal surveillance and response) to ensure that all births and maternal and perinatal deaths are recorded, with a medically certified cause of death, and duly notified to the civil registration authorities. In communities Supporting community health workers to record all deaths occurring in their communities and to notify registration authorities accordingly Developing appropriate and innovative methods for community health workers to record births and deaths such as mobile telephones and instant messaging (SMS), using secure systems to ensure confidentiality and privacy of data. Ensuring that all deaths of children occurring outside health facilities have a cause of death determined through verbal autopsy. Using systems for the identification and follow-up of child deaths to notify civil registration authorities and to ensure that all such deaths have a medically certified cause of death or a cause determined through verbal autopsy. 6

7 Causes of Death The health sector is responsible for determination of the causes of death and characteristics of the deceased through medical certification of cause of death. In many countries large proportions of deaths occur outside the health system and formal medical certification is not possible. In such circumstances, probable cause of death at the population level (cause-specific mortality fractions) can be estimated using verbal autopsy, which involves interviews with family members and/or persons who cared for the deceased person prior to death. 14 Good practices in relation to cause of death determination include: HEALTH SECTOR ACTIONS TO IMPROVE CAUSES OF DEATH INFORMATION: GOOD PRACTICES Medical certification: Ensuring use of the international form of medical certification of cause of death for all deaths that occur in health facilities with appropriately trained medical staff. Ensuring that all medically trained personnel and physicians have the skills and support to accurately determine cause of death according to ICD standards, including innovative approaches to train (pre-service and in-service) all medical certifiers in the correct completion of a death certificate. Promoting the use of IT to improve the quality and timeliness of coding of causes of death according to ICD standards, such as automated coding. Developing web-based electronic reporting systems of mortality and causes of death in hospitals. Use of a medical certificate cause of death as a notifying document for death registration. Verbal autopsy: Supporting the scale up of verbal autopsy to estimate population level cause of death for deaths occurring outside health care facilities; Promoting innovative approaches for the registration of all deaths and use of verbal autopsy in communities, e.g. using CHWs, linked to the CRVS; Exploring the use of a verbal autopsy record as a notifying document for death registration. Generating vital statistics from CRVS and related systems Countries and development partners have a shared interest in measuring the results of their efforts and investments. In health, this requires reliable data on births, as well as mortality trends by age, sex and cause. In countries with weak vital events registration systems alternative sources are used to obtain vital statistics, such as population censuses, sample surveys and demographic surveillance. Some countries have local health and demographic surveillance systems (HDSS), some have long running, nationally representative sample registration systems (India, China), which combine active case finding of deaths coupled with verbal autopsy to determine causes (SAVVY). These alternative mortality data collection methods aim to produce reliable mortality statistics in the near future, recognizing that obtaining reliable statistics from CRVS will take some time. However, these 7

8 approaches do not have the merits of universality, continuity, and sustainability of CRVS. Nor do they offer individuals the documentation they need to support their claims to identity and family relationships. Such methods have been described by the UN as short- to medium-term measures that cannot replace functional CRVS systems. 1 They should, therefore, be implemented in ways that complement and strengthen the CRVS. Good practices in health sector investments and innovations in relation to interim methods for generating vital statistics include: HEALTH SECTOR ACTIONS TO IMPROVE CAUSES OF DEATH INFORMATION: GOOD PRACTICES Capacity strengthening: Data quality and analysis: Harnessing the skills developed in surveillance sites and sample registration systems to strengthen CRVS processes and build capacities for birth and death registration and cause of death ascertainment. Developing effective linkages between HDSS and civil registration systems, for example, by encouraging the follow up actions for vital events identified through population surveillance. 19 Promoting the use of alternative sources of vital statistics in order to assess completeness and accuracy of the civil registration system. Developing techniques and tools for analyses of data from multiple sources to obtain reliable fertility and mortality trends. Innovation: Testing innovative approaches for the ascertainment of causes of death using IT in surveillance settings prior to scale up in CRVS systems. 8

9 Annexes Annex 1: Health Statistics by Region Births Deaths Proportion births in hospitals % (by UNICEF region) 1 Proportion of births attended by a skilled health personnel 2 Africa Americas South East Asia (South Asia) Europe Eastern Mediterranean na 64 (Middle East and North Africa) Western Pacific 84 (East Asia and Pacific) Antenatal Care (at least one visit) % 3 Immunization (DTP1) (2012) % 4 Post natal care (visit within 2 days) % 5 Births Coverage: % member states with less than 75% coverage Proportion deaths in < not not hospitals % 7 available available % member states which cannot report by ICD or have low quality ICD 8 Number of HDSS sites using VA in region 9 Deaths Coverage: % member states with less than 75% coverage 10 1 UNICEF Child Info website 2 WHO 2013 World Health Statistics. 3 WHO Global Health Observatory WHO 2013 Immunization Coverage Estimates 5 ibid 6 WHO Global Health Observatory WHO internal estimates based on 2005 Survey, unpublished 8 WHO 2012 World Health Statistics 9 INDEPTH Network WHO Global Health Observatory

10 Annex 2: CRVS Regional Programmes and Progress Political Commitment Africa Declaration of African Ministers Responsible for Civil Registration. Ministerial Statement, Second Conference of African Ministers responsible for Civil Registration. Conference of Ministers Responsible for CR is now institutionalized as a permanent forum under AUC. States report on progress every two years Asia-Pacific UNESCAP Region ESCAP resolution 67/12 (2011): The Improvement of CRVS in Asia and the Pacific ESCAP resolution 69/15 (2013): Implementing the outcome of the Highlevel Meeting on the Improvement of CRVS in Asia and the Pacific PLANNED: tripartite Ministerial meeting December Eastern Mediterranean (WHO EMRO) Regional Strategic Plan endorsed in WHO/EMRO 60th session of the Regional Committee. Latin America & Caribbean (AMRO) PAHO: Regional Plan of Action for Strengthening Vital and Health Statistics since 2008 Resolution AG/RES (XXXVII-O/07) of the Organization of American States Parliamentary workshop on the right to identity: Promoting universal birth registration in Latin America and the Caribbean CRVS Results so Far More than 30 CRVS experts trained in assessment techniques More than 20 countries currently undertaking a rapid assessment of CRVS systems. More than 48 ESCAP member States have completed a rapid assessment. 28 ESCAP member States have completed or are in the process of completing a comprehensive assessment that will lead to national CRVS plans 22 of the 23 EMR countries completed their rapid CRVS assessments. More than half of the EMR countries have now completed comprehensive assessments of their CRVS systems, and are developing national CRVS plans. Annual reporting of changes and improvements in birth and death registration and coverage. 10

11 Annex 3: Snapshot of progress in 75 countries This list is designed to capture the known CRVS status and assessment activities in each country among the 75 countries of the report of the Commission on Information and Accountability for Women s and Children s Health, as well as activities through WHO / and the former HMN MOVE IT project. It is not exhaustive, and does not accurately reflect all project or partner activities in countries. There are multiple partners working in countries, including those working through programs such as the APAI- CRVS and the UNESCAP and EMR Regional Plans for CRVS. Country Status Birth Registration Coverage xi (%) Death Coverage xii (%) Afghanistan 37 Rapid Comprehensive completed Angola Upcoming Jan 2014 Azerbaijan Rapid Bangladesh 10 Rapid Comprehensive complete Actions CRVS Assessment Innovations and Progress Political Commitment MOVE IT project on IT design completed. National ID system linked to CRVS. Strategic Plan developed Strategic Plan in development and Commitment to Pilot technology (ecodirs) Benin 60 National strategy and action plan for CRVS Bolivia 76 PAHO report declines in birth registration in Bolivia - active monitoring under regional strategy. Botswana 72 Comprehensive Underway CRVS activities in country; MOVE IT analysis completed Not yet initiated strategic plan under strategic framework. Government Strategic Plan complete Brazil Improvement in, birth registration. PAHO report increased birth and death registrations. Burkina Faso 77 Rapid Comprehensive complete Burundi 75 Rapid Cambodia 62 Rapid Comprehensive complete Cameroon 70 Comprehensive Underway CAR 61 Chad 16 ICD-10 mortality coding in 2 pilot hospitals. Interest in developing ehealth strategy and architecture using CRVS user story Commitment to national target. Situation Assessment completed under regional framework. National CRVS committee National CRVS committee. Stocktaking on CRVS investments by government and partners underway xi WHO World Health Statistics 2013 derived from UNICEF coverage estimates. xii WHO World Health Statistics 2013 derived from WHO coverage estimates 11

12 Country Status Birth Registration Coverage (%) Death Coverage (%) Actions CRVS Assessment Innovations and Progress Political Commitment China 4 Rapid So far 1 of 3 provinces in the WHO Western Area Health Initiative (WAHI) expressed interest in CRVS strengthening. Comoros Rapid Congo 81 Brazaville Côte d'ivoire 55 DR Congo 28 Rapid DPR Korea 100 Rapid Comprehensive underway Djibouti 89 Rapid Egypt Rapid Equatorial Guinea Eritrea Ethiopia 7 Rapid CRVS strengthening underway in Egypt, especially causes of death; MOVE IT ICD project complete Gabon Rapid Gambia 53 Ghana 63 Rapid Guatemala PAHO report declines in birth and death registration coverage. Guinea 43 Guinéa-Bissau 24 Rapid Haiti 81 Exploring Piloting of new technology (ecodirs )as part of COIA Roadmap Strategic Plan developed Strategic Plan developed Strategic Plan complete. National Committee formed (20 Ministries, 9 regions, 2 urban administrations) Developing a Strategic Plan within PAHO regional India 41 8 Rapid Discussions to set up VA Validation Study, as part of SRS; birth registration technologies Indonesia 53 Rapid Iraq Rapid Kenya 60 Comprehensive Underway Krgyzstan Rapid 12 Sample Registration System (SRS) rolled out. MOVE IT project Cause of death automation complete and being used in SRS. Implementing automated Verbal Autopsy using WHO VA tool. Strengthening between Health and Registry underway; MOVE IT project community reporting project in district. CDC VA project testing. Strategic Plan complete. SRS using WHO VA tool & InterVA Pilot agreed to be conducted soon Strategic Plan Developed National CRVS Committee

13 Country Status Birth Registration Coverage (%) Actions Death Coverage (%) CRVS Assessment Innovations and Progress Political Commitment Laos 72 Rapid Lesotho 45 Liberia 4 Madagascar 80 Rapid ICD coding in Main Hospital. Coding top 300 CODs. Strategic Plan complete. New law enacted, and new agency created for birth and death registration. Malawi Comprehensive In Planning Mali 81 Mauritania 56 Mauritius > Sample Registration System and VA testing (CDC) National CRVS Committee; Strategic Plan for CRVS Mexico 93 Work on reviewing births and deaths. PAHO report that Mexico have reached their regional target for birth and death. Morocco 27 Rapid Piloting a new digitized CRVS management system Mozambique 31 Comprehensive Underway Myanmar 31 Comprehensive In Planning Nepal 42 Rapid MOVE IT hospital reporting project, linked with community reporting. Strategic Plan complete under regional framework. Strategic Plan Developed National CRVS committee Commitment to Pilot new technology (ecodirs) Niger 32 The national strategy dates back to Nigeria 30 In the process of developing a national strategy Pakistan 27 Rapid Strategic Plan in development Peru PAHO report Peru have increased birth and death registration coverage under regional plan. Philippines >90 92 Rapid National registration week, ICD coding in district offices. MOVE IT project on local level reporting completed. Linking with mhealth application Watching Over Mother and Babies (WOMB). Will be undergoing TofT on physician training on underlying COD. Papua New Guinea Comprehensive Underway Rwanda 63 Rapid MOVE IT - district reporting on vital events with VA Developing a Strategic Plan within PAHO regional framework National Strategic Plan. National CRVS Committee 13

14 Country Status Birth Registration Coverage (%) Death Coverage (%) Sao Tomé-et- 75 Principe Sénégal 75 Rapid Sierra Leone 78 Rapid CRVS Assessment Actions Innovations and Progress Political Commitment Solomon Islands Comprehensive underway Linking aggregated COD data with DHIS2 Somalia 3 Rapid for all three regions South Africa Full birth and death reporting. Automated (IRIS) coding for cause of death and MOVE IT technology project completed South Sudan 35 Comprehensive Planned Sudan 59 Rapid Swaziland 50 Comprehensive in Planning Tajikistan Rapid National Steering Committee Regional leadership and support for CRVS. Finalized the drafting of the civil registration bill (yet to be approved by Parliament) National CRVS Committee Tanzania 16 Comprehensive Underway Togo 78 Turkmenistan 96 Rapid Uganda 30 Comprehensive In Planning Uzbekistan Rapid Vietnam 95 Rapid Yemen 22 Rapid Zambia 14 Rapid Zimbabwe 49 Sample registration system in 23 districts 9SAVVY) operational; run by Ifahora Health institute. MOVE IT project on SRS completed. CRVS birth registration project coordinated between Registry and Health (UNICEF). SRS operational under National Bureau of Statistics. National CRVS Committee, agreement to an Action Plan National CRVS Committee Strategic Plan developed. National CRVS Committee, national action plan (under review) 14

15 1 United Nations Department of Economic and Social Affairs (2013) UN Principles and Recommendations for a Vital Statistics System Revision 3 DRAFT April United Nations General Assembly (2012) Human Rights Council Nineteenth session Agenda item 3. Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development A/HRC/19/L.24 3 WHO 2012 Strengthening civil registration and vital statistics for births, deaths and causes of death: Resource Kit 4 UNICEF 2013 Every Child s Birthright; inequities and trends in birth registration sourced at 5 WHO 2012 World Health Statistics Setel et al 2007 Who Counts? A Scandal of Invisibility: making everyone count by counting everyone, The Lancet, 370(9598): World Health Organization (2013) Every Woman, Every Child: Strengthening Equity and Dignity through Health: the second report of the independent Expert Review Group (ierg) on Information and Accountability for Women s and Children s health. ISBN (NLM classification: WA 310) World Health organization Africa Programme on Accelerated Improvement of Civil Registration and Vital Statistics (AP AI-CRVS) (2012). Second Conference of African Ministers Responsible for Civil Registration Durban, South Africa, September Accessed 15 September 2013 from 9 REGIONAL COMMITTEE FOR THE EASTERN MEDITERRANEAN Sixtieth Session Agenda item 5(b) EM/RC60/R.7 October 2013 Regional strategy for the improvement of civil registration and vital statistics systems The BRISBANE ACCORD GROUP and the PACIFIC VITAL STATISTICS ACTION PLAN ( ) Outline Document 11 UNESCAP (2012) Regional Strategic Plan for the Improvement of Civil Registration and Vital Statistics in Asia and the Pacific 12 Global Summit on Civil Registration and Vital Statistics (2013) Accessed on 15 September 2013 at : 13 World Health Organization and University of Queensland (2013) Strengthening civil registration and vital statistics for births, deaths and causes of death: resource kit. ISBN (NLM classification: WA 900) WHO/HMN/13.1 World Health Organization World Health Organization (2007). Verbal autopsy standards: Ascertaining and attributing cause of death. Geneva, World Health Organization. Retrieved 22 August 2012 from: 15 Yang G, Hu J, Rao KQ, Ma J, Rao C, LopezAD (2005) Mortality registration and surveillance in China: History, current situation and challenges. Population Health Metrics 2005, 3:3 doi: / Hill K et al. (2007) on behalf of the Monitoring of Vital Events (MoVE) writing group.. Who Counts? 3. Interim measures for meeting needs for health sector data: births, deaths, and causes of death. The Lancet, 370(9600): doi: /s (07) Retrieved 22 August 2012 from: 17 World Health Organization and University of Queensland (2013) Strengthening civil registration and vital statistics for births, deaths and causes of death: resource kit. ISBN (NLM classification: WA 900) WHO/HMN/13.1 World Health Organization World Health Organization (2007). Verbal autopsy standards: Ascertaining and attributing cause of death. Geneva, World Health Organization. Retrieved 22 August 2012 from: 19 Ye Y, Wamukoya M, Ezeh A, Emina J, Sankoh O (2012). Health and demographic surveillance systems: a step towards full civil registration and vital statistics system in sub-sahara Africa? BMC Public Health, 12:741. doi: / retrieved 10 September 2012 from: 15