Incorporating verbal autopsy into the civil registration and vital statistics system
A stepwise process
Introducing verbal autopsies (VAs) into a civil registration and vital statistics (CRVS) system requires a step-by-step process, including the establishment of a national CRVS committee and the involvement of local experts with knowledge of mortality patterns.
It is essential to ensure that existing country laws and regulations can facilitate the integration of VAs into the CRVS system, and these should be reviewed prior to implementation of VAs.
Consideration also needs to be given to the flow of information in the existing CRVS system, particularly relating to notifying, registering and certifying deaths.
Sufficient capacity (human resources, supervision, IT infrastructure, and so on) should be available to ensure that VAs can be successfully collected and the data integrated into the CRVS system.
Countries will need to decide on the scope of implementation of VAs: this should initially be in a limited number of areas, with a targeted number of deaths, to field test the chosen questionnaire, choice of interviewers and assess any resourcing implications.
Once targets have been reached, the implementation of VA should be reviewed: clear indicators are needed to evaluate different aspects of both the process and the data that have been collected.
Implementation of a national plan should be based on recommendations and learning from the test phase. It is important that the scale-up be incremental and designed with inbuilt monitoring and evaluation.
Country experience: Myanmar
Myanmar's efforts to incorporate VA into its CRVS system have centred around improving the midwife system. Myanmar's 20,000 midwives are key informants in the vital events reporting stream, and as such, BD4H has begun training midwives to perform VA in villages using computer tablets and the SmartVA software, which can ascertain COD without a physician.
Midwives are best-placed to conduct VA given that they work in close contact with village populations for routine health monitoring activities like immunisations, and are thus often the first to know about deaths. SmartVA has been rolled out to 14 townships and districts in Myanmar thus far, covering 2.2 million people, and by 2019 this number is due to increase to 48 townships.