Almost all CRVS systems in low and middle-income countries are failing to achieve adequate levels of completeness and quality, despite attempting to apply standard methods proven to work well in high income countries. This suggests system failure rather than technical failure. To date, most attempts to improve CRVS systems have been reductionist and aimed at the technical faults. Countries need technical solutions such as verbal autopsy or digitisation of CRVS operations to overcome some of the challenges they have been facing during the last 20 years. They have an opportunity to bring CRVS systems to acceptable levels of coverage and quality. However, they will fail if they do not face up to the structural changes that their CRVS systems require.

CRVS stakeholders struggle to capture the complexity of such systems, partly because they only know the activities of the CRVS system where they are directly involved. For instance, people working in civil registration offices are not usually aware of the implications of their activity on the production of vital statistics. Similarly, health professionals are not familiar with the difference in terms of legal entitlements between the medical certification of cause of death (MCCOD) that they issue and the death certificate issued by the civil registration office. It is difficult to find someone in the system with an understanding of the entire CRVS system and its operations.

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Cobos Munoz D. and de Savigny D. (2017) Process mapping: a tool for visualizing system processes from end to- end'. This can be found in: D. de Savigny, K. Blanchet and T. Adams (Eds.), Applied Systems Thinking for Health Systems Research: A Methodological (1st ed., pp.280). Londo: McGraw Hill.