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Incorporating verbal autopsy into the civil registration and vital statistics system

Criteria for introducing automated verbal autopsy into civil registration and vital statistics systems

The introduction of VAs will depend on a careful analysis of, and response to, the structure and capacity of peripheral health and statistical services in the country. VAs should be integrated within civil registration systems. It should be noted that introducing VAs outside CRVS systems may divert resources from efforts to strengthen those systems. 

In making decisions about the introduction of VAs into settings with limited resources, three broad criteria need to be considered: 

  • Efficiency – This is the extent to which approaches for the introduction of VAs make the best possible use of scarce resources. A program needs to be sustainable (that is, operate independently of external inputs) in the medium and long term.
  • Effectiveness – This is the extent to which the chosen VA and diagnostic method can accurately predict cause of death (COD) from a sufficiently large sample of all deaths and so provide valid cause-specific mortality fractions (CSMFs) for national and subnational populations. 
  • Cost – It is important to compare the cost of ongoing collection of VAs with other strategies for the collection of COD data, such as surveys. This cost comparison will support decision making in ministries of health, which are the principal users of COD data. A distinction needs to be made between the opportunity costs (for example, of using existing health staff to collect data) and the additional costs incurred by hiring specific survey staff. It is also important to distinguish between start-up costs and ongoing operational costs.

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