In this blog, Dilip Hensman, Bloomberg Philanthropies Data for Health Fellow and Technical Officer for Health Information Systems in WHO Lao PDR, reflects on how COVID-19 surveillance challenges could be turned into opportunities to strengthen CRVS.
Lao PDR has done well to control the transmission of COVID-19, with just 19 cases and no deaths reported so far. Timely non-pharmaceutical interventions and strengthened surveillance contributed to this success with a countrywide lockdown imposed on 23rd March. With most cases recovered and no new COVID-19 cases for 21 days, the lockdown was finally lifted on 4th May. While Lao PDR is gradually getting accustomed to the “new normal” with many public health measures still in place, it is also using this time wisely to strengthen surveillance for subsequent waves. While testing for COVID-19 continues among suspected cases, contacts and migrant worker returnees, it is also stepping up its Event Based Surveillance. One of the key priorities as part of these strengthening initiatives is to monitor deaths in the community.
In Lao PDR, with less than 10% of the deaths taking place in health facilities, the Ministry of Health does not have access to information on community deaths. The current death notification system established by the Ministry of Home Affairs bypasses the health system and is built upon a process of death notification by Village Chiefs to its district offices. Therefore, the Ministry of Health completely misses out on having access to this key information which is vital for public health policy. There have been ongoing negotiations between the Ministry of Health and the Ministry of Home Affairs in the past for a workable data sharing mechanism, which have not yet resulted in a positive outcome. With the COVID-19 outbreak, the Ministry of Health requires this data as part of its efforts to strengthen community surveillance in observing any unusual mortality patterns in the community. Reliable and routine access to mortality data from communities and health facilities would not only be important for public health policy in the longer term, but also for routine surveillance through the continuous tracking of deaths. This would support the detection of any outbreaks in the community that may otherwise go undetected.
The Ministry of Health, being at the helm of all emergency operations, has better convening power now. The timing has never been better for it to gain access to this information. The Ministry of Health intends to reignite a high-level discussion between the two ministries about continuous formal access to this data, which will set the foundation for a holistic death notification system in the country. Once these community deaths are followed up with automated verbal autopsies, the country could start utilising mortality statistics for public health policy for the first time.
A woman and her baby wait for a COVID-19 test in Oudomxay Province, Lao PDR.