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Incorporating verbal autopsy into the civil registration and vital statistics system

Systems prerequisites for introducing verbal autopsy

VA is a complex intervention that usually requires system-level changes. As such, it is recommended that it be implemented in a staged manner, with evaluation at each of the stages. A step-by-step process is essential, starting with the establishment of a national CRVS committee and the involvement of local experts with knowledge of mortality patterns. When considering VA implementation within CRVS, consideration must be given to some key prerequisites that will be important if the effort is to succeed.

Checklist of system-level considerations

The following is a checklist of system-level considerations for planning VA integration in CRVS systems:

  • Ensure that a high-level national CRVS policy and coordination committee is in operation
  • Ensure that the relevant authorities, agencies and ministries for civil registration, statistics, local government and health and are all engaged with CRVS
  • Ensure that a comprehensive CRVS assessment has been conducted in the past four years and has been used to develop a national CRVS vision and strategy, or is being planned
  • Set up a national subcommittee on mortality and COD
  • Establish a task force for VA implementation reporting to the national subcommittee on mortality and COD
  • Ensure that detailed process mapping of CRVS processes for registration of death in health facilities and death in communities has been done as part of the comprehensive assessment, and if not, prepare such process maps
  • With all relevant stakeholders, use these process maps of notification and registration processes of death in the community as a base to develop the plan of implementation for how VA would be integrated into a modified set of processes
  • Prepare an investment case to justify using VA as a method to increase notification and registration of deaths and ascertain underlying cause of death
  • Consider a legal and regulatory review of the implications of VA in CRVS as an early step in the plan
  • Apply the enterprise architecture Digital CRVS Guidebook to assess the additional IT needs
  • Map the existing CRVS and DHIS2 IT infrastructure and its gaps; seek synergies with existing IT for population registration efforts (for example, national identification agencies)
  • Determine how mobile tablets will be supported, maintained and securely transmit/receive data (wireless, general packet radio service and so on)
  • Design data flow and quality assurance mechanisms
  • Ensure that e‑governance, interoperability, data security, confidentiality and data encryption issues are addressed
  • Decide how VA-coded deaths will be distinguished from medically certified deaths in aggregate databases
  • Decide on scale (sample system or full coverage) and phased introduction
  • Use a VA costing tool to develop the start-up and annualised budgets
  • Prepare a profile of the existing CRVS human resources and needs
  • Develop job descriptions, training plans and training materials for new and revised positions 
  • Consider adding VA functions to existing position descriptions of community workers
  • Plan for an increase in the workload for existing staff
  • Develop a training program for master trainers, trainers of trainers, and training of VA supervisors, interviewers and analysts
  • Prepare a monitoring and evaluation plan for the new VA processes, including the use of VA costing tools to document costs and an independent quality assurance mechanism
  • Work with stakeholders to develop a learning platform for phased introduction, and assemble necessary funding.

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