dr peter ebongue mbondji - who · un commission on information and accountability for women’s and...
TRANSCRIPT
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Dr Peter Ebongue Mbondji Regional Adviser
Evidence and Natinal Health Oservatories (ENO) WHO Regional Office for Africa
COIA Sub-Regional Workshop. Harare, Zimbabwe, 01-03 October 2012
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UN Commission on Information and Accountability
for Women’s and Children’s Health - 2011
COIA Recommendation 1: Better Information for better results
“Vital events: By 2015, all countries have taken significant steps to establish a system for registration of births, deaths and causes of death, and have well-functioning health information systems that combine data from facilities, administrative sources and surveys”
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VITAL EVENTS
Vital events is essentially about
Births, Death and Causes of death.
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Vital events data provide key health status indicators
1. Birth : – Adolescent birth rate MDG 5 indicator
2. Mortality: – Under-5 mortality rate (U5MR) – Infant mortality rate (IMR) – Maternal mortality ratio (MMR) – Life expectancy (e0) – Adult mortality rate (45q15) – Neonatal mortality rate (NMR)
3. Causes of Death: – Incidence and death rates associated with malaria – Incidence, prevalence and death rates associated
with tuberculosis
MDG 4 & 5 indicators
MDG 6 indicators
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Public health importance of cause of death data
• Monitor the health of the population – Leading causes of death
– Mortality rates (geographic variations)
– Trends over time
• Inform decisions about health policy and strategy – Prevent premature deaths
– Service provision
– Health budgets
• Evaluate health service outcomes
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Why vital statistics data are important (1)
• Used to derive demographic and epidemiologic measures needed in national planning in health
• Understanding the – prevalence and distribution of mortality, – emerging health challenges (NCDs, HIV/AIDS, Injuries,…)
• Identification of health inequalities and priorities, • Monitoring of trends and progress towards MDGs • Evaluation of the impact and effectiveness of health
programmes including tracking of health reforms • Complete and Accurate measures of infant, child, and
maternal mortality.
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Not only health:
• Education
• Labour
• Other government activities
• Commercial enterprises (e.g. life insurance, marketing of products).
• Tracking national processes such as poverty reduction strategies, and development efforts overall
Why vital statistics data are important (2)
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Civil Registration and Vital Statistics (CRVS) System
• Statistics on births and deaths are recorded through the government’s civil registration system Permanent Record (PR) of each event
• Two primary uses of PR:
– Personal legal documents for every citizen
– Basis of the vital statistics system, core of a country’s HIS
CIVIL REGISTRATION RECORDS = Best source for Vital statistics data.
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Health sector needs
• Mortality and cause of death data are foundation for health planning, monitoring and evaluation: this includes MDGs, national health plans, evaluation studies
• Levels, trends and differentials (equity) for mortality indicators:
– Mortality rates • key indicators: Neonatal, infant and child mortality, adult mortality, life
expectancy…
– Causes of death, including maternal mortality, infectious diseases, NCD, injuries…
• Disaggregation essential: by age and sex, by cause, by geographic location, socio-economic factors
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Current situation CRVS
• Most countries in the region do not have well functioning systems
• Birth registration and death registration levels are low
• There are no/very few vital statistics generated from the civil registration systems
• Cause of death information is not available, or of poor quality (from hospitals but not using ICD) – Many cases of reporting causes of death still have at least
one error!!
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Coverage of births and deaths in AFR, 2000-2008
Coverage of deaths in AFR, 2000-2008
Birth and death registration levels are still low
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Cause of death information is not available, or of poor quality
Quality of globally available information on causes of death
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Mortality data sources
• CRVS: best source if complete and high quality system
• Household surveys and censuses: main source for most countries in the region
– Recent household deaths, birth and sibling histories…
• Hospital data: Reporting of causes of deaths
• Health and demographic surveillance studies: local only
– INDEPTH network, use of verbal autopsy…
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Health Sector: A major producer of CRVS data
Health sector produces birth, death and causes of death data through:
1. Hospital reporting
• Complete reporting by hospitals of births and deaths • Causes of death, using the ICD 10
2. Community reporting: CHWs; with electronic devices... Most deaths and births occur at home, outside health facilities
• Community reporting of birth and deaths: first line for reporting
• Verbal autopsy when there is a death
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STRENGTHENING THE CRVS SYSTEM:
• Assessment
• Reporting
• Data
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• Focus is on births, deaths, causes of death
• Built on global standards developed by UN and WHO
Describes standards against which to assess country CRVS systems
Identify gaps and weaknesses in birth, death and cause-of-death statistics and the system that produces them
Actively involve multisectoral stakeholders
Generate evidence for an improvement strategy
Suggest a roadmap to follow
http://www.uq.edu.au/hishub/theme3
Strengthening CRVS Systems (1): Assessment
A comprehensive, standards-based framework
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1. Assessment of current status and practices – Rapid assessment often done
to raise awareness and advocacy for CRVS
– Full assessment forms the basis for a plan
2. National plan for strengthening CRVS
• Developed with all relevant stake holders
• Costing 3. Strong coordination
mechanism 4. Political (and financial)
commitment from the government (can never be donor driven)
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Process for reviewing civil registration and vital statistics systems
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Process for reviewing civil registration and vital statistics systems
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5. Hospital reporting
• Complete reporting by hospitals of births and deaths
• Causes of death using the ICD 10
6. Community reporting
• Most deaths and births occur at home, outside health facilities
• Community reporting of birth and deaths, e.g. CHWs and with electronic devices
• Verbal autopsy if there is a death
Strengthening CRVS Systems (2): Reporting
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Immediate cause on top line
Any causal sequence with underlying cause
Contributing cause but not in causal sequence
in Part 2
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Attending doctor: • Establish diagnosis • Complete medical certificate of cause (International form –
WHO)
Coding by Statistical Office: • Code causes of death (ICD code for each cause listed) • Classify cause of death (select a single underlying cause of
death for stats according to ICD selection rules) • Check validity, query
Analysis by Statistical Office: • Tabulate and disseminate data
Source: Adapted from Johansson LA, 2008
Main stages in production of cause of death
statistics
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Practices affecting the quality of cause-of-death data
• Access to cause-of-death information • Would HIV/AIDS or suicide be assigned to a more socially
acceptable cause of death? • Does the death certificate state whether a woman was
pregnant or had recently been pregnant? Are maternal deaths reviewed separately?
• Are perinatal deaths monitored using a special form that obtains details about the mother as well as the baby?
• What training do doctors receive in COD certification? • Has there been an evaluation of the quality of medical
certification? • Who certifies whether the cause of death is natural or
unnatural? How well does this system work? Are certifying doctors aware of how this system works?
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7. Vital statistics • Data quality assessment of birth and death data
is critical as no system will be perfect
• Vital statistics from Civil Registration need to be produced regularly
8. Community reporting • If there is no good CRVS, health and
demographic surveillance sites can be used to obtain intermediate data
• Many countries have such HDSS but the data are not used
Strengthening CRVS Systems (3): Data
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Who is involved in CRVS? Government: CR Authority/Dept. National Statistics Office Ministry of Health Ministry Interior Ministry of Local Government Ministry of Justice Min. of Information Ministry of Finance Ministry of Planning Academia Research National Identification Agency
Others:
• Citizens Non-citizens • Civil Society • Community/Tradiotional/Religiou
s Leader • Development Partners • UN Agencies (UNFPA, UNICEF,
WHO, UNDP, UNAIDS, UNHCR) • Developmnet Banks • Private Sector • ICT Companies • Education Sector • The Press and Media Practitioners • Community Workers and
Community voluteers
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Interventions
1. Strengthening health information systems:
Better information Better actions to improve quality of care Prevent future deaths...
• Data quality gaps: relevance, accuracy and punctuality
– Quality of death & causes of death statistics • Deaths that occur outside hospital (verbal autopsy , …) • Mortality coding practice
• Harmonization of HIS
2. Develop a framework for integration of CRVS and health systems
Civil registration records Best source for vital statistics data Health sector a major contributor to CRVS systems
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Opportunities Initiatives and programmes from WHO and partners:
• Available tools to improve CRVS data:
– A comprehensive, standards-based framework to improve quality of birth, death and cause-of-death information
– WHO verbal autopsy standard, based on ICD10
• MoVE-IT Initiative: Monitoring of Vital Events through Innovation/IT; working with countries to enhance CRVS including innovative reporting systems - HMN/ WHO
• African Health Observatory: WHO platform for assessment, promotion, sharing and use of information, evidence and knowledge for health (http://www.aho.afro.who.int) – National Health Observatories: one-stop shop repository of country
health information and data
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National Health Observatory: A key role to Integration of CRVS and health
• Birth, death and causes of death registration and statistics (including data quality gaps) – Provide the most accurate, up-to-date and relevant data
from all sources on one unique national platform
• Monitoring of vital events – Monitoring health status of the population including
progress towards MDGs, by regularly providing trends and situation analyses
– Makes standards and tools available
• Advocacy and accountability – Make translated information openly available to all potential
users/reviewers – Provide an open space for networks and CoPs
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Regional Commitments
• UN Commission on Information and Accountability of Women and Children’s Health (COIA) Recommendations
• Statistical Commission for Africa: priority on CRVS
–UNECA: African Programme for Acceleration of Improvement of CRVS (APAI-CRVS)
• African Symposia for Statistical Development (ASSD): CRVS priority (Cape Town, Jan, 2012)
• Recommendations from the 2nd African Conference for Ministers in charge of CRVS (Sept 2012)
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10/10/2012 30
Monitoring of vital events using Standards and Tools: Assessment, Quality Control, Mobile Devices
Need for functional Civil Registration - Vital Statistics systems in Countries
Generate Evidence on what works: building upon existing work or systems
CONCLUSION
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Perspectives
• Assessment of CRVS
• Plan for strengthening CRVS
• Coordination mechanism
• Commitment
• Hospital reporting
• Community reporting
• Vital Statistics
• Local Studies
Self assessment report and country road map to strengthen CRVS
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THANK YOU !
Peter E. MBONDJI: [email protected] – African Health Observatory (http://www.aho.afro.who.int)
http://www.afro.who.int