Getting Deaths Right

Paperwork at a public health clinic in Mongolia.
Paperwork at a public health clinic in Mongolia.

By Eduardo P. Banzon

A policy brief from the Asia Pacific Observatory on Health Systems and Policies is helping Asian countries capture in a more appropriate manner causes of death and disease burden.

As ebola, MERS, and most recently zika have made clear, diseases do not respect borders. This means countries must collaborate in gathering, analyzing and sharing data on who is dying—and why—in each country. Getting the death data right means countries can get health care right, and prevent more people from meeting an untimely end.

In the five years since ADB became part of the Asia Pacific Observatory (APO) on Health Systems and Policies and provided it with funding under a technical assistance project, APO had been preparing health systems in transition country reports, policy briefs and comparative country studies. Among the policy briefs is one called Strengthening Vital Statistics Systems, which found out that many countries in Asia and the Pacific are not collecting the basic data on the total number of deaths, such as the age and gender of those who have died. The picture is even murkier when we start looking for data on the causes of deaths.

The APO policy brief estimated that more than half of all countries in the region cannot depend on their own respective civil registration and vital statistics (CVRS) systems to deliver the data on the number and causes of deaths, data that are critical to shaping domestic health plans and working with neighboring countries to deal with common challenges.

CRVS systems are supposed to provide a big chunk of death data. If these systems are weak, countries end up making health system interventions that are not responding to current—or looming—needs and problems.

The policy brief pointed  to a number of critical areas that need to be strengthened for countries to get deaths right. All deaths should be registered with the causes of death certified by accountable health and/or local officials. Medical record practices have to be strengthened, particularly the correct coding of death certificates.

Lastly, given that many deaths in developing countries occur outside of hospitals or other medical facilities and without a health worker present, governments need to adopt practical, cost-effective and reliable systems of diagnosing causes of deaths. The best way to do this is through so-called ‘verbal autopsies’ to get information on the symptoms and circumstances that preceded death. Questionnaires or interviews can also provide information about the contact—if any—the deceased person had with healthcare professionals, providing other valuable information. While not perfect, verbal autopsies are cheap and easy to roll out.

A total of 14 country transition reports, 2 comparative country studies, and 8 health policy briefs produced by the APO are helping us understand health systems in Asia and the Pacific. Besides making countries aware of the gaps in death registration and convincing them to take action to get deaths right, other APO reports are providing valuable lessons on provider payment reforms, and country examples showing how the reforms have improved the accountability and management systems of government hospitals. These reports had APO to rank among the top 35 global health policy think tanks in the list compiled by the Think Tanks and Civil Society Program at the University of Pennsylvania.  

The success of APO, the health observatory established by countries in Asia and the Pacific together with ADB, the World Health Organization and the World Bank, has shown how this collaboration and cooperation with health centers of excellence in the region is helping drive country-level and  region-wide policy reform efforts. Indeed, several developing countries in Asia are now considering the recommendations of the brief to help them capture in a more appropriate manner causes of death and disease burden. Soon, we will be observing Asia and the Pacific getting deaths right.