Elements of a strategic approach for strengthening national mortality statistics programmes.

Information on cause-specific mortality from civil registration and vital statistics (CRVS) systems is essential for health policy and epidemiological research. Currently, there are critical gaps in the international availability of timely and reliable mortality data, which limits planned progress towards the UN Sustainable Development Goals. This article describes an evidence-based strategic approach for strengthening mortality data from CRVS systems. National mortality data availability scores from the Global Burden of Disease study were used to group countries into those with adequate, partial or negligible mortality data. These were further categorised by geographical region and population size, which showed that there were shortcomings in availability of mortality data in approximately two-thirds of all countries. Existing frameworks for evaluating design and functional status of mortality components of CRVS systems were reviewed to identify themes and topics for assessment. Detailed national programme assessments can be used to investigate systemic issues that are likely to affect death reporting, cause of death ascertainment and data management. Assessment findings can guide interventions to strengthen system performance. The strategic national approach should be customised according to data availability and population size and supported by human and institutional capacity building. Countries with larger populations should use an incremental sampling approach to strengthen CRVS systems and use interim data for mortality estimation. Periodic data quality evaluation is required to monitor system performance and scale up interventions. A comprehensive implementation and operations research programme should be concurrently launched to evaluate the feasibility, success and sustainability of system strengthening activities.