Data Situational Assessment

Step 2

A situational assessment is essential to gain an in-depth understanding of the existing mortality data systems, their strengths and limitations, and how the SMSS will fit within the country data landscape. It will help determine whether the system will measure only all-cause mortality or will also measure cause-specific mortality, which specific age categories will be included, and whether maternal mortality will be captured. The assessment may also include formative research to identify effective community monitoring strategies, key actors to engage, and how to communicate the initiative at the community level.

Situational Assessment of Country Health Data Systems and Data Gaps

The assessment will seek to document and understand the strengths and shortcomings of existing mortality data systems, current data gaps and their distribution across the country. For example, the review will assess mortality data reported by the RHIS and its quality, limitations in CRVS and survey data, and whether there exists an integrated and functioning system or repository of mortality and health statistics, whether existing systems are interoperable, whether they are used, and what digital technology solutions are implemented. Experiences from existing Health and Demographic Surveillance System (HDSS) across the country and other community-based vital events and mortality data collection initiatives must be reviewed and their possible roles or implications in a national SMSS described. It will also be essential to document the existing administrative and geographic structure in the country, from the smallest community level geographic unit that a SMSS can rely on as geographic cluster.

For the assessment of existing systems, it is critical to ensure that objectives of the assessment are clearly documented and understood by stakeholders. Where the SMSS planning is happening in the context of a broader and integrated mortality surveillance planning, the objectives should accommodate the information needs for both activities. Compiling and documenting the data use needs of key stakeholders is critical to inform system design and to build synergy across mortality surveillance activities.

Where necessary and relevant, site visits by the inter-disciplinary teams in charge of the assessment can help increase understanding, identify opportunities for synergy, and needs for improvement across systems. To support linkage or integration across systems, it might be relevant to capture existing business process maps/workflows for core systems producing mortality data. For linkage with CRVS for example, the assessment must take particular note of the processes for identifying, notifying, declaring and registering vital births and deaths in accordance with national CRVS regulations, document the forms required to complete these processes and note bottlenecks and barriers to effective processes, document who has the legal mandates for the functions of registration, medical certification, statistical reporting, integrated surveillance, public health response, etc.

Separate of SMSS planning, a robust assessment process is likely to reveal opportunities for improvement of various systems; improvement may be in terms of timeliness, efficiency, accuracy/quality, accessibility, etc. Documenting these observations as part of the assessment report, regardless of how long they may take to achieve, will facilitate their inclusion in CRVS/mortality statistics planning/improvement efforts The review must also document the demand for mortality data by the government and stakeholders and their buy-in and support for a SMSS as relevant for the country. It will highlight sub-national geographic areas that may have been identified as priority areas for specific health program targets. The output of the review will help inform the design of the SMSS, and refine its purpose and scope.

During the situational assessment, it would essential to assess feasible strategies for optimal linkage or interoperability with the existing CRVS system. This may entail working closely with technical teams from CRVS and other stakeholders. Supporting field visits by teams representing multiple sectors can help learn about CRVS process at local levels and identify appropriate opportunities for linkage and interoperability.

Defining and Agreeing on the Data Content of the SMSS

The basic data contents of an SMSS include enumeration of population, births, and deaths; they can also include pregnancies and migrations; however, these are often more challenging to successfully implement. They also include follow-up to families with recent deaths for verbal autopsy interviews for cause of death assessment. Ideally verbal autopsies are conducted for all deaths, but they could also target a specific age group such as children under-five or maternal deaths, depending on the country’s interest.

However, the system can be extended to include additional data that the country needs, such as place of delivery, birth weight, birth and death registration, child immunization, child growth monitoring, or sero-surveillance of vaccine preventable and neglected tropical diseases. Through consultation with the Ministry of Health and other government stakeholders, a small set of additional data elements that are of utmost priority and utility for the country can be established. Such consultation must be carefully implemented and streamlined to avoid creating a long list of indicators which will ultimately cripple the functioning of the system. System planners must keep in mind that special data collection may be added on later, once the SMSS is launched and functioning successfully.

COMSA/SIS-COVE Example

In Mozambique, the SIS-COVE proposal development included the review of the RHIS data on mortality, an on-going national evaluation platform data, existing health and demographic surveillance systems (HDSS) (the Manhiça HDSS and Chókwè HDSS), and discussion with the government about priority sub-national areas and the overall usefulness of the system. These discussions led to the oversampling of four high mortality provinces prioritized by the Ministry of Health. The Mozambique SIS-COVE collects data on pregnancies, pregnancy outcomes (pregnancy loss, stillbirths, live births), and deaths of all ages. All deaths are followed-up for verbal and social autopsy interviews to identify not only the biological causes of death but also the social, household, health system factors that were associated with the death. The social autopsy component has been specifically requested by the government. Questions were also included to collect information of maternal death, birth and death registration, and facility deliveries.

The SIS-COVE platform is continuously engaged to serve as a sampling frame for other studies, such as the Rapid Mortality Mobile Phone Survey project (RaMMPS), and the Impact of COVID-19 on the coverage of reproductive, maternal, newborn and child health services. The collection of additional data can strengthen the sustainability of the system by demonstrating the versatility of the system and its usefulness to multiple other programs.

Formative Research

Prior to roll-out of the implementation of the community vital event registration system, a formative study is recommended. The main objective of the study is to produce information for the design of effective procedures for the identification and recording of community vital events and conducting interviews for verbal autopsies to determine the causes of death.

Specifically, the study will identify: a) Existing community platforms and structures for the identification and registration of pregnancies, births and deaths, and the cultural context of registration of these events; b) Community key informants to assist with community engagement and acceptance of the idea of routinely reporting births and deaths; c) Processes of identification of vital events, their notification and registration steps, and delivery of legal registration documents; d) The communities’ level of interest in learning about the main causes of death; and e) The most culturally acceptable approach to conducting interviews for verbal and social autopsy, including whether there is a strong preference for having female data collectors interview pregnant women and bereaved mothers.

This study should be designed by researchers who are experienced in qualitative or ethnographic research in the country where the SMSS will be implemented. Although the specific design will vary depending on the context and the planned SMSS, the general approach is that in a few selected provinces and regions, in-depth interviews, focus group discussions or a combination of these will be conducted with community leaders, women’s groups, and parents with young children in both rural and urban communities. Health officials at provincial/regional and central levels can also be interviewed Example of guides used in Mozambique for the formative research

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Last updated
Apr 16, 2025

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