Opportunities and Challenges for Implementing Sample Registration Systems for Mortality and Cause of Death Monitoring in Sub-Saharan Africa: Review of Global Evidence and Lessons from the Countrywide Mortality Surveillance for Action in Mozambique

Agbessi Amouzou, Johns Hopkins Bloomberg School of Public Health
Almamy Kante, Johns Hopkins Bloomberg School of Public Health
Kelsey Zack, Johns Hopkins University
Fred van Dyk, Johns Hopkins Bloomberg School of Public Health
Emily B. Wilson, Johns Hopkins University Bloomberg School of Public Health
Alain K. Koffi, Johns Hopkins University
Emma K. Williams, Johns Hopkins Bloomberg School of Public Health
Akum Aveika, Johns Hopkins Bloomberg School of Public Health
Hafiz Rahman, Johns Hopkins University
Celso Monjane, Instituto Nacional de Saude
Ivalda Macicame, Instituto Nacional de Saúde - Moçambique

Sub-Saharan African (SSA) countries face chronic challenges in timely availability of mortality and cause of death data, compromising accurate monitoring of the effectiveness of health programs. CRVS systems continuously struggle for completeness. Health Information Systems are limited to facility users and suffer from reporting completeness. Health demographic surveillance sites remained limited. National surveys are used for mortality data generation, but are infrequent, limited in size, and often too loaded. National sample registration systems (SRS) hold promise for continuous and timely mortality and cause of death data collection on a sample of population, selected to produce nationally and sub-nationally representative estimates. SRS has been adopted successfully by several countries in Asia, including India, Bangladesh, China, Indonesia but have received less attention in sub-Sahara Africa. There is a renewed attention in SRS in SSA, with a recent launch in Mozambique and Sierra Leone, and enthusiasm in many countries supported by the Bill & Melinda Gates Foundation and technical partners. This paper reviews the successful evidence in countries currently implementing an SRS, examining governance, financing, methodological design, implementation, data release, dissemination, use, and sustainability. We discuss challenges and opportunities for the successful adoption of this approach in SSA, focusing on Mozambique.

Keywords: Data and Methods, Mortality and Longevity, Health and Morbidity, Comparative methods

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