Implementation research for mortality statistics development: Findings from Indonesia

Abstract

Abstract Civil Registration and Vital Statistics (CRVS) systems are the optimal source for data on births, deaths and causes of death for health policy, program evaluation, and research. In Indonesia, indicators such as life expectancy at birth, infant and maternal mortality rates, and cause-specific death rates need to be routinely monitored for national health policy. However, the CRVS system has not yet been fully established, which creates a challenge for evidence-based health action. In 2019, the Indonesian government released a national strategy for accelerating the CRVS system, with targets for improved coverage and data quality by 2024. This article describes findings from a program of formative and implementation research to guide the application of the national strategy. At first, a detailed CRVS assessment and gap analysis was undertaken using an international framework. The assessment findings were used to develop a revised business process model for reporting deaths and their causes at village, sub district and district level. In addition, a field instruction manual was also developed to guide personnel in implementation. Two field sites in Java – Malang District and Kudus Regency were selected for pilot testing the reporting procedures, and relevant site preparation and training was carried out. Data compilations for Malang in 2019 and Kudus in 2020 were analyzed to derive mortality indicators. High levels of death reporting completeness (83 to 89%) were reported from both districts, along with plausible cause-specific mortality profiles, although the latter need further validation. The study findings establish the feasibility of implementing revised death reporting procedures at the local level, as well as demonstrate sustainability through institutionalization and capacity building, and can be used to accelerate further development of the CRVS system in Indonesia.