South Africa’s paper-based death registration process is cumbersome and fraught with problems, and moving to an electronic system will not only reduce the administrative burden but also improve efficiency, write Dr Pam Groenewald and Professor Debbie Bradshaw, both of the South African Medical Research Council’s (SAMRC) Burden of Disease Research Unit, in Spotlight.
A recent report by the SAMRC highlights the under-reporting of HIV in official mortality statistics, while in the past, multiple studies have identified concerns about the quality of the information provided by doctors on the death registration reports.
The Department of Health has been urged– in a policy brief – to address this, as it clearly undermines the quality of data used by government for health planning and resource allocation.
A recent study found extensive under-reporting of HIV as a cause of death. Only 28% of deaths occurring in a national sample of public sector hospitals where the medical record had clear clinical indications of HIV, had HIV specified on their death notification form.
Aside from ensuring that medical certification of the cause of death is part of the medical training curriculum, and that additional training is provided during internship periods, another key issue to address is that many doctors are reluctant to record HIV/Aids as a cause of death due to concerns about maintaining patient confidentiality.
In 2014 a self-sealing section was added to protect information about cause of death on the notification form, but this has clearly not had the desired effect.
After the deaths of at least 22 children from contaminated food last year, President Cyril Ramaphosa announced that the department would develop an electronic system for recording causes of death as one of several responses to the emergency.
This would offer a strategic opportunity to address the challenge around confidentiality, and promises far more. It allows for secure, institution-based data management that protects confidentiality, encourages accurate reporting, and strengthens the integrity of vital statistics.
Benefits of this digital transition will include:
• Improved data quality and confidentiality, encouraging accurate reporting of sensitive conditions such as HIV/Aids;
• Automated validation checks, reducing certification errors at the point of data entry;
• Real-time access to mortality data, enabling rapid public health responses; and
• A platform for quality assurance and feedback, currently not possible under the paper-based system.
Ultimately, moving away from a paper-based process of death registration will reduce the administrative burden and improve efficiency across the system. This presents a timely and valuable opportunity to collaborate across departments, including health, home affairs and Statistics South Africa to modernise the civil registration and vital statistics system.
We are at a pivotal moment for such co-ordinated policy action. Investing in a robust electronic system for cause-of-death certification will strengthen public health planning, improve disease surveillance, and increase accountability.
The long-term returns – through faster, more reliable data – are substantial for both governance and health outcomes. It is a win-win situation all round.
See more from MedicalBrief archives:
SAMRC study finds HIV death stats worse than thought
The rights and wrongs of the South African health system
Diabetes a leading killer in SA, but we don’t know how many have it
Emergency HIV testing effective in identifying patients currently missed