Reliable mortality statistics, the cornerstone of national health information systems, are necessary for population health assessment, health policy and health service planning, programme evaluation and epidemiological research. These data are essential for monitoring progress towards the health-related United Nations Millennium Development Goals of reducing child and maternal mortality, and mortality from HIV/AIDS, tuberculosis and malaria. (1) They are also required to assess the impact of non-communicable diseases, emerging infectious diseases, injuries and natural disasters. The World Health Organization (WHO) compiles mortality statistics by age, sex and cause reported by Member States on an ongoing basis. (2) However, mortality statistics have not been published for Viet Nam, (3) which had an estimated population of 88 million in 2009. (4)
The Global Burden of Disease study used a combination of statistical models and local data to estimate mortality in 2001 for countries that had not yet published data. (5) In Viet Nam, total mortality was estimated from model life tables with under-five mortality measures derived from birth history surveys as model inputs. Cause-of-death patterns in Viet Nam were assumed to approximate a combination of estimated patterns for Chinese, Indian and Thai populations. (5) The resultant Vietnamese mortality and cause-of-death estimates were anchored only weakly in local data. Mortality patterns were also derived around the same period (1999-2001) for a demographic surveillance site covering about 50 000 people in northern Viet Nam, (6,7) but these data were limited in their generalizability due to small sample size and narrow geographic coverage.
Civil registration and vital statistics systems (vital registration systems) are considered the optimal source of mortality statistics because data on deaths recorded under legal provisions are likely to be complete. (8) In Viet Nam, although civil registration was mandated under the first Vietnamese national civil code in 1956, (9) no vital statistics from civil registration sources have been published to date. Hence a critical assessment of the operational characteristics of vital registration systems in Viet Nam was needed to identify limitations in the system's ability to produce accurate local mortality statistics.
Vital registration systems operate through a complex network of agencies at different levels in the national administrative structure. These systems comprise two distinct but related operations: (i) registering vital events and issuing certificates of civil status, and (ii) compiling statistical information from vital records (Fig. 1). Assessments of vital registration systems should be based on a comprehensive framework (10) that covers key aspects of their operations. The assessment framework we used explores administrative, technical and societal issues that influence civil registration systems.
First, administrative aspects were assessed through: (i) comprehensive review of the legal framework, including definitions of vital events and delegation of duties and responsibilities for reporting and registration; (ii) mapping of different elements in the structure and organization of registration and statistical processes; and (iii) scrutiny of the system design, in terms of the format and content of key documents used to record vital events, or to compile statistics.
Second, from a technical perspective, data management and quality assurance procedures together with the availability of skilled human resources were studied because of their critical influence on vital registration systems. Key technical aspects included compliance with international data standards, capacity to provide the cause of death, efficiency in the processing and management of vital records and statistical data, and periodic data evaluation with demographic and epidemiological methods.
Third, influences on vital registration systems have a societal perspective that involves the political will to support the system as well as public awareness and participation in the registration process. …