Bulletin of the World Health Organization
Volume 94, Number 1, January 2016, 1-76
http://www.who.int/bulletin/volumes/94/1/en/

.
Editorials
Health systems strengthening, universal health coverage, health security and resilience
Joseph Kutzin a & Susan P Sparkes a
a. World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
Bulletin of the World Health Organization 2016;94:2. doi: http://dx.doi.org/10.2471/BLT.15.165050
Initial text
Global and national initiatives focused on health systems strengthening, universal health coverage, health security, and resilience suffer when these terms are not well understood or believed to be different ways of saying the same thing. Here we aim to facilitate understanding and highlight key policy considerations by identifying critical attributes of each concept and emphasizing the distinction between ends and means in health policy…

.

Research
Estimating mortality using data from civil registration: a cross-sectional study in India
Mamta Gupta, Chalapati Rao, PVM Lakshmi, Shankar Prinja & Rajesh Kumar
Abstract
Objective
To analyse the design and operational status of India’s civil registration and vital statistics system and facilitate the system’s development into an accurate and reliable source of mortality data.
Methods
We assessed the national civil registration and vital statistics system’s legal framework, administrative structure and design through document review. We did a cross-sectional study for the year 2013 at national level and in Punjab state to assess the quality of the system’s mortality data through analyses of life tables and investigation of the completeness of death registration and the proportion of deaths assigned ill-defined causes. We interviewed registrars, medical officers and coders in Punjab state to assess their knowledge and practice.
Findings
Although we found the legal framework and system design to be appropriate, data collection was based on complex intersectoral collaborations at state and local level and the collected data were found to be of poor quality. The registration data were inadequate for a robust estimate of mortality at national level. A medically certified cause of death was only recorded for 965 992 (16.8%) of the 5 735 082 deaths registered.
Conclusion
The data recorded by India’s civil registration and vital statistics system in 2011 were incomplete. If improved, the system could be used to reliably estimate mortality. We recommend improving political support and intersectoral coordination, capacity building, computerization and state-level initiatives to ensure that every death is registered and that reliable causes of death are recorded – at least within an adequate sample of registration units within each state.

.

Policy & Practice
An integrated national mortality surveillance system for death registration and mortality surveillance, China
Shiwei Liu, Xiaoling Wu, Alan D Lopez, Lijun Wang, Yue Cai, Andrew Page, Peng Yin, Yunning Liu, Yichong Li, Jiangmei Liu, Jinling You & Maigeng Zhou
Abstract
In China, sample-based mortality surveillance systems, such as the Chinese Center for Disease Control and Prevention’s disease surveillance points system and the Ministry of Health’s vital registration system, have been used for decades to provide nationally representative data on health status for health-care decision-making and performance evaluation. However, neither system provided representative mortality and cause-of-death data at the provincial level to inform regional health service needs and policy priorities. Moreover, the systems overlapped to a considerable extent, thereby entailing a duplication of effort. In 2013, the Chinese Government combined these two systems into an integrated national mortality surveillance system to provide a provincially representative picture of total and cause-specific mortality and to accelerate the development of a comprehensive vital registration and mortality surveillance system for the whole country. This new system increased the surveillance population from 6 to 24% of the Chinese population. The number of surveillance points, each of which covered a district or county, increased from 161 to 605. To ensure representativeness at the provincial level, the 605 surveillance points were selected to cover China’s 31 provinces using an iterative method involving multistage stratification that took into account the sociodemographic characteristics of the population. This paper describes the development and operation of the new national mortality surveillance system, which is expected to yield representative provincial estimates of mortality in China for the first time.