Mortality surveillance and verbal autopsy strategies: experiences, challenges and lessons learnt in Papua New Guinea

Abstract

Full notification of deaths and compilation of good quality cause of death data are core, sequential and essential components of a functional civil registration and vital statistics (CRVS) system. In collaboration with the Government of Papua New Guinea (PNG), trial mortality surveillance activities were established at sites in Alotau District in Milne Bay Province, Tambul-Nebilyer District in Western Highlands Province and Talasea District in West New Britain Province.Provincial Health Authorities trialled strategies to improve completeness of death notification and implement an automated verbal autopsy methodology, including use of different notification agents and paper or mobile phone methods. Completeness of death notification improved from virtually 0% to 20% in Talasea, 25% and 75% using mobile phone and paper notification strategies, respectively, in Alotau, and 69% in Tambul-Nebilyer. We discuss the challenges and lessons learnt with implementing these activities in PNG, including logistical considerations and incentives.Our experience indicates that strategies to maximise completeness of notification should be tailored to the local context, which in PNG includes significant geographical, cultural and political diversity. We report that health workers have great potential to improve the CRVS programme in PNG through managing the collection of notification and verbal autopsy data. In light of our findings, and in consultation with the main government CRVS stakeholders and the National CRVS Committee, we make recommendations regarding the requirements at each level of the health system to optimise mortality surveillance in order to generate the essential health intelligence required for policy and planning.

Diversity of epidemiological transition in the Pacific: Findings from the application of verbal autopsy in Papua New Guinea and the Solomon Islands

“…We have supported trials of several strategies to increase notification, including incentivising notification agents at the ward level to inform health centres about deaths in PNG. [10] Many of the challenges are related to extremely remote and hard-to-reach locations but the notification and VA teams endeavoured to visit and support collection of VAs from the majority of local government areas across the study sites. Whilst it would be preferable to achieve full death notification, the estimated completeness in this study, from a broad geographical area of each district, is expected to be adequate to estimate mortality fractions, particularly for broad cause groupings.…”

“…Notification of community deaths, the prerequisite for obtaining cause of death data through VA, is a particular challenge in rural areas of both Solomon Islands and PNG, and we have supported pilot strategies using different notification agents and data systems. [ 9 , 10 ] The notification systems trialled in PNG required the notification agent, usually a ward recorder or village health volunteer, to inform the nearest health centre of deaths in their designated area, using paper forms or electronic methods. Receipt of death notifications at the health centre was the trigger for health workers to organise community visits during which they would validate the notification data and enter it in a tablet computer, as well as conduct the VA interviews.…”

Integrating community-based verbal autopsy into civil registration and vital statistics: lessons learnt from five countries

“…Multiple notification strategies in PNG included trials of paper and electronic methods and engaging different cadres of notification agent. 22 A key recommendation in both PNG and Myanmar was to identify a community reporting agent tasked with alerting relevant authorities about deaths. 23 In the Solomon Islands, three death notification strategies were piloted, using religious leaders, cemetery administrators and primary health staff as notifying agents.…”

Validating the InterVA-5 cause of death analytical tool: using mortality data from the Comprehensive Health and Epidemiological Surveillance System in Papua New Guinea

“…‘Old age’ is also commonly referred to as a COD in communities. Lessons learnt with implementing mortality surveillance activities in PNG suggested that logistical arrangements and incentives should be considered as strategies to maximise completeness of mortality data, and health workers have great potential to improve the completeness of death registration in PNG 14…”