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. 2024 Dec 30;22(1):177.
doi: 10.1186/s12961-024-01275-8.

Exploring the potential of introducing an electronic death registration system in South Africa

Carmen Sant Fruchtman #  1   2 , Natasha Kallis #  3 , Sudarshan Govender  3 , Debbie Bradshaw  3 , Daniel Cobos  1   2 , Diane Morof  4   5 , Pamela Groenewald  6
Affiliations

Exploring the potential of introducing an electronic death registration system in South Africa

Carmen Sant Fruchtman et al. Health Res Policy Syst. .

Abstract

Background: Despite South Africa's well-established Civil Registration and Vital Statistics system (CRVS) and good completeness of death registration, challenges persist in terms of the quality of cause of death information and the delayed availability of mortality statistics. The introduction of an electronic medical certification of cause of death (eMCCD) system may offer opportunities to improve both the quality and timeliness of this information.

Methods: This study used an exploratory mixed methods design to investigate perceptions surrounding an electronic solution for registering deaths in South Africa. We conducted 14 key informant interviews from 23 key informants invited, surveyed 208 out of 250 targeted health workers and engaged with more than 500 South African health professionals in a participatory workshop about the acceptability of introducing an eMCCD. Mentimeter was used to obtain feedback from the participants. Rapid qualitative analysis methods were used to analyse the key informant interviews and descriptive statistics for the survey and workshop data. During the interpretation phase, qualitative and quantitative data were integrated according to key themes that emerged from the data.

Results: During the qualitative interviews, the underlying factors mentioned as contributing to inadequate mortality data quality included insufficient MCCD training, diseases subjected to stigma, limited access to and quality of patient health information, and a significant proportion of deaths occurring outside medical facilities. More than 80.8% of the surveyed health professionals (168/208) rated the importance of mortality statistics as high, but the current quality was rated as low or very low by 29.3% (61/208). An eMCCD appeared to be acceptable to most workshop participants who registered on Mentimeter and was perceived as a means to strengthen the timeliness of mortality information. However, 43.0% (68/158) of the workshop participants who responded to this question on Mentimeter saw poor internet use as the main barrier to introducing an online system.

Conclusions: Our results shed light on critical aspects surrounding cause of death information in South Africa, as well as the challenges faced in maintaining the quality of such data. The findings suggest that the implementation of an eMCCD system could provide opportunities to strengthen the cause of death information in South Africa if it is designed to integrate into the current system and provide supplementary functionalities.

Keywords: Digital health; Health systems South Africa; Mortality information; Public health.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the South African Medical Research Council ethics committee (EC009-4/2022) and an exemption from an ethics review by the Swiss Tropical and Public Health Institute. This project was reviewed in accordance with CDC human research protection procedures and was determined to be non-research public health surveillance. All participants in the study provided informed verbal consent, which was recorded, after being given a written study information sheet and a verbal explanation of the consenting process. All interviewed study participants provided recorded consent to participate, and their responses were recorded. Consent for publication: All authors provided consent for publication of the manuscript. Competing interests: The authors declare no competing interests.

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