Health Research Organization, National Research and Innovation Agency Republic of Indonesia, Jakarta Pusat, Indonesia.
Center for Health Financing and Decentralization Policy, Ministry of Health, Jakarta, Indonesia.
BMJ Glob Health. 2023 Jul;8(7). doi: 10.1136/bmjgh-2023-012358.
Civil Registration and Vital Statistics (CRVS) systems are the optimal source for data on births, deaths and causes of death for health policy, programme evaluation and research. In Indonesia, indicators such as life expectancy at birth, childhood and maternal mortality rates and cause-specific death rates need to be routinely monitored for national health policy. However, the CRVS system is not yet producing reliable vital statistics, which creates a challenge for evidence-based health action. In 2019, the Indonesian government released a national strategy for the CRVS system, with targets for improved coverage and data quality by 2024. This article describes findings from a programme of formative and implementation research to guide the application of the national strategy. At first, a detailed CRVS assessment and gap analysis were undertaken using an international framework. The assessment findings were used to develop a revised business process model for reporting deaths and their causes at village, subdistrict and district level. In addition, a field instruction manual was also developed to guide personnel in implementation. Two field sites in Java-Malang District and Kudus Regency were selected for pilot testing the reporting procedures, and relevant site preparation and training were carried out. Data compilations for Malang in 2019 and Kudus in 2020 were analysed to derive mortality indicators. High levels of death reporting completeness (83% to 89%) were reported from both districts, along with plausible cause-specific mortality profiles, although the latter need further validation. The study findings establish the feasibility of implementing revised death reporting procedures at the local level, as well as demonstrate sustainability through institutionalisation and capacity building, and can be used to accelerate further development of the CRVS system in Indonesia.
民事登记和生命统计（CRVS）系统是获取出生、死亡和死因数据的最佳来源，可用于制定卫生政策、评估规划和开展研究。在印度尼西亚，需要定期监测出生时预期寿命、儿童和孕产妇死亡率以及特定死因死亡率等指标，以制定国家卫生政策。然而，CRVS 系统目前还无法提供可靠的生命统计数据，这对循证卫生行动构成了挑战。2019 年，印度尼西亚政府发布了一项 CRVS 系统国家战略，目标是到 2024 年提高覆盖范围和数据质量。本文描述了一项形成性和实施研究计划的研究结果，该计划旨在为国家战略的应用提供指导。首先，采用国际框架对 CRVS 系统进行了详细评估和差距分析。评估结果用于开发一个经过修订的村级、乡镇级和县级死亡报告及其死因的业务流程模型。此外，还制定了一份实地操作手册，以指导人员实施。选择爪哇省玛琅地区和库都斯摄政区的两个实地地点对报告程序进行试点测试，并开展了相关的现场准备和培训。对玛琅 2019 年和库都斯 2020 年的数据进行了汇编，以得出死亡率指标。两个地区的死亡报告完整性水平都很高（83%至 89%），死因特异性死亡率概况也具有合理性，尽管后者需要进一步验证。研究结果证实了在地方一级实施修订后的死亡报告程序的可行性，并通过体制化和能力建设证明了可持续性，可用于加快印度尼西亚 CRVS 系统的进一步发展。
