Percent of deaths registered in the country

The percent of deaths registered during a specified time period for a country or designated region. This should be at least 90 percent of all deaths. An intermediate goal is 50 percent.  WHO recommends scoring this indicator as <50 percent = 0; 50 to 89 percent = 1; and ≥ 90 percent = 2 (WHO, 2010).

This indicator is calculated as:

(Number of deaths registered / Total deaths for the same time period and geographical region) x 100

This indicator is one of the 26 indicators in the WHO Health Systems Strengthening (HSS) Handbook of Indicators Health Information Systems Performance Index (HISPIX), which can be summed to form a composite score (WHO, 2010). For more background on the process and criteria used in developing the WHO Handbook of Indicators for HSS and for details on this and related indicators, see WHO (2010); USAID (2009); and The Global Fund (2009).


Reports of deaths by civil or sample registration systems, hospitals, and community-based reporting systems. Where information on total deaths is not available because of incomplete civil registration, total deaths can be estimated by extrapolating from the census or on the basis of information about death rates derived from population-based surveys, such as Demographic and Health surveys (DHS), the UNICEF Multiple Indicator Cluster Surveys (MICS); WHO World Health Survey (WHS).  Data can be disaggregated by type of source (e.g., hospital or community-based) and by district, urban/rural location.


Death registration systems; hospital and community-based reporting systems; estimates from population-based surveys (e.g., DHS, MICs, WHS)


This indicator assesses the country’s capacity to design and implement an effective civil registration system to report vital statistics including births and deaths. A well-functioning national health information system (HIS) that provides sound and reliable information is the foundation of decision-making across all aspects of the health system. Collection and analysis of accurate and timely data on vital statistics are essential for informing health system policy development, allocation of funds, and the implementation of programs and interventions. Comparisons between regions and across time can help identify regional or localized problems in reporting or breakdowns in the HIS system.

WHO recommends that countries fund and implement an HIS that, at minimum, can track these vital statistics (WHO, 2010):

  • Birth registration of at least 90% of all births (intermediate goal 50%)
  • Death registration of at least 90% of all deaths (intermediate goal 50%)
  • International Classification of Diseases (ICD-10) used in district hospitals and   causes of death reported to national level

The United Nations Statistics Division provides guidelines and support for national governments in establishing and maintaining reliable civil registration systems (UN, 1998). Strengthening national HIS capacity for collection of vital statistics is fundamental to the achievement of the health-related Millennium Development Goals: #4 reduce child mortality; #5 improve maternal health; and # 6 combat HIV/AIDS, tuberculosis and malaria.


The quality of reporting may vary between sources, for instance, hospitals may provide more complete reporting than community-based sources. Thus, disaggregation of the indicator by type of reporting source may be important for identifying these differences, particularly where the overall percent of reported deaths is low. While this indicator can show if the country has developed an effective vital registration system, it does not capture whether and how the information generated by this system is used for policy decision-making, planning and programs.


policy, health system strengthening (HSS), management

The Global Fund, 2009, Monitoring and Evaluation Toolkit: HIV, Tuberculosis and Malaria and Health Systems Strengthening, http://rbm.who.int/toolbox/tool_MEtoolkit.html

United Nations Statistics Division, 1998, Principles and recommendations for a vital statistics system, revision 2. New York, NY, United Nations. http://unstats.un.org/unsd/demographic/standmeth/handbooks/default.htm  

USAID, 2009, Measuring the Impact of Health Systems Strengthening, A Review of the Literature, Washington, DC: USAID. http://www.usaid.gov/our_work/global_health/hs/publications/impact_hss.pdf

WHO, 2010, Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies, Geneva: WHO. http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf

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