Table 3

Adaptation of the VA intervention

PhilippinesMCCOD by physicians is mandated for all deaths, not just those that occur in hospitals.SmartVA was adapted for physicians and a novel application of VA called ‘SmartVA for Physicians’ was introduced. Here doctors use SmartVA as a tool for medical certification in the event of a community death.
PNG‘Dead on arrival’ cases assigned to ‘unknown’ or unusable cause on the MCCODSmartVA for Physicians was introduced for dead on arrival cases (similar to the Philippines model).
Solomon IslandsDead on arrival cases were not assigned a cause of death as physician certification was reserved for patients who were admitted or who had significant physician contact before/on arrival at hospital.VA for dead on arrival cases was provided by nurses so that these cases could be assigned a cause of death.
MyanmarInformation from MCCOD (~16% of deaths) was used for annual population statistics. With increased community cause of death information from VA the government requested technical assistance to combine the data to obtain more representative estimates.VA cause of death and MCCOD data were integrated for inclusion in the Myanmar Annual Statistical Yearbook. A workshop was held for the D4H team to capacitate staff to do this and to produce baseline values for non-communicable disease indicators for Sustainable Development Goals.
ChinaResearchers wished to investigate if COVID-19 related questions in VA could reliably predict this disease as a cause of death and the relationship between smoking and COVID-19 mortality.Following pilots of the standard SmartVA questionnaire, questions were added to the SmartVA interview related to COVID-19, disease exposure and to tobacco use. This was tested against known hospital cases of COVID-19.
  • D4H, Bloomberg Philanthropies Data for Health Initiative; MCCOD, medical certification of cause of death; VA, verbal autopsy.