| Summary: | Mortality statistics, including causes of death, are the foundation of public health planning, monitoring and evaluation of interventions. Yet, the overwhelming majority of low- and middle-income countries do not have reliable mortality statistics. Out of 119 countries reporting causes of death to the World Health Organization (WHO), only 34 countries - representing 15% of the world population - produce high-quality cause-of-death data, and almost all of these countries are in Europe and the Americas. A further 85 countries - representing 65% of the world population - produce lower-quality cause-of-death data, while 74 countries, mostly in sub-Saharan Africa, lack such data altogether. This information paradox - where information is lacking where it is needed most - has critically hindered the ability of governments and country programmes to track progress in addressing the HIV epidemic. A well-functioning civil registration system is the best way to monitor mortality and causes of death. Civil registration systems aim to register all the births, deaths with cause of death, and marriages. Many countries do not have civil registration systems that produce reliable vital statistics, as coverage tends to be low, especially for deaths, and information on causes unreliable. Even though there is increasing awareness and commitment to strengthening civil registration and vital statistics (CRVS) systems, it will take considerable time before these systems can produce reliable mortality statistics. Therefore, alternative methods to collect information on causes of death, including HIV, need to be considered. Such methods include sample registration systems, household surveys, hospital data, burial systems, clinical autopsy, analytical methods and others
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