From f56a8b7f283c1ad188aa99d3b38ad49b71d04116 Mon Sep 17 00:00:00 2001
From: "Dr. B. M. Riazul Islam" <riaz.somc@mis.dghs.gov.bd>
Date: Tue, 19 Aug 2025 00:15:12 +0600
Subject: [PATCH] added CRVS content

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diff --git a/CRVS.md b/CRVS.md
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+# Civil Registration and Vital Statistics (CRVS) in Bangladesh
+
+## 1. Overview of CRVS in Bangladesh
+
+Civil Registration and Vital Statistics, known as CRVS, is the national system in Bangladesh for recording births and deaths and producing official statistics about these events. The backbone of this system is the **Birth and Death Registration Information System (BDRIS)**, which is managed under the Office of the Registrar General. BDRIS is the legal authority for birth and death certificates in the country.
+
+The health sector contributes information into CRVS through the **District Health Information Software version 2 (DHIS2)**, which is managed by the Management Information System under the Directorate General of Health Services (MIS, DGHS). DHIS2 captures health-related events such as facility births and facility deaths, and also stores cause-of-death information certified by physicians.
+
+For community deaths, which occur outside health facilities, Bangladesh uses **Verbal Autopsy (VA)** tools. Currently, the data is collected using **Open Data Kit (ODK)**. Importantly, Verbal Autopsy is conducted only after a death has been legally registered in BDRIS. VA is not a trigger for registration; rather, it is a method to assign a probable cause of death for public health statistics.
+
+Some facilities in Bangladesh also use **OpenMRS**, which is an electronic medical record system. OpenMRS follows the same process of entering cause-of-death information, but at present, the data from OpenMRS is not yet fully integrated into the national Health Information System (HIS) for routine use.
+
+---
+
+## 2. Facility Deaths and the Medical Certification of Cause of Death (MCCoD)
+
+For deaths that occur inside hospitals or health facilities, Bangladesh uses the **Medical Certification of Cause of Death (MCCoD)** process. A physician fills in a **World Health Organization (WHO) cause-of-death form** on paper.
+
+The physician then selects the **Underlying Cause of Death (UCoD)**, which is the single disease, condition, or injury that started the sequence of events leading to death. This selection is based on the **International Classification of Diseases, Tenth Revision (ICD-10)** index and tabular list.
+
+After the physician’s certification, a nurse or health information officer enters the information into **DHIS2 Tracker Capture**. The ICD-10 code is automatically generated by the system from the physician’s text description of the cause. This digital entry allows the information to be centrally analyzed.
+
+At the central level, statisticians and physicians perform **analysis, validation, and tabulation** of the cause-of-death data. A tool called **ANACOD2** is used to evaluate patterns, check data quality, and produce tabulations.
+
+Finally, the validated mortality statistics are disseminated to and used by the **Health Services Division (HSD)**, the **Ministry of Health and Family Welfare (MoHFW)**, and the **Directorate General of Health Services (DGHS)** for policy and planning.
+
+Currently, Bangladesh uses ICD-10 for coding causes of death. However, **ICD-11 (International Classification of Diseases, Eleventh Revision)** is being piloted in six hospitals to prepare for future adoption.
+
+---
+
+## 3. Community Deaths and Verbal Autopsy (VA)
+
+Most deaths in Bangladesh occur outside health facilities. To understand the causes of these deaths, the country conducts **Verbal Autopsy (VA)**. Verbal Autopsy is a method where trained interviewers talk to family members or caregivers of the deceased to collect information about the signs, symptoms, and circumstances before death.
+
+In Bangladesh, Verbal Autopsy is conducted using **ODK (Open Data Kit)** on mobile devices. The collected data is analyzed to assign a probable cause of death. Currently, Bangladesh is using the **Smart Verbal Autopsy (SmartVA)** tool, but the country is now working towards adopting the **WHO standard Verbal Autopsy instrument**, which is internationally recommended.
+
+Verbal Autopsy in Bangladesh is not applied to every community death. It is conducted on a **sample basis**. At present, **69 upazilas (sub-districts)** have been selected for VA implementation. The national program aims to cover approximately **5,000 deaths per month** through Verbal Autopsy. This provides a representative picture of mortality patterns in the community.
+
+It is important to note that Verbal Autopsy is performed **only after the death has already been registered in BDRIS**. The VA data therefore does not feed into BDRIS for registration, but rather into statistical systems for public health analysis.
+
+---
+
+## 4. Interoperability Between DHIS2 and BDRIS
+
+The connection between the health information system (DHIS2) and the civil registration system (BDRIS) is a key innovation in Bangladesh’s CRVS. When a birth or death is recorded in DHIS2, a notification is sent electronically to BDRIS.
+
+If the person’s residence is in a rural area, the information is forwarded to the registrar’s office, and the **Registrar’s Office (RO)** follows up, sometimes with additional forms if required. If the residence is urban, the respective registrar monitors notifications directly through the BDRIS dashboard. Central monitoring can also be supported by sending government-issued SMS messages.
+
+After the registrar completes the registration, BDRIS sends an **electronic confirmation back to DHIS2**. This loop ensures that health events are matched with civil registration records and that DHIS2 always has an updated record of whether a birth or death has been legally registered.
+
+---
+
+## 5. Role of OpenMRS
+
+In some facilities, especially where OpenMRS is deployed, physicians and staff use OpenMRS to record deaths and causes of death. The process of certification and selection of the underlying cause of death is the same as in the MCCoD pathway described above. However, at present, the data from OpenMRS is **not yet included in the national Health Information System for routine reporting**. This means that although the information exists in OpenMRS, it does not yet contribute to the official CRVS statistics.
+
+---
+
+## 6. Key Performance Indicators for CRVS in Bangladesh
+
+To measure progress and data quality, Bangladesh uses several indicators in the CRVS system:
+
+* **Completeness of registration**: The proportion of births and deaths that are legally registered within a defined period.
+* **Timeliness of registration**: The time gap between the occurrence of a birth or death and its registration.
+* **Quality of MCCoD data**: The proportion of deaths with a correctly assigned underlying cause of death, the proportion coded to ill-defined categories, and the consistency of coding.
+* **Coverage of Verbal Autopsy**: The proportion of the monthly target of 5,000 community deaths achieved across the 69 upazilas.
+* **Interoperability efficiency**: The percentage of DHIS2 notifications that are successfully transmitted to BDRIS and confirmed back.
+* **Integration gap**: The extent to which OpenMRS data remains outside the national HIS.
+
+---
+
+## 7. Frequently Asked Questions
+
+* **Does Verbal Autopsy trigger death registration?**
+  No. Verbal Autopsy is conducted only after a death is already registered in BDRIS. It is used for statistics, not for registration.
+
+* **Which coding systems are used in Bangladesh?**
+  ICD-10 is used nationwide, but ICD-11 is being piloted in six hospitals.
+
+* **What tools are used for facility deaths?**
+  Physicians fill out WHO paper forms, causes are coded in DHIS2, and analysis is done with ANACOD2.
+
+* **How many deaths are covered by Verbal Autopsy?**
+  Verbal Autopsy is sample-based, currently in 69 upazilas, with a monthly target of 5,000 deaths.
+
+* **Is OpenMRS data included in official statistics?**
+  No. OpenMRS follows the same entry process, but its data is not yet integrated into the routine HIS.
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