Sustaining Mortality Surveillance: How African Countries Are Funding Sample Registration Systems

May 7

This post summarizes a webinar that took place in April 2025 for representatives of countries planning to launch sample registration systems. The sessions convened leaders from Africa CDC, Mozambique, Zambia, and Vital Strategies to share insights and experiences from the frontlines of SRS financing. Their stories, set against the dual challenges of shrinking development aid and mounting health crises, underscore the power of strategic planning, multisectoral collaboration, and local ownership.

Introduction: Funding SRS in a Changing Landscape

Across Africa, governments and public health institutions are forging new paths to secure funding for sample registration systems, which are critical infrastructure for collecting accurate mortality and cause-of-death data.

Africa CDC’s Approach: Building Capacity from Within

Atuheire Emily from the Africa Centres for Disease Control and Prevention opened the session by highlighting the financial hurdles many African health systems face, especially with declining official development assistance and increasing national debt. To respond to these realities, Africa CDC introduced a resource mobilization training course for African Union member states. Delivered in multiple languages, the course includes structured modules on donor engagement, proposal writing, and financial planning. It also provides hands-on workshops and individualized technical support. To date, representatives from 25 countries have completed the training, with four securing funding for mortality surveillance as a result.

Mozambique’s Journey: From Donor Support to Government Ownership

Dr. Ivalda Macicame from Mozambique’s Instituto Nacional de Saude shared their SRS system’s transition from donor funding for building the system to ongoing support and full national ownership. Launched in 2017 with initial backing from the Gates Foundation, Mozambique’s SRS gradually moved toward institutionalization. Key to this shift were efforts such as rigorous cost documentation, early engagement with the Ministry of Health, and alignment with The Global Fund’s priorities through its Resilient and Sustainable Systems for Health (RSSH) platform.

· Learn more about Mozambique’s transition

Zambia’s Experience: Co-Financing for Scale-Up

Zambia adopted a co-financing strategy to expand its Sample Registration with Verbal Autopsy system. Dr. Stephen Longa Chanda described how the country began with a planning grant from the Gates Foundation to craft a comprehensive protocol and costing plan. This groundwork enabled Zambia to attract funding from multiple sources, including the U.S. CDC, The Global Fund, and domestic contributions. Although this multi-donor approach allowed for a broader funding base and risk-sharing, it also brought operational challenges, such as aligning disbursement schedules and managing multiple reporting frameworks. Dr. Chanda emphasized the importance of flexible administration and ongoing stakeholder engagement to navigate these complexities effectively.

· Learn more about Zambia’s system

Vital Strategies’ Regional Work: Integrating SRS into CRVS Frameworks

Dr. Philip Setel of Vital Strategies brought a broader perspective, drawing from regional work in Ethiopia, Rwanda, and Tanzania. His team’s approach focused on integrating verbal autopsy systems into existing Civil Registration and Vital Statistics (CRVS) structures while aligning these initiatives with the Global Fund’s disease-specific priorities, particularly for HIV, TB, and malaria. One of the key drivers of success was close collaboration with country coordinating mechanisms, which play a central role in shaping national funding proposals. In Rwanda, these efforts culminated in the CRVS system being formally recognized as the country’s official source of mortality data. In all cases, support extended beyond data collection to include policy integration, capacity building, and system-wide strengthening.

· Read Dr. Setel’s 2020 article in Stanford Social Innovation Review

Key Takeaways: What Works in SRS Financing

Several cross-cutting strategies emerged throughout the webinar. Countries that successfully mobilized resources treated their SRS as integral components of national health infrastructure rather than temporary donor projects. Proposals that aligned with major donor strategies, especially the Global Fund’s RSSH module, gained traction. Administrative flexibility and adaptive planning helped countries accommodate shifting requirements, while strong government coordination ensured seamless implementation. Importantly, fostering a culture of data use across sectors helped solidify the SRS as a long-term public health investment.

Conclusion: From Counting Deaths to Saving Lives

Funding mortality surveillance is not solely a financial exercise. It is a commitment to better governance, improved public health decision-making, and long-term system resilience. The examples shared from Mozambique, Zambia, Rwanda, and beyond illustrate that with the right vision, partnerships, and planning, African countries can transform their SRS into life-saving platforms. By investing in how deaths are counted, they are also shaping the future of how lives are protected.