“Real-Time” Monitoring of Under-Five Mortality: Lessons for Strengthened Vital Statistics Systems

• Calls for improved civil registration and vital statistics systems as a central part of the development agenda for low-income countries have noted the absence of evidence on the feasibility and accuracy of such systems. • We synthesize findings from a seven-year project in Ethiopia, Ghana, Malawi, Mali, and Niger that tested methods for the real-time monitoring of under-five mortality (RMM), with particular attention to their implications for strengthening vital statistics systems. • We tested three broad approaches, and found that none offers a surefire approach to obtaining accurate information on child deaths for recent periods of one year or less. • Those working to strengthen vital statistics systems should anticipate three ongoing challenges: ensuring data quality; addressing local challenges to community-based reporting; and planning for open data access. • This Collection underscores the importance of comprehensive reporting of results, including negative results. Full documentation and reporting of efforts to improve vital statistics systems are needed to inform future efforts.