Exploring challenges and recommendations for verbal autopsy implementation in low-/middle-income countries: a cross-sectional study of Iringa Region-Tanzania.

Background: Verbal autopsy (VA) plays a vital role in providing cause-of-death information in places where such information is not available. Many low-/middle-income countries (LMICs) including Tanzania are still struggling to yield quality and adequate cause-of-death data for Civil Registration and Vital Statistics (CRVS).

Objective: To highlight challenges and recommendations for VA implementation to support LMICs yield quality and adequate mortality statistics for informed decisions on healthcare interventions.

Design: Cross-sectional study.

Study Setting: Iringa region in Tanzania.

Participants: 41 people including 33 community health workers, 1 VA national coordinator, 5 national task force members, 1 VA regional coordinator and 1 member of the VA data management team.

Results: The perceived challenges of key informants include a weak death notification system, lengthy VA questionnaire, poor data quality and inconsistent responses, lack of clarity in the inclusion criteria, poor commitment to roles and responsibilities, poor coordination, poor financial mechanism and no or delayed feedback to VA implementers. Based on these findings, we recommend the following strategies for effective adaptation and use of VAs: (1) reinforce or implement legislative procedures towards the legal requirement for death notification. (2) Engage key stakeholders in the overall implementation of VAs. (3) Build capacity for data collection, monitoring, processing and use of VA data. (4) Improve the VA questionnaire and quality control mechanism for optimal use in data collection. (5) Create sustainable financing mechanisms and institutionalisation of VA implementation. (6) Integrating VA Implementation in CRVS.

Conclusion: Effective VA implementation demands through planning, stakeholder engagement, upskilling of local experts and fair compensation for interviewers. Such coordinated endeavours will overcome systemic, technical and behavioural challenges hindering VA's successful implementation.