Death registration plays a crucial legal and administrative role, serving both individuals and the state. For individuals, a death certificate enables access to inheritance, insurance claims, pensions, and survivors’ benefits. For governments, it underpins mortality statistics essential for public health planning, disease surveillance, and resource allocation. In countries and territories with interconnected databases like the Republic of Korea and Türkiye, registering a death also triggers updates across government and private systems, ensuring administrative efficiency.
To strengthen death registration, the Regional Action Framework includes six key targets. Targets 1D and 2B aim for universal death registration and timely issuance of death certificates. Target 1E ensures that medically attended deaths have medically certified causes of death recorded using the international form of the death certificate. Targets 3C and 3D focus on the quality of cause-of-death data, requiring accurate coding of causes of death according to the International Classification of Diseases (ICD) and a reduction in ill-defined codes. Target 3E promotes the use of verbal autopsies to collect data on deaths occurring outside health facilities.
Progress has been made across Asia and the Pacific. Just under two-thirds of reporting countries and territories have achieved the target for death registration completeness (1D), while nearly 75% met the goal for timely issuance of death certificates. Countries and territories like Bangladesh and Indonesia improved their registration completeness significantly from very low baselines in 2015. However, disparities remain. An estimated 6.9 million deaths, or 21% of all deaths, go unregistered each year in the region.
Although death registration and certification has improved, data quality remains a concern. Only half of the reporting members and associate members have met their national targets for medical certification of causes of death and adequate causes of death coding according to ICD standards. A high proportion of ill-defined codes further undermines data quality. Additionally, many deaths occur outside of medical settings and go undocumented, distorting public health data. Verbal autopsies can help fill this gap, but their use remains limited—only 30 per cent of reporting countries and territories use them, and just 16 per cent provide regular training for community workers conducting them.
To address these gaps, tailored, context-specific interventions are needed. Health sector involvement is essential, particularly by shifting responsibility for reporting from families to medical professionals. Integration of registration services into hospitals and electronic notification systems can improve efficiency. Training remains a cornerstone: doctors, coroners, and coders must be regularly trained in international standards. While over half of reporting countries and territories now offer such training, continued investment is needed, especially as countries transition to ICD-11.