Botswana launched a national initiative focused on improving the coverage and quality of cause-of-death reporting. The initiative forms part of Botswana’s broader efforts to strengthen health information systems and ensure that mortality statistics provide a sound basis for evidence-informed decision-making.
Supported by the Bloomberg Philanthropies Data for Health Initiative and implemented by the Ministry of Health with technical support from WHO, the projects seeks to strengthen Medical Certification of Cause of Death (MCCoD) and adopting the International Classification of Diseases, 11th Revision (ICD-11) in six implementing health districts: Gaborone, Francistown, Serowe, Goodhope, Kgatleng and Mahalapye.
The project was formally introduced during the inaugural Medical Certification of Cause of Death (MCCD) Technical Working Group (TWG) meeting held on 12 May 2026. Bringing together representatives from government ministries, health facilities, academia, development partners, and other stakeholders, the meeting highlighted the critical role of high-quality mortality data in tracking disease trends, guiding health policies, allocating resources, and evaluating public health interventions. Participants reviewed the status of mortality reporting in Botswana, endorsed the project activity plan, and discussed the institutionalization of the WHO 2016 MCCD form and the country's transition from ICD-10 to ICD-11.
Presentations during the TWG meeting revealed persistent challenges affecting mortality data quality. Although at the national level, Botswana has achieved approximately 80% civil registration death coverage, the proportion of ill-defined causes of death remains high at over 40%, resulting in a mortality data usability score of only 48%. These gaps limit the ability of policymakers and health planners to accurately understand disease patterns and health priorities. Stakeholders emphasized that improving the quality of cause-of-death certification is as important as improving death registration coverage itself.
A major milestone in the project was the successful conduct of a five-day national Training of Trainers (ToT) workshop on MCCoD and ICD-11 from 18–22 May 2026. Held at UNICEF, the training brought together health professionals from the six target districts to build technical expertise in medical certification, ICD-11 coding, mortality reporting, forensic considerations, and the use of electronic systems for recording deaths. Participants explored practical challenges encountered in death certification, including brought-in-dead (BID) cases, certification following post-mortem examinations, documentation gaps between clinicians and pathologists, and the need for standardized operating procedures across health facilities.
The training also highlighted several systemic barriers that affect accurate certification. These include inconsistent use of the appropriate death certification forms, limited feedback mechanisms following autopsies, the absence of standard guidelines for certification of deaths occurring in the community, and insufficient access to mortality data managed by other sectors, particularly law enforcement. Participants called for stronger collaboration between the Ministry of Health, Police Services, Civil Registration and Pathology Departments to establish comprehensive national guidelines and improve data-sharing systems.
An important component of the programme focused on Botswana’s transition from ICD-10 to ICD-11. Participants learned about the benefits of ICD-11, including improved digital functionality, expanded clinical content, better compatibility with electronic medical records, and enhanced alignment with international standards. The transition is expected to improve the accuracy, comparability, and usefulness of mortality statistics while supporting integration with the Integrated Patient Management System (IPMS) and DHIS2 platforms.
The project has established ambitious targets for the coming year, including training at least 80% of the country's identified death certifiers, training all 26 ICD coders on ICD-11, achieving full ICD-11 implementation in participating facilities, and reducing the proportion of ill-defined causes of death from 32% to below 10% in the implementing districts. To support these goals, a structured programme of stakeholder engagement, district-level trainings, system integration, routine data quality audits, and performance reviews has been developed.
Assessment results from the ToT workshop demonstrated substantial improvements in participant knowledge, with post-test scores showing marked gains compared with baseline assessments. Participants subsequently developed district-specific rollout plans covering stakeholder sensitization, virtual training approaches, monitoring mechanisms, and implementation timelines to ensure effective cascading of knowledge to health facilities.
Looking ahead, stakeholders agreed on several priority actions. These include aligning the MCCD Technical Working Group with existing mortality surveillance structures, accelerating training schedules, adoption, printing and dissemination of the new MCCD form, finalizing integration of MCCD and ICD-11 functionality into IPMS, and disseminating digital versions of the updated certification tools to clinicians nationwide. High-level sensitization of senior management teams and public awareness campaigns are also planned to support successful implementation. Through this initiative, Botswana is positioning itself to produce more accurate, complete, and internationally comparable mortality statistics. By strengthening medical certification practices and modernizing disease classification systems, the country is laying the foundation for better health planning, stronger evidence-based policies, and improved population health outcomes.
