The Central Statistical Office (CSO) is mandated by the Government of Zambia to collect, compile, analyze, and disseminate national statistics. The FY 2010 plan aims to build-up and sustain staff expertise in vital registration. In FY 2010 there will be continuation and expansion of the Sample Vital Registration with Verbal Autopsy (SAVVY) to cover all provinces in Zambia. The FY 2010 activity builds upon the first phase conducted in COP 2009. In the second phase of the SAVVY, the CSO will continue with the demographic and mortality surveillance to estimate the number and causes of deaths and the number of births occurring in sampled areas with baseline census information. In addition to this, the activities will include the strengthening of the civil registration at the Department of National Registration, Passports and Citizenship (DNRPC) to obtain mortality and births data alongside census data that will be collected from sampled areas. This activity will also include training 175 staff from CSO and other ministries (e.g. office staff, interviewers, census enumerators, community health workers, community service providers, verbal autopsy interviewers and supervisors, and other health workers). Beyond training of individuals in SAVVY methods, this activity will yield information on the number of deaths ascertained by community informants, number and quality of verbal autopsy forms completed by interviewers, and number and quality of verbal autopsy forms coded with cause of death. The estimated duration of time from death to notification and completion of verbal autopsy, time to cause of death coding, and estimated mortality rate observed in the SAVVY areas and communities will be captured. The ability to capture specific causes of death of interest using the verbal autopsy form will also be examined, with observed strengths and weaknesses of the verbal autopsy form used in Zambia. The activity will also yield information on the number of births occurring in selected areas, number of births occurring in hospitals, and the number of births that are registered by councils. The CSO will continue to collaborate with the Ministry of Health (MOH), the DNRPC under the Ministry of Home Affairs, Ministry of Local Government and Housing (MLGH), and Ministry of Community Development and Social Services (MCDSS) to expand its surveillance of vital events in Zambia by increasing areas of coverage, examining and supporting existing data sources and data capture systems, refining and validating the verbal autopsy, capturing information on births and facilitating birth registration in selected areas, and collecting information on births and deaths from hospitals, clinics and councils close to the sample areas in Zambia.

The second FY 2010 activity that the CSO will implement is the AIDS Indicator Survey. The main objectives of the survey are to:

1) determine unmet HIV/AIDS community service needs such as lack of access to ART, PMTCT and VCT;

2) determine the prevalence of HIV, HSV-2, and syphilis in adults age 15-64, and the distribution of CD4 counts among HIV-infected adults, an indicator not previously captured under any population-based HIV/AIDS surveys carried out in Zambia to date;

3) describe socio-demographic and behavioral risk factors related to HIV and other STI and provide information on how HIV/STI prevention programs are performing; and,

4) provide an estimate of HIV incidence through laboratory testing, a critical indicator of the effectiveness of HIV/AIDS prevention programs.

The CSO will have a complete M&E program for the two Strategic Information activities. Monitoring activities will include training and retraining of field staff to ensure accuracy of data collection, and routine field visits to monitor data collector performance and quality control of data processing. To ensure quality and safety of SAVVY data, personal computers used for SAVVY data (which will be stored on external hard drives and analyzed) will not be connected to the CSO network, and will be placed in a secure cabinet in the SAVVY office which has restricted access. Data will be stored in two parts, one set will contain personal identifiers and the other the rest of the data, both of which can be linked by a password or code. Access to this code will be restricted to key personnel at the SAVVY office. Paper records will be stored in locked cabinets at site offices which only SAVVY site supervisors will have access to, and collected every month from site offices for further editing and storage at the SAVVY offices at CSO headquarters. Monthly program performance evaluations will be conducted.

The CSO intends to carry out two activities in FY 2010. The first activity is the continuation and expansion of the SAVVY from the current coverage of 4 provinces to 9 provinces. It will also continue with efforts aimed at improving the civil registration by building capacity at the DNRPC. The information collected through verbal autopsy interviews will assist in ascertaining the causes of death that are not captured through the health facilities and hence inform policy. About 60% of Zambia's population resides in rural areas with little or no access to heath facilities and the births and deaths occurring in these areas are unrecorded. Additionally, birth registration compliance is very low, estimated at below 40% of all births occurring in health facilities while those occurring in rural areas are rarely recorded. This activity aims at collecting such information from sampled areas and, once the cause of death has been ascertained, the DNRPC will issue a death certificate. It is envisaged that in due course the database recording of births and deaths will be located in health facilities as an integral part of the SmartCare electronic health records system. The second activity that the CSO intends to undertake in FY 2010 is the AIDS Indicator Survey. This is an HIV surveillance activity whose objectives are to provide information on access to and unmet needs to HIV/AIDS services, HIV prevalence of HIV, HSV-2, and syphilis in adults age 15-64, and the distribution of CD4 counts among HIV-infected adults, socio-demographic and behavioral risk factors related to HIV and other STIs, and estimate HIV incidence through laboratory testing. This information is vital to the prevention efforts, treatment and care programs. The accuracy of information on persons in need of HIV treatment has critical fiscal implications. The CSO will collaborate with the University Teaching Hospital (UTH), the Tropical Disease Research Centre (TDRC), the National AIDS Council (NAC) and the Ministry of Health (MoH) in this surveillance activity. The CSO will be responsible for the collection of socio-demographic data from the households while UTH and TRDC will oversee the collection and testing of biological specimens.