Getting the numbers right in Africa--a tribal solution.

It often seems that the health care numbers and vital statistics in Africa are as hazy as the sun on the horizon. Medical statistics, for example, can come with staggering margins of error. The World Health Organization notes in “2011 World Health Statistics” that “there are considerable uncertainty ranges for many countries due to limitations in data availability, quality and timeliness. Uncertainty ranges in estimated all-cause mortality for 2008 vary from ±1% for high-income countries to ±15–20% for sub-Saharan Africa.” Health officials contend that they have no option but to rely on the information available, which is usually only hospital data. But in many sub-Saharan African countries, that’s almost deceptive, as many births and deaths, as well as medical services, occur in nonhospital settings. But Malawi appears to be pointing the way toward harder, more accurate numbers by creating a data collection system that makes “village headmen” responsible for collecting vital data. “We have given the headmen of the villages registers,” says Bester Mandere, commissioner of the district of Thyolo, home to about 600 000 of Malawi’s 13 million residents, an estimated 12% of whom are HIV-positive. “If there are births in the communities, they record them. If there are deaths too, they record in the register.” The Thyolo district is divided into 12 administrative areas called traditional authorities. Each is headed by a chief and composed of several villages. Each village, in turn, is led by a headman. A group of 6–10 villages is led by a group headman. In total, the district has 423 village headmen and 65 group headmen. “The chiefs and the headmen are better placed to know what happens in their communities and to report them,” says Geoffrey Kumbuyo, a district officer in Thyolo. “Normally, in terms of reporting [of births and deaths], things have to come from the group village headmen to the chiefs of the traditional authorities. Then the chiefs of the authorities report to the district commissioner.” Cultural traditions in Malawi make such data collection possible, says Anthony Harries, honourary professor of medicine at the London School of Hygiene and Tropical Medicine in the United Kingdom, where he now lives, and a former resident of Malawi for more than 20 years. Village headmen keep a record of births and deaths in part because no one can be buried in a village unless the headman gives approval. When people die, they must be sent to their home villages for burial. Village headmen must provide periodic updates to chiefs because the latter must have accurate information when, for example, arbitrating property disputes after someone dies.