Sierra Leone concludes inaugural workshop on institutionalizing medical certification of cause of death and ICD-11

Freetown, 25 September 2025 - The Ministry of Health (MoH) and the National Civil Registration Authority (NCRA), in collaboration with the World Health Organization (WHO), have concluded a two-day inaugural meeting of the death reporting sub-committee, bringing together health professionals, civil registration experts, academia, and partners. This marks the first step in a series of activities aimed at strengthening the mortality reporting through institutionalizing the Medical Certification of Cause of Death (MCCD) and implementing the WHO International Classification of Diseases, 11th Revision (ICD-11) in Sierra Leone.

Accurate and timely data on causes of death are essential for effective health planning, policy development, and resource allocation. However, Sierra Leone's health information system faces challenges in generating reliable mortality data, largely due high proportion of community deaths not reported to the health system and to the limited use of standardized medical certification practices. Currently, only 13.4% of deaths in the country are fully registered with the NCRA, with the lack of certified causes of death from health facilities being a key barrier.

To address these gaps, the MoH, with support from WHO, has embarked on strengthening medical certification practices and adopting ICD-11. This initiative will enable standardized classification of causes of death, promote international comparability, and reinforce Sierra Leone's health management information system (HMIS) and civil registration and vital statistics (CRVS) system.

The workshop focused on defining the terms of reference of the sub-committee, finalizing the roadmap, exploring the governance frameworks and building consensus on the next steps which include community awareness, tools deployment and monitoring and evaluation.

Speaking at the workshop, Dr. George Ameh, WHO Country Representative in Sierra Leone, highlighted the importance of reliable mortality data: "Every life matters, and every death must be counted. Timely and accurate reporting is not just a statistical obligation, it is a moral imperative. By bringing together health, civil registration, academia, and the UN family, we can ensure that every death is reported, every cause is understood, and the data is put to use in guiding decisions that save lives."

The Director General of NCRA, Mohamed Mubashir Massaquoi thanked WHO for its continued support and emphasized inter-institutional collaboration: "Sierra Leone has a legal framework that guides cooperation on civil registration. The NCRA depends on many institutions to make this system work, and the Ministry of Health is a critical partner, particularly when it comes to death reporting. The technical guidance of WHO is much appreciated in helping us build functional processes. We recognize the challenges, but this workshop provides an opportunity to confront those challenges together and find solutions."

Adding a gender perspective, Emmanuella Anderson, Gender Representative from the Ministry of Health, stressed the importance of inclusivity: "Behind every statistic is a human story. Women, families, and communities often bear the greatest burden when deaths go unreported. By institutionalizing medical certification and strengthening death reporting, we ensure every life regardless of gender or status is counted, valued, and used to shape policies that protect the most vulnerable."

The workshop validated terms of reference, explored enabling legal and policy frameworks, and set the stage for phased implementation of the adapted WHO MCCD tool and ICD-11 in the country. Next steps will include a multi-sectoral roll-out of the MCCD, transition to and scale-up of ICD-11 , and institutionalization of the same at academic levels.

Through these efforts, Sierra Leone aims to establish a sustainable and standardized national cause-of-death reporting system. This will improve death registration coverage and ensure that policy and health program decisions are informed by accurate and timely mortality data.

WHO reaffirmed its commitment to supporting Sierra Leone in institutionalizing cause-of-death reporting, strengthening MCCD, aligning with global best practices, and advancing capacity, digital innovations, and integration into health information systems.