Overview and Use of

SmartVA in the Philippines

• In the case of medically unattended deaths, physicians
may assign a CoD based on very little information and
in a way that is not standardized

• To get better and more consistent CoD information,

verbal autopsy (VA) is the only practical alternative
for medically unattended /out-of-hospital deaths
What is Verbal Autopsy (VA)?
• Process for deriving a cause of death from an interview
using a structured set of questions on signs/symptoms
experienced by the deceased prior to death

• Principle is to mirror the clinical process in terms of

symptom assessment/ medical history
Two stage process of VA
a) Interview of the deceased’s family to gather
information on signs and symptoms experienced
before death

b) Diagnosis of cause of death based on this information

• Physician review
• Computer based algorithm (software)
Improvement actions in the Philippines for
better quality mortality statistics
a) Introduce ‘SmartVA for Physicians’ for medically
unattended/out-of-hospital (community) deaths
b) Train hospital doctors in correctly certifying according
to the ICD rules
c) Introduce automated ICD mortality coding in PSA
d) Introduce a new death certificate form
What is Smart Verbal Autopsy (SmartVA)
for Physicians?
SmartVA is an internationally recognized and validated tool which
electronically determines the most probable CoD/UCoD.

Physician
SmartVA SmartVA decides
Questionnaire software to underlying
(on electronic assign Cause COD and
device) of Death completes
MCCOD
SmartVA for Physicians Pilot
Implementation
Pilot Areas

Region NCR:
10 more cities

Region 3:
Bulacan

Region 4A
Rizal

Region VI (Ilonggo)
Iloilo
Negros Occidental

Region VII and XIIII (Cebuano)

Cebu
Sarangani
Key statistics drawn from the evaluation of
the pilot implementation
a) 97% of the interviewees were family members
b) 91% of MHOs used SmartVA when no medical records were available
c) 90% of the interviews were conducted by the MHOs
d) 65% agreed with the SmartVA CoD, remainder modified or chose another one

• Other cancers into specific types of cancers

• E.g. liver cancer, nasopharyngeal cancer
• Other injuries into specific types of injuries
• E.g. gunshot wound
• Maternal deaths into specific types of maternal deaths
• E.g. pre-eclampsia
Top 20 CoDs when Physicians used
SmartVA
Conclusion on the Pilot Implementation
Generally, SmartVA is acceptable to the MHOs who have used it
and can be implemented in the country to improve the quality
of death certification of community deaths.
Value of SmartVA for Physicians
a) SmartVA for Physicians provides a standardized method to help physicians
assign a CoD where they did not attend the death and have little health
data on the deceased.
b) SmartVA for Physicians utilizes a standardized questionnaire and computer
software able to assign 33 adult, 21 child and 6 neonatal causes
c) Physicians are able to assign different or more specific causes by asking
additional questions and reviewing health records
d) SmartVA for Physicians is needed in the Philippines to help improve
mortality information and reduce the proportion of deaths due to
unknown causes and garbage codes
e) AO 2020-0008 “Rules on MCCOD” direct that verbal autopsy must be used
on all unattended deaths that are not medico-legal cases