“Real-Time” Monitoring of Under-Five Mortality: A Vision Tempered by Reality

• Civil registration and vital statistics (CRVS) systems have emerged as a major priority in the post-2015 development agenda, largely based on their assumed potential to generate population data for use in guiding investments and managing programs in low-income countries. • The evidence base on how best to design, implement, and sustain such systems is weak, especially for mortality statistics. There are global calls for new research and analysis to inform the CRVS agenda, whether the results are positive or negative. • The Real-Time Monitoring of Under-Five Mortality (RMM) project aimed to develop and test methods for producing estimates of child mortality for recent periods of one year or less. Three broad approaches were assessed: community-based reporting of vital events; calibration of facility data to represent deaths in the population; and rapid survey methods. • Between 2008 and 2013, we applied and rigorously evaluated at least two of these approaches in each of five countries in sub-Saharan Africa: Ethiopia, Ghana, Malawi, Mali, and Niger. • The RMM project, reported here as the PLOS Collection on RMM, has generated an important body of evidence that can inform efforts to strengthen CRVS in low-income countries and provides a foundation for continuing CRVS implementation research.