International donors, including the United States, spent more than $80 billion in 2004 on overseas medical aid, yet there is no conclusive evidence that this money is making a difference in preventing deaths, including those from AIDS, tuberculosis and malaria, because most people in Africa and Asia are born and die without leaving a trace in any official records.
In the lead paper of The Lancet’s “Who Counts” series, Philip Setel, Ph. D., and colleagues discuss this “scandal of invisibility" and analyze the inadequacy of civil registration systems for counting births, deaths and causes of death.