Every country in the world needs to know about the characteristics of, and trends in, its population. The best way to achieve this information is through a civil registration and vital statistics (CRVS) system. CRVS systems are inherently complex because they involve multiple government partners with numerous responsibilities, are often poorly coordinated, and lack sufficient human capacity and other resources. Almost all CRVS systems in low- and middle-income countries are failing to achieve adequate levels of coverage and quality, despite attempting to apply standard methods proven to work well in high-income countries. This suggests system failure, rather than technical failure. System strengthening has the potential to rapidly improve overall performance of CRVS.