Cause of death data from vital records are the principal source for population level assessment of the magnitude and rank order of disease specific mortality. Such assessments provide information for health policy and planning purposes, as well as enable monitoring of existing health programmes. Only about a third of all countries in the world have civil registration systems that produce complete, valid, and timely statistics of this nature. In this article, we examine critical issues that determine the functioning of national mortality registration systems in nine African countries and identify key administrative, technical and societal issues. We propose a priority setting strategy to address such problems, drawing on the recent experience of South Africa in improving vital registration. African countries should be encouraged to establish expert teams to critically review their national civil registration systems in terms of the legal framework, organisational issues, system design, training needs and quality control issues. Country level expert teams should examine the feasibility of innovative approaches such as sample registration systems and verbal autopsy questionnaires should be used as interim measures to obtain data for policy and planning. Political will is an essential ingredient. The need to revitalise vital registration and statistics must be placed high on the development agenda.