Improving Civil Registration and Vital Statistics

Global Forum on Gender Statistics

Rome, 10-12 December 2007

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HMN: what it is and what it does HMN: what it is and what it does

A global partnership whose goal is to increase availability and use of timely, reliable health information in countries and globally through shared agreement on goals and coordinated investments in health information systems

How?How? Develop framework and standards for HIS Support countries to implement HMN framework Stimulate dissemination and use of health information

Principles: Principles: Country ownership and stakeholder involvement Link health and statistical constituencies Harmonization and alignment; Paris Declaration Sustainability; catalytic funding Systems approach to health information

Why measuring cause-of-death data mattersWhy measuring cause-of-death data matters

• To understand pattern of deaths in a population– Cause of death data is the cornerstone of health

information– Not enough to know who dies, but also why

• To guide interventions in public health, to inform policy and planning

• To evaluate program effectiveness (e.g. AIDS, tuberculosis, malaria, maternal health), needed by

– National and sub-national health authorities– International donors

• For epidemiological research

MDG indicators in health sector ideally measured through Civil Registration (partly or fully)

MDG indicators in health sector ideally measured through Civil Registration (partly or fully)

Indicators Data supplied from CR

Prevalence of underweight children <5

Births

Proportion of 1-year-old children immunized against measles

Births

Proportion of births attended by skilled health personnel

Births

<5 mortality rate Births, deaths by age (and sex and causes of deaths)

Infant mortality rate Births, deaths by age (and sex and causes of deaths)

Maternal mortality ratio Births, deaths by age, sex, causes of deaths

Death rates associated with malaria

Deaths (by age and sex), causes of deaths

Death rates associated with tuberculosis

Deaths (by age and sex), causes of deaths

All indicators Accurate data on population size

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Number of countries reporting cause-of-death data from their civil registration system to WHO, 2003Number of countries reporting cause-of-death data from their civil registration system to WHO, 2003

Table: Number of countries reporting cause-of-death data from their civil registration system to WHO, December 2003.

WHO Region # Countries in

Region # Countries with

Useable data

# Countries with Complete CoD

Reports Africa 46 4 1 The Americas 35 33 14 Eastern Mediterranean 21 7 3 Europe 52 50 39 South-East Asia 11 4 0 Western Pacific 27 17 7 World 192 115 64

• Source: WHO, Statistics Division

Birth vs death registrationBirth vs death registration

• In general, the proportion of births registered in a country is higher than the proportion of deaths registered,

• in part this is because incentives for birth registration (e.g. entry to schooling) are more effective than those for death registration, especially in settings where property inheritance is a marginal issue

Alternative to civil registration to generate vital statistics (1)Alternative to civil registration to generate vital statistics (1)

• Censuses with questions on fertility and mortality– Representative (in principle)– Useful for estimating fertility, child and adult mortality,

potential for estimating maternal deaths– Not continuous (10 years apart), captures deaths prior to

the survey

• Household surveys – For mortality: Two stage process:

• Identify households with deaths• 40 min. Verbal Autopsy interview

– Requires a larger sample to capture adult deaths (very wide confidence intervals - not appropriate for measuring trends)

Costly (US$2-5 per respondent), also need to consider cost-benefit of adding VA modules

Alternative to civil registration to generate vital statistics (2)Alternative to civil registration to generate vital statistics (2)

• Demographic surveillance sites (DSS) – Continuous monitoring– Already in place in many regions (eg, INDEPTH Network) – Relatively cheap (US$0.02 per registration)– Non-representative (sampling, intervention trails, etc.)

• Sample vital registration system (SRS)– Continuous monitoring– Representative sample– Requires strong commitment and maintenance– Work in two biggest populations: India SRS and China DSP– Preferred alternative to complete VR

Alternative to civil registration to generate vital statistics (3)Alternative to civil registration to generate vital statistics (3)

These approaches can be of immense value in terms of the production of statistics, however they do not bring the legal and human rights benefits associated with civil registration.

Monitoring Vital Events (MoVE) Initiative: Goals

Monitoring Vital Events (MoVE) Initiative: Goals

Spearhead a global movement for improving the coverage and quality of vital events monitoring in low-income countries:

– Develop and test innovative approaches to recording vital events and the identification of strategic options appropriate to diverse country settings. 

– Generate better data on mortality levels, trends, differentials and causes of death by age and sex and on births

– Encourage counting of all vital events or, where this is not possible, the highest feasible level of representativeness of sample of deaths

– Enhance the use of mortality data for resource allocation, planning and evaluation

– Enhance national capacity to run and maintain their own civil registration systems

MembersMembers

• AMMP/MEASURE Evaluation

• India SRS/University of Toronto

• INDEPTH Network

• University of Queensland

• Harvard University

• UNFPA

• UNICEF

• UN Statistical Division

• World Bank

• WHO (HQ/ROs)

• Countries (China DSP, Thailand, Ghana, South Africa, etc.)

Products and On-going activities (as of December 2007)Products and On-going activities (as of December 2007)

• Monitoring Vital Events Resource Kit (launched October 2007)

• Lancet series "Who Counts" (launched October 2007)

• Standardized Verbal Autopsy tools

• Development of assessment tool for vital statistics systems

• Development of guidelines for using VA with census and household surveys

• Research on innovative approaches at country-level

• Assistance to countries to improve civil registration

Possible gender-relevant issues in the process of civil registrationPossible gender-relevant issues in the process of civil registration

• Differences in completeness and quality of registration between male and female population?

• If so, what are the barriers to gender-specific registration?

• How to address this?

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