Improving Civil Registration and Vital Statistics

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• Improving Civil Registration and Vital Statistics
• Global Forum on Gender Statistics
• Rome, 10-12 December 2007

www.healthmetricsnetwork.org
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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?
• Develop framework and standards for HIS
• Support countries to implement HMN framework
• Stimulate dissemination and use of health
  information
• Principles
• Country ownership and stakeholder involvement
• Link health and statistical constituencies
• Harmonization and alignment Paris Declaration
• Sustainability catalytic funding
• Systems approach to health information

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Why 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

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Civil registration system as a source of Cause
of Death data

• Ideally all deaths registered with medical
  certification of cause of death
• However
• Not all deaths are registered
• Those that are registered, are often without CoD
• Those that are registered with CoD, may be
  without medical certification
• Those that are registered with medical
  certification of CoD, may be incorrect
• Those that are registered with medical
  certification and correct assignment of CoD, may
  be mis-coded along the reporting flow
• Evaluation of quality is very important.

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MDG indicators in health sector ideally measured
through Civil Registration (partly or fully)
Indicators Data supplied from CR
Prevalence of underweight children lt5 Births
Proportion of 1-year-old children immunized against measles Births
Proportion of births attended by skilled health personnel Births
lt5 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, 2003
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Birth 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

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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 (US2-5 per respondent), also need to
  consider cost-benefit of adding VA modules

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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 (US0.02 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

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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.
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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

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Members

• 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.)

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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

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Possible 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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