Civil Registration in Sultanate of Oman

1
Civil Registration in Sultanate of Oman
Its Development and Potential Implications on
Vital Statistics

• Dr. Medhat K. ElSayed

2
Objectives

• Health System in Oman Brief
• Development of Civil registration birth and
  death notifications
• Reporting on Vital Events before and after Civil
  registration
• Status of Vital Events Data
• Implications on Mortality Fertility Estimates

3
Health System in Oman

• Total area is 309.5 thousands Km2
• 3 Plans
• 15 Mountains
• 82 Wadis Desert
• 8 Governorates / Regions (now 9) with 60
  Wilayates (61)
• 10 Health Regions (now 11)
• Upper Middle Income
• Total Government Expenditure millions RO 4469.8
  (US11,579.8 millions)
• Per Capita GDP RO 5321.5 (US13,786)
• Total Health Expenditure 3 of GDP
• Per Capita Health Expenditure RO 84 (US214)

Source Monthly Statistical Bulletin, Ministry of
National Economy, volume 18(4), April 30, 2007
4
Health System in Oman cont

• Population is about 2.6 millions of whom 1.9
  millions are Omanis (27 Expatriates)
• About 95 of enumeration areas are less than 1000
  and present only 17.6 of the total Population

5
Health System in Oman cont

• Relatively young
• 38.9 below 15 years of age
• 11.9 below 5 yeas of age
• Relatively high fertility
• TFR 3.14 per women 15049
• CBR 24.75 per 1000 population
• Low Death Rates
• CDR 2.53 per 1000 population
• Life Expectancy at Birth 74.3 years
• IMR 10.28 per 1000 Live Births
• Natural Increase Rate 2.2
• Expected to double in 30 years

6
Health System in Oman cont

• Public Health System
• Government finance and provide health care and
  health services
• Public health expenditure accounts for 80 of
  total health expenditure
• Public inpatient services 98, public dental
  services 41 and public outpatient services 81
• Government provides 93 of hospitals and 97.6 of
  hospital beds
• Public health services has 78 of doctors 92.5
  of nurses and 85 of other paramedics
• Ministry of Health is the main health Care
  provider (49 H, 4549 B, 145 HC)
• Other health care providers
• Armed Forces Medical Services (AFMS) (3 H, 260 B,
  31 C)
• Royal Oman Police Medical Services (ROPMS) (1 H,
  48 B, 3 C)
• Sultan Qaboos Hospital (SQUH) (1 H, 307 B, 1 HC)
• Diwan Medical Services (Diwan MS) (1 C)
• Petroleum Development Oman Medical Services
  (PDOMS) (9 C)
• Private Sector (5 H, 732 C)

H Hospital, B Beds, HC Health Center, C
Clinics
7
Health System in Oman cont

• A modern state started with the Omani Renaissance
  in 1970
• Interests to document births and deaths started
  gradually after 1970
• During early 80s age estimation for public
  employees
• Age may not be accurate for a considerable
  proportion of people above the age of 25 years

8
Health System in Oman cont

• Estimates for fertility and mortality indicators
  were based on surveys and studies with indirect
  statistical methods and models
• Events taking place were notified and
  certificates issued but no compulsory
  registration
• Public Health Institutions Issue certificates
• Private Health Institutions Notification of
  event to MOH
• Home events Notification of event by community
  leader (Sheikh Wali) to MOH
• Well established information system capturing
  service events
• Deaths hospital deaths, dead on arrival, AE
  deaths
• Births hospital births, born before arrival

9
Health System in Oman cont

• Coverage of events registered could not be
  properly assessed
• Estimates could not be segregated by important
  parameters as age and sex
• Mortality Estimates
• Age sex specific death rates to allow for a life
  table analysis
• Infant mortality Rate, Under 5 mortality Rate
• Life expectancy
• Fertility Estimates
• Age specific fertility rate for male and female
  births separately to allow estimating
  reproduction rates

10
Mortality Estimates
11
Fertility Estimates
12
Development of Civil Registration

• A Royal Decree (66/99) to develop a civil status
  was made in October 1999 but implementation took
  place only in May 2004
• The law has established the Directorate General
  of Civil Status (DGCS) at Royal Oman Police (ROP)
• Develop the implementing regulations of the Law
• Register civil status events
• Events birth, death, marriage, divorce,
  citizenship, residence
• Issue certificates
• Issue ID Cards

13
Notification of Births and Deaths

• Registration is based on notifications of events
• Establishment of a System of notification of
  vital events
• Identification of all possible sources of
  notifications
• One notification system
• Birth Death Notification Forms Consider
  requirements of CS Law and health sector
• Notification path
• Birth and Death Notification forms were developed
  by a body established by Minister of Health
• Notifications considered needs administrative
  needs, health needs

14
Possible sources of Notifications
Notification of Births and Deaths cont
Place of birth or death Source of notifications
MOH Hospitals HC MOH health institutions
AFMS Hospitals and dispensaries AFMS health institutions
ROP Hospitals and dispensaries ROP health institutions
SQU hospital HC SQU hospital
Private hospitals clinics Private health institution
Home Community leader (Sheikh Wali)
Factors, companies, roads, transportation Nearest health institution with ROP
Outside Oman Omani mission in country where event
15
Flow of Notifications
Notification of Births and Deaths cont
MOH Ministry of Health AFMS Armed Forces
Medical Services Prvt HI Private Health
Institutions ROPMS Royal Oman Police Medical
Services CL community leaders OM Omani
Missions
16
Assessment of 2006 Data from Vital Events
Notification

• Missing segregation information
• Pattern according to age
• Completeness (coverage)

17
Segregation of information
Assessment of 2006 Data from Vital Events
Notification cont
Gender unknown for 30 of notified deaths
18
Segregation information cont
Assessment of 2006 Data from Vital Events
Notification cont
Unknown age of notified deaths
19
Segregation information cont
Assessment of 2006 Data from Vital Events
Notification cont
Sex of newly born un reported
20
Segregation information cont
Assessment of 2006 Data from Vital Events
Notification cont
Un-reporting age of mother for newly born
21
Pattern according to Age and Sex
Assessment of 2006 Data from Vital Events
Notification cont
22
Completeness or Coverage
Assessment of 2006 Data from Vital Events
Notification cont
Using Brasss Growth Balance Method (preliminary
analysis)
Males Coverage 98
Females Coverage 97
23
Mortality Estimates
2006 Current estimate 2006 Current estimate 2006 estimates using notifications of Vital events 2006 estimates using notifications of Vital events
Omani Expat Omani Expat
CDR - Overall 2.48 Not available 2.9 1.2
CDR - Male Not available Not available 3.4 1.2
CDR- Females Not available Not available 2.3 1.1
e0 - Overall 74.29 Not available 72.6 81.6
e0 - Male Not available Not available 70.4 81.9
e0 - Females Not available Not available 74.9 81.2
ASDR Projected Not available available available
24
Mortality Estimates cont
2006 Current estimate 2006 Current estimate 2006 estimates using notifications of Vital events 2006 estimates using notifications of Vital events
Omani Expat Omani Expat
IMR - Overall 10.25 Not available 10.1 8.1
IMR - Male Not available Not available 11 9
IMR- Females Not available Not available 9.2 7.1
U5MR - Overall 11.02 Not available 12.8 12.9
U5MR - Male Not available Not available 13.8 13.5
U5MR - Females Not available Not available 11.8 6
25
Fertility Estimates
2006 Current estimate 2006 Current estimate 2006 estimates using notifications of Vital events 2006 estimates using notifications of Vital events
Omani Expat Omani Expat
CBR - Overall 24.17 Not available 24.2 5.7
CBR - Male Not available Not available 24.6 3.7
CBR- Females Not available Not available 23.7 13.4
TFR 3.19 Not available 3.19 1.03
Sex ratio birth Not available Not available 105.8 101.7
GRR (females) Not available Not available 1.55 0.51
NRR Not available Not available 1.51 0.50
26
Obstacles and challenges

• Notifications by Community Leaders
• Need to assess completeness
• Data on notification forms need to be completed
  especially health related data
• Cause of death is an issue to consider
• Burial permit
• No burial permit is required
• Can affect completeness of death registration
• Cultural believes and attitudes for registration
• Age estimation has been practice for a long time
• Changes in believes about importance for
  registration
• Cause of death data
• Physician and coders need training
• Deaths outside health facilities DOA, AED,
  Notified by CL