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

1. Improving Civil Registration and Vital Statistics Global Forum on Gender Statistics Rome, 10-12 December 2007 www.healthmetricsnetwork.org

2. 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

6. 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

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

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

12. 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

13. 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

14. 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

15. 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.

16. 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

17. 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.)

18. 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

19. 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?

20. www.healthmetricsnetwork.org