Transcript Slide 1

Civil Registration in Sultanate of Oman
Its Development and Potential Implications
on Vital Statistics
Dr. Medhat K. ElSayed
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
Dec 10-12, 2007
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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 (≈US$11,579.8 millions)
• Per Capita GDP RO 5321.5 (≈US$13,786)
• Total Health Expenditure 3% of GDP
• Per Capita Health Expenditure RO 84
(≈US$214)
Source: Monthly Statistical Bulletin, Ministry of National Economy, volume 18(4), April 30, 2007
Dec 10-12, 2007
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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
Dec 10-12, 2007
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Health System in Oman … cont
80 +
• 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
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
• Natural Increase Rate 2.2%
• Expected to double in 30 years
10-14
5-09
0-04
10%
Dec 10-12, 2007
8%
6%
4%
2%
Males
Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics
0%
2%
4%
6%
Females
8%
5
10%
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
Dec 10-12, 2007
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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 80’s age estimation for public employees
• Age may not be accurate for a considerable proportion of
people above the age of 25 years
Dec 10-12, 2007
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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, A&E deaths
– Births: hospital births, born before arrival
Dec 10-12, 2007
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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
Dec 10-12, 2007
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Mortality Estimates
200
100
Based on IMR estimates
90
Based on IMR
160
80
140
70
120
60
2003 Census
100
50
1993 Census
Projection
40
based on
2003 Census
80
Preceeding
Birth
Technique
60
30
40
20
Survey data
20
10
CDR
IMR
U5MR
06
20
04
20
02
20
00
20
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
19
78
19
76
19
74
19
72
0
19
19
70
0
Dec 10-12, 2007
years
per 1000
180
e0
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Fertility Estimates
60
12
LB per 1000
10
40
8
30
6
20
4
TFR (per women 15-49)
census
+
service data
50
Survey
10
2
1993 census
2003 census
0
19
70
19
72
19
74
19
76
19
78
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
0
CBR
Dec 10-12, 2007
TFR
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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
Dec 10-12, 2007
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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
Dec 10-12, 2007
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Notification of Births and Deaths … cont
Possible sources of Notifications
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
Dec 10-12, 2007
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Notification of Births and Deaths … cont
Flow of Notifications
Copy of notification forms from places other than MOH
MOH
SQUH
AFMS
Prvt HI
Client
ROPMS
CL
DG CS
OM
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
Dec 10-12, 2007
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Assessment of 2006 Data
from Vital Events Notification
• Missing segregation information
• Pattern according to age
• Completeness (coverage)
Dec 10-12, 2007
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Assessment of 2006 Data from Vital Events Notification … cont
Segregation of information
Gender unknown for 30% of notified deaths
40%
32%
30%
30%
20%
10%
0%
Omani
Dec 10-12, 2007
Expatriate
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Assessment of 2006 Data from Vital Events Notification … cont
Segregation information … cont
Unknown age of notified deaths
30.0%
27.0%
20.0%
12.2%
9.6%
10.0%
5.8%
0.0%
Omani
Expatriate
Males
Dec 10-12, 2007
Females
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Assessment of 2006 Data from Vital Events Notification … cont
Segregation information … cont
Sex of newly born un reported
10.0%
0.3%
0.8%
0.0%
Omani
Dec 10-12, 2007
Expatriate
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Assessment of 2006 Data from Vital Events Notification … cont
Segregation information … cont
Un-reporting age of mother for newly born
20.0%
13.6%
10.0%
5.0%
0.0%
Omani
Dec 10-12, 2007
Expatriate
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Assessment of 2006 Data from Vital Events Notification … cont
Pattern according to Age and Sex
Natural log (ln) of ASDR for Males 2006
Natural log (ln) of ASDR for Females 2006
6.000
5
5.000
4
4.000
3
3.000
2
2.000
1
1.000
0
1
2
3
4
5
6
7
8
9
10 11 12
13 14 15 16 17 18
-1
0.000
1
2
-1.000
Dec 10-12, 2007
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18
-2
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Assessment of 2006 Data from Vital Events Notification … cont
Completeness or Coverage
0.1600
0.1400
0.1400
0.1200
0.1200
0.1000
Nx/Nx+
Nx/Nx+
Using Brass’s Growth Balance Method
(preliminary analysis)
0.1000
0.0800
0.0800
0.0600
0.0600
0.0400
0.0400
0.0200
0.0200
-
-
0.0200
0.0400
0.0600
0.0800
0.1000
0.0100 0.0200 0.0300 0.0400 0.0500 0.0600 0.0700 0.0800
0.1200
Dx+/Nx+
Dx+/Nx+
Males
Coverage 98%
Dec 10-12, 2007
Females
Coverage 97%
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Mortality Estimates
2006
Current estimate
2006 estimates using
notifications of Vital events
Omani
Expat
Omani
Expat
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
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
Projected
Not available
available
available
CDR - Overall
e0 - Overall
ASDR
Dec 10-12, 2007
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Mortality Estimates … cont
2006
Current estimate
IMR - Overall
2006 estimates using
notifications of Vital events
Omani
Expat
Omani
Expat
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
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
U5MR - Overall
Dec 10-12, 2007
11.02
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Fertility Estimates
2006
Current estimate
2006 estimates using
notifications of Vital events
Omani
Expat
Omani
Expat
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
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
CBR - Overall
TFR
Dec 10-12, 2007
3.19
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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, A&ED, Notified by CL
Dec 10-12, 2007
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