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

Improving Civil Registration and Vital Statistics
Global Forum on Gender Statistics
Rome, 10-12 December 2007
www.healthmetricsnetwork.org
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:
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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
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)
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, 2003
T able: Number of countries reporting cause-of-death data from their
civil registration system to WHO, December 2003.
WHO Region
# Countries in # Countries with
Useable data
Region
46
Africa
35
The Americas
21
Eastern Mediterranean
52
Europe
11
South-East Asia
27
Western Pacific
192
World
 Source: WHO, Statistics Division
4
33
7
50
4
17
115
# Countries with
Complete CoD
Reports
1
14
3
39
0
7
64
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
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 costbenefit of adding VA modules
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)
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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)
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
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
Members
• AMMP/MEASURE Evaluation
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India SRS/University of Toronto
INDEPTH Network
University of Queensland
Harvard University
UNFPA
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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)
• 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 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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