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What can be done to rapidly improve CRVS systems?

Addressing human resource constraints

The shortage and ill-defined roles of registrars, especially in rural areas, is often highlighted as a major contributing factor to low levels of registration coverage and can contribute to poor data quality. In some countries, registrars only work part time on registration activities, sometimes in an honorary capacity. The quality of registration will be increased when registrars are treated as professionals with important responsibilities. 

Registration officials should be:

  • Carefully recruited and trained;
  • Literate with the completion of secondary (high school) education
  • Able to demonstrate a sound understanding of the purpose and rules of registration
  • Independent of the elected government, with strict legal duties and responsibilities to protect the integrity of the data collected
  • Treated with trust and respect, and motivated by an awareness of the importance of their work. 

As a last resort, penalties can be introduced for noncompliance with the established rules and regulations.

In addition to registrars, the human resource base of CRVS systems should include statistical clerks, coders and medical records officers to convert individual records to useful health data. Competent staff are also vital in completing critical feedback loops between data generation and data use. 

Both pre-service and in-service training are essential for health workers with responsibilities for ascertaining COD and issuing death certificates. Currently, medical curricula do not devote a significant amount of time to training in the use of the ICD as a health tool. As a result, death certificates are often poorly completed and valuable health information is lost.

World Health Organization (2012). Strengthening civil registration and vital statistics for births, deaths, and causes of death: Resource Kit.

Potential use of immunisation services for birth registration
As the diagram above shows, around the world, rates of immunisation coverage in young infants (often less than one week old) are generally significantly higher than rates of birth registration. In part, this is because most parents recognise the health benefits of immunisation but see relatively little value in registration at birth.  In addition, community-based health workers make it part of their duties to identify and visit newborn infants in order to offer immunisation. 
This is an opportunity to increase birth registration coverage; health workers offering immunisation could be delegated to notify the registration authorities of births and to provide the essential information needed for birth registration. Combining efforts in immunisation and birth registration would not only benefit the national government by increasing birth registration coverage, but also benefit families by saving them time and costs of visiting the registration office in person. In many countries, health workers issue the child with a vaccination card that could be adapted to include a space to mark whether the child was registered. With the rapid increases in computerised immunisation registries and unique identifiers, health workers could also make note of the child in an immunisation registry at the same time as informing the country’s civil registration system. 

Read more

United Nations Children’s Fund (2017). Better Data for Women and Children: Strengthening Civil Registration and Vital Statistics Across the Continuum of Care. Technical Meeting Report 4–6 October 2016, New York.

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