The Ten CRVS milestones framework
Notification is the capture and onward transmission of minimum essential information on the fact of birth or death by a designated agent or official of the CRVS system using a CRVS authorised notification form (paper or electronic) with that transmission of information being sufficient to support eventual registration and certification of the vital event.
Problems can arise where confusion exists about the meaning of terms such as vital event notification, declaration, certification and medical certification of cause of death, which are explained below.
- Notification: The issuance of a form confirming the occurrence of a vital event by an appropriate authority.1
- Declaration (death): The point in time at which a health professional, having determined that an individual is dead, formally states this finding.2
- Certification: Issuance by the Civil Registrar of a legal document certifying the fact of birth or death.3
- Medical certification of cause of death: Completion of a medical certificate of cause of death (MCCOD) by a medically trained person, listing the immediate, intermediate and underlying causes of death in accordance with the World Health Organization International Classification of Disease (ICD) certification standards.3
A formal notification or declaration is an essential first step to enable vital events to be officially registered by the Civil Registrar and included in vital statistics. However, notification processes are poorly designed and not well known by CRVS stakeholders in low- and middle- income countries (LMICs).
For example, when a birth or death occurs in a medical facility, the informant is usually the physician or nurse who attended the event. They may collect information from the mother (for a birth) or family members (for a death), along with evidence from the medical record and compile this in a form. The notification form should then be taken by the family to register the event and obtain the relevant certificate. However, families may not always understand the difference between, for example, the notification form and the legal birth certificate issued by the civil registration office. They may therefore fail to register the event.
There are three essential components in every notification process:
Declarant/informant and notification agent
For an event to be notified, someone with knowledge about the event must provide information to an official agency or its representative. This person is usually referred to as an ‘informant’. The informant should be the person who is the most knowledgeable about the people involved in the vital event and its circumstances.
- Healthcare professionals
- Community health workers
- Traditional/trained birth attendants
- Village authorities
- Ward or subdistrict authorities
- Civil registration officials or community key informants
- Local government executive officers
- Government health workers
- Physicians in the private sector
- Local civil registration offices
Information to be captured during notification
- On the form: administrative area to district, sub district or community level (usually to census administration level 5); unique serial number of the record (preferably automatically generated); and date of notification
- For the deceased: full name, personal identification number (if available), sex, date of birth, date of death, age at death (if the date of birth is not available), place of death and place of usual residence
- For the event: date and time of occurrence, place of occurrence, cause of death (if medically attended), and manner or mode of death (if not attended)
- For the declarant/informant: full name, personal identification number, place of usual residence, occupation, relationship to the deceased, telephone number and date of reporting
- Documentation presented by declarant/informant: remarks and signatures
- For the notification agent: signature testifying to have been notified, and name, title, and date
- Disclaimer explaining that the completed notification form does not have legal status and is not a death certificate. It provides instructions about how to proceed to register the death officially at a civil registration office (if this is the policy). Otherwise, the notification agent takes care of transmitting the form for registration.
A designated agent, such as a physician, issuing a notification form is not enough to register the vital event. This form must be sent to where the validation and registration of the vital event takes place – usually the civil registration office.
In many countries, the family takes the notification form to register the event and obtain the relevant certificate. However, families may not always understand the difference between the notification form and the legal certificate issued by the civil registration office, and may therefore fail to register the event.
Countries moving towards digital systems can transmit the information in the notification form to a regional office (as done in the Philippines) or directly to the central level (as done in Ecuador).
Barriers to death notification (Ghana)
Interview with Francis Yeji, Research Officer at the Ghana Health Service and Fellow at the University of Melbourne's Bloomberg Philanthropies Data for Health Initiative.
Barriers to death notification in the Solomon Islands
What are the barriers to death notification in the Solomon Islands and how does the country plan to use innovative methods to improve data? Dilip Hensman, Technical Officer, World Health Organization explains. Watch Dilip describe the outcomes to improved death data: https://youtu.be/ILg_E0M6iUs