The provision of registration services can be adversely affected by many factors. For example:

• Shortage of registration infrastructure and poor distribution of registration offices, which are often located in urban areas, may limit physical access to registration services. 
• Registration facilities may not be available on a continuous basis in areas where religious rites require rapid burial.
• There may be a lack of outreach to communities and awareness-raising of the importance of birth and death registration (especially on the need to declare fetal deaths).
• There may be insufficient financial and human resources for CRVS.
• Lack of transport infrastructure and geographic barriers such as seas, mountains, rivers, or problems due to climatic conditions at certain periods of the year may intervene.
• Registration officials usually have multiple responsibilities and may not always prioritise registration, so people may face long delays at registration offices.
• Registration forms are complex, hard to understand and not available in local languages.
• Registration may require multiple visits (eg to register and to collect the associated certificate).
• There may be costs associated with registration, such as registration fees, additional costs of late or delayed registration.
• In some settings, there may be complex registration requirements – eg the need to be accompanied by witnesses to the vital event.
• There may be inadequate collaboration across departments or agencies involved in aspects of registration. For example, between the health sector and the registration and statistical agencies.
• Those responsible for aspects of registration, for example determination of cause of death, may not have the necessary knowledge or skills.

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Improving quality and presentation of CRVS data