CHWs and their Role in Civil Registration and Vital Statistics

Erin K. Nichols, PhD, MPHNational Center for Health Statistics

International Statistics Program

CORE Group Spring Meeting - 3 May 2012

National Center for Health Statistics

International Statistics Program

Overview

Civil registration & vital statistics (CR/VS) systems and their challenges

Efforts to improve CR/VS systems globally

The role of CHWs as vital events reporting & registration agents

Your experience

Civil Registration SystemA system government uses to record vital events as required by laws or regulations of the country

Community volunteer gathering information in the Northern Region of Ghana.

• Main purpose – To establish the legal documents required by law

• Goal – To record all vital

events occurring in the country as they occur

Vital Statistics SystemThe process of collecting, compiling & analyzing information from vital events filed through the civil registration system

• Main purpose – Presentation of vital event data in statistical form

• Goal – To have

accurate data from all vital events occurring in the country

Health Metrics Network

Uses of Vital RecordsCR/VS Data Census Surveys

Advantages

+ Complete data

+ Continuous data

+ Data are fully representative

+ Low cost to maintain

+ Small area data

+ Complete data

+ Broader scope

+ Well recognized & supported by governments

+ Smaller number of observations

+ Customizable

+ Low cost/ survey

+ Closer monitoring; better data quality

+ Can be representative

Disadvantages

-Expensive up front cost; many resources required

- Limited scope- Requires inter-ministerial cooperation

- Not continuous

- Many resources required

- Higher cost

- Difficult to monitor; lower data quality

- Lack of in-depth information

- Not continuous

- Only estimates- Expensive for continual surveys

- Inability to produce small area estimates

The Challenge:

48 million infants are not registered each year (~ 40%)

38 million deaths are not registered (2/3 of all deaths globally)

85 countries have zero or unreliable cause of death information an additional 52 countries have low-

quality data

WHO, 2007

Previous International Efforts to

Strengthen CR/VS Systems• Setting standards to improve VS comparability

• International collection & publication of data

• Strengthening national statistical systems

– Not a government priority

– Lack of recognition as key component of development

Strengthening National Systems

• Increase coverage of vital events registration

• Improve quality of cause of death information

Making a passive system ACTIVE

Strengthening National Systems

• Increase coverage of vital events registration

• Improve quality of cause of death information

Making a passive system ACTIVE

CHWs to reach every household

What Has Changed? Most countries are now more

developed

Mobile technology is eliminating previous communication problems

National ID systems require birth, death info.

Focus on unique advantages of CR/VS:• Identification – via birth registration• Continuous data flow• Small area data • Cause of death information• Inexpensive data source

Creating Demand for Vital Statistics

Millennium Development Goals # 4 (child mortality) & # 5 (maternal mortality)

Best measured via vital statistics

Improving CR/VS Systems: Create Demand by Requiring Certificates

for Government Services

Birth certificates now required by Kenya Ministry of Education to sit for exams at end of secondary school

Improving CR/VS Systems: Mobile Technology Applications

Create registration-related apps:

Order a copy of your/ your child’s birth certificate

Enquire re status of certificate request

Devices such as smart phones can provide real-time data access from remote areas. WHO.

TUNISIA

MOROCCO

ALGERIA

MAURITANIA MAL

I NIGER

LIBYA

CHAD

Sea

EGYPT

SUDAN

ETHIOPIA

DJIBOUTI

ERITREA

SOMALIAKENYA

TANZANIA

DEMOCRATIC

(ZAIRE)

CENTRAL

RWANDA

GABON

EQUATORIAL

ANGOLA

CONGO

NIGERIA

BENIN

DTVOIRE

SIERRA

SENEGAL

GHANA

THE

GUINEA

LIBERIA

CAMEROON

MALAWI

ZAMBIA

MOZAMBIQUE MADAGASCARZIMBABWE

BOTSWANA

SWAZILANDLESOTHO

NAMIBIA

ANGOLA

Rd

UGANDA

OF THE CONGO

REPUBLIC

BURUNDI

GUINEAREP. OF

TOGOCOTE

BURKINA

GUINEA

LEONE

GAMBIA

BISSAU

SOUTH

REPUBLIC

AFRICAN

THE

AFRICA

Improving CR/VS Systems: HMN/MoVE Collaboration

Collaboration with other

groups leverages efforts & budgets, improves project quality

Improving CR/VS Systems: Establish Regional Training Sites

To promote South-South technical assistance

The Role of CHWs

Reporting occurrence of births and deaths

Registering births and deaths into national system

Conducting verbal autopsies

Conducting local level data use and action meetings

Health Metrics Network

For Successful Linkages

Connect CHWs to the public sector: paid employees connected to a legal system

Support strong linkages between government sectors involved in CR/VS

Take advantage of advances in IT

Others?

Types of CHW Program Involvement

CHWs reporting and/or registering vital events to be included in the national CR/VS system

CHWs reporting vital events for local useCan these data be connected to a national

CR/VS system?

Programs evaluating the quality of vital events data collected by CHWs

Your Experience

Location

Organization

Collaborators

Description of project

Contact information– Name– Email address– Project website, if available

Kenya – Homa Bay X

CDC/MOH/ Improving CR/VS coverage using DCR mobile IT; VA on mobile devices

Location Organization Description

Kenya – Homa Bay CDC/MOH/DCR Improve CR/VS coverage with mobile IT; VA on mobile devicesKenya – Naivasha WHO/HMN/MOH/DCR Improving CR/VS coverage using mobile ITEthiopia – Koraro MVP/MOH Expansion of ChildCount+ ; VA on mobile devicesMalawi – Zomba IIP-JHU/NSO/UM Test methods for measuring U5 mortality; assess data quality

National integration

Local collection

Data quality assessment

Erin K. NicholsE-mail: igd1@cdc.gov Web: http://www.cdc.gov

Sam Notzon, Director – International Statistics ProgramE-mail: fcn2@cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Health Statistics

International Statistics Program