The Center of Excellence for Universal Health Coverage (COE-UHC) at the James P Grant School of Public Health, and UNICEF co-hosted the 9th round of the Tanahashi Rounds on 11th May, 2014. It showcased a presentation on “State of Birth Registration in Bangla-desh within 45 days of Birth” by AKM Saiful Islam Chowdhury, Project Direc-tor (Additional Secretary) of the Birth and Death Registration Project, Local Government Division.

The discussion was moderated by Dr. Malabika Sarker, Co-PI and Dr. Pascal

Villeneuve, UNICEF Representative.

Mr. AKM Saiful Islam Chowdhury provided a detailed picture of the state of birth registration in Bangladesh, both in terms of the legislative environment and actual practice. Article 7 of the Con-vention on the Rights of the Child stipu-lates that a child be registered immedi-ately after birth and have the right to a name and nationality as well as to know and be cared for by his or her parents. Center of Excellence for

Universal Health Coverage (CoE-UHC) project, James P Grant School of Public Health

(JPGSPH)Level-6, icddr,b, Mohakhali

Dhaka, Bangladesh

Secretariat

REPORT

11th May, 2014

Mr AKM Saiful Islam Chowdhury Presenting at Tanahashi Round 9

State of Birth Registration in Bangladesh Within 45 Days of Birth

Tanahashi Round-9

REPORT

Programme Description:

In Bangladesh, according to the Birth and Death Registration Act, the father, mother or guardian of a child are responsible for submitting information relating to the birth of the child within 45 days of the child’s birth. Mr. Chowdhury explained that acquiring a birth certificate is the right of every child born in the country. Birth registra-tion is important because it validates the existence of the child, but also its right to health services, school-ing, and protection from child labor, child trafficking, child marriage and other forms of exploitation. Regis-tering the baby in time is also important for gathering statistics to inform fact-based planning, moni-toring and budgeting.

In terms of the institutional struc-ture that oversees the registration of births and deaths, the Birth and Death Registration Act 2004 was amended in 2013 to provide a legal basis for establishment of the Office of the Registrar General, to implement its mandate of register-ing births within 45 days. Birth registration service points are embedded in local government administrations nationwide and in some Bangladeshi missions abroad. All 4,996 registrar offices are currently using the online Birth Registration Information System (BRIS). Currently, the national plan is to improve civil registration and vital statistics with a focus on accel-erating registration of children within 45 days of their birth. According to the Bangladesh government, 160.8 million births

have been registered online in the systemand manually. The rate of registration of children under the age of five has increased from 9.8 % in 2006 to 31 % in 2011. However, between January and December only approximately 37,759 children (1.42% of expected births) were registered within 45 days of birth. Effective coverage of birth registra-tion is defined as births registered within 45 days of birth with a certificate. The rate of increases and decreases in birth registration are thus measured through the official government census, sample vital registration system and surveys such as the multiple indicator cluster survey.

Tanahashi Round-9

Average, 100

Average, 73.1

Average, 12.4

Average, 4.8Average, 2.1

88.6

43.7

28.8

0.00

15.7

0.00

6.8

0.00

Birth Registration within 45 Days in 19 deprived Unions in Bangladesh, 2013

REPORTTanahashi Round-9

Difference Domains Bottlenecks

Enabling Environment (Management and coordination)

Lack of coordination and clarity between Directorate ofHealth and Local Government Division on the role of EPIworkers and how they will coordinate in the grassroots levelin providing information to the parents on when, where andhow to register the birth of their children.

Supply (Availability of essential commodities/ inputs)

No essential campaign or drive to promote and disseminate the importance of birth registration.

Supply (Access to adequately staffedservices, facilities and information.

Though EPI workers have a role to provide information andsupport the parents to register birth of the children, EPIworkers are not very clear about their specific roles forinforming the parent about Birth Registration.

Demand (Social and cultural practices and beliefs)

The community people do not demand the information onbirth registration as they do not see any importance untilthey need the birth certificate for access to services.

Availability

Accessibility

BR Bottleneck Analysis - 1

The survey done of 19 unions in 2013 showed some interesting results .

1) Availability: All birth regis-tration units in 19 unions have adequate resources and staff.

2) Accessibility: An average of 73% of parents know how and where to report births to obtain a birth certificate.

3) Utilisation: The proportion of children born in the last 12 months whose parents applied for birth registration is low at only 12.4

per cent.

4) Adequate coverage: Only 4.8% of children born in the last 12 months who were registered, were actually provided with a birth certificate.

5) Effective coverage: Only 2.1 percent of children under the age of one had their births regis-tered with a certificate issued within 45 days.

Bottleneck analysis examines the barriers and bottlenecks to reaching effective coverage of birth registra-

tion as a service. Within the 19 unions, in retrospect, the highest performers are those with the greatest resources and least constraints; on the other hand, the lowest performers are working with the most constraints and are thus under extreme pressure. As a result, there is a bottleneck or “sliding-down” effect.

Tanahashi Round-9REPORT

Bhairab Paurashava registered 644 births within 45 days in 2013, amounting to 28 percent of estimated births. According to Mr. Chowdhury, after the initial inspection stage by the Project Director, this paurashava was able to double its performance upon handed over the correct equip-ment and data-gathering tech-niques.

Keys for success:

1) Health workers are also responsible for birth registration. Furthermore, they prepare preg-nant mothers’ lists and frequently visit and sensitize mothers to-be on the importance of birth regis-tration as well as other health

services.

2) Health workers completed the birth registration application between delivery and first date of immunization and sent the form to the Sanitary Inspector who is authorized to register births by the Mayor.

3) To avoid missing births, Birth Registration Number is entered on the EPI card on the first date of immunisation.

4) If there were any missing births, health workers support parents to submit BR application.

The key barriers to effective

coverage of birth registration are as follows:

1) Many residents of Bangla-desh, including those from higher socio-economic classes, are not aware of the significance of a birth certificate.

2) Some parents wait until their child is enrolled in primary school to register their birth;

3) Sometimes, teachers change the date of birth to ease enrolment into schools.Mr. Chowdhury made the follow-ing recommendations to increase effective coverage of birth regis-tration.

Best Practice

Mr. Chowdhury made the follow-ing recommendations to increase effective coverage of birth regis-tration:

Stimulating demand for birth registration:

1) Mandatory registration of births within 45 days should be encouraged and it is necessary to raise the awareness of parents and communities on the importance of registering births within 45 days.

2) Online birth registration application should be encouraged.

Role of health/EPI workers in birth registration:

3) EPI workers should verify

the birth certificate and write the birth registration number on the EPI register and card during the first EPI contact. If EPI workers have a functional internet connec-tion, they can send birth registra-tion applications online to regis-tration offices.

4) If a baby is brought to an EPI point without a birth certifi-cate, health workers should support parents to submit a birth registration application to the Registrar Office and collect the birth certificate before the second doze of immunization Birth registration after more than 45 days:

5) No births can be regis-tered by a Registrar without formal permission from a higher

authority after 6 months of birth.

6) When children enroll in primary school, schools should verify the enrolment age through the birth certificate. If the child does not have a birth certificate, schools should advise and support parents to obtain one.Coordination and capacity-building:

7) Capacity of birth and death registration units should be strengthened with time.

8) Systematic coordination between health institutions and birth-death registration units in facilitating birth registration of newborn children should be strengthened.

Tanahashi Round-9 REPORTQuestions and Answers

Points to consider which were brought up during the Q/A session were:

1) Efforts should be made to ensure birth registration is made within 45 days of birth, including penalizing parents that fail to comply.

2) On partnerships especially in hard-to-reach and remote areas, the linkage of birth registration to the EPI service is being strengthened. The Office of the Registrar General is willing to collaborate with NGOs, grassroots organizations operating

at local levels to increase effective coverage in hard-to-reach and underperforming areas.

3) New unions created from existing ones take time to set up the birth registration service. It was suggested that local governments be made more responsible for registration with continuing support of the Office of the Registrar General in promptly setting up BRIS in new unions carved out of existing unions.

4) Use all options and contact with health services such as post-natal care to increase coverage of birth

registration.

In conclusion, the presentation highlighted the benefit of the Tana-hashi approach - specifically in dem-onstrating the equity gap between the low performing and best performing areas; and showing where focused efforts must be directed in order to close the gaps, and achieve effective coverage.

Difference Domains Bottlenecks

Enabling Environment (Management and coordination)

Lack of coordination and clarity between Directorate ofHealth and Local Government Division on the role of EPIworkers in Birth Registration. EPI workers did not see birthregistration as their duty.

Although BR issues have been included in the reportingformat of EPI workers, none of the stakeholders in the EPIreporting chain have been held accountable for this job.

Supply (availability of essential commodities and inputs)

As the first contact person for newborn babies, EPI workers are supposed to help parents fill in forms. However, EPI workers often do not have birth registration forms with them.

Demand (Financial access)

Sometimes the Registrar Offices illegally asks for money forbirth registration which often discourages parents to applyfor birth registration for their children.

Demand (timing and Continuity of use)

Children do not need the birth certificate until they seekadmission to school so parents do not apply for it until theyneed one to access this service.

Accessibility

Utilization

BR Bottleneck Analysis - 2

Nadia Ishrat AlamgirLecturer III

Center of Excellence for Universal Health Coverage (CoE-UHC) projectJPGSPH, Level-6, icddr,b, Mohakhali

Email: nishrat@bracu.ac.bd

Contact

REPORTTanahashi Round-9

Pascal Villeneuve of UNICEF and Dr Malabika Sarker of BIGH moderated the session with Mr Saiful Islam

Tanahashi organizing team:

Overall Supervision:Dr. Sadia A. ChowdhuryDr. Syed Masud Ahmed

Overall coordination and Report preparation:Nadia Ishrat AlamgirNabila Chowdhury

Invitation and Reception: Md. Tarek HossainNabila Chowdhury

Design/Communications:Kazi Shamsul Amin Imran Jamal

IT support:Tapan BiswasA. Rouf Sarker

Logistics:Sohel Rana

Support:Mansura Akter