1 Country Experiences in Civil Registration Systems Development Health Metrics Network/ World Health Organisation DATE: 1 8 TH- 19 TH MARCH, 2009 G ENEVA G HANA S SITUATION P R E S E N T E D B Y K I N G S L E Y A S A R E A D D O
Birth Registration Process Live Births occurring in Hospitals/Health Facilities Public Hospitals Private Hospitals Clinics Maternity Homes Medical Certification ( Road to Health Card) (Doctor/Midwife/ Child Welfare Clinic) 2 PARENTS/ RELATIVE BIRTHS AND DEATHS REGISTRY (Birth Certificate) GHANA STATISTICAL SERVICE Live Births Occurring outside Health Facilities Home TBA Others PARENT/RELATIVE CHN CV Abandoned Children Police Social Welfare Children s Home
Death Registration Process Deaths occurring in Hospitals /Health facilities Public Hospitals Private Hospitals 3 Medical Certification (Medical Certificate of Cause of Death) Clinics (Doctor) RELATIVE Cemetery (Burial Permit) BIRTHS AND DEATHS REGISTRY Ghana Statistical Service Deaths occurring outside health facilities Home Police Coroner RELATIVE (Coroner s Inquest Report) Others Community Volunteer Cemetery
Result of Rapid Assessment Test Thematic Area Score Interpretation Overall Assessment of system Legal Framework 5 Registration Infrastructure and resources 7 Organisation and functioning of vital statistics system 6 Coverage and Completeness of registration 3 Data Storage and transmission 6 ICD-compliant practices and certification in and outside hospitals 4 Practices affecting the quality of cause of death 3 ICD coding practices 3 Coder qualification and training, and quality of coding 2 Data quality and plausibility checks 1 Data access and dissemination 4 Total 44 Poor Numerous aspects of system need to be improved 4
REGION POPULATION (2000 POPN. CENSUS) The Staff Situation NO. OF REGISTRIES NO OF STAFF ADDITIONAL STAFF REQUIRED ALL REGIONS 18,912,079 374 339 3782 7 H/ OFFICE 0 0 43-3 WESTERN 1,924,577 32 30 385 1 CENTRAL 1,593,823 43 37 319 1 GT. ACCRA 2,905,726 46 62 421 1 EASTERN 2,106,696 50 40 421 0 VOLTA 1,635,421 48 24 327 0 ASHANTI 3,612,950 49 35 723 1 B/AHAFO 1,815,408 37 22 363 0 NORTHERN 1,820,806 30 14 364 0 U/EAST 920,089 18 12 184 0 U/WEST 576,583 21 20 115 0 5 NO. OF VEHICLES
Registered birth (0-12 months only) 2000-2007 REGION POPULATIO N EXPECTED BIRTHS REGISTERED BIRTHS % COVERED 2000 18,912,079 756,483 236,335 31 2001 19,422,705 776,908 211,081 27 2002 19,947,118 797,885 138,151 17 ALL REGION S 2003 20,485,690 819,428 239,919 29 2004 21,038,804 841,552 430,127 51 2005 21,606,852 713,026 476,251 67 2006 22,190,237 732,278 391,841 54 2007 22,789,373 752,049 466,129 62 2008 23,404,686 772,355 6
Trend of infant birth registration(0-12 months only) 7 Registered Births 0-12 months. 2000-2007 900,000 800,000 700,000 756,483 776,908 797,885 819,428 841,552 713,026 732,278 752,049 600,000 500,000 400,000 430,127 476,251 391,841 466,129 300,000 200,000 236,335 211,081 239,919 100,000 138,151 0 2000 2001 2002 2003 2004 2005 2006 2007 EXPECTED BIRTHS REGISTERED BIRTHS
REGISTERD DEATHS IN GHANA 2000-2007 YEAR POPULATION EXPECTED DEATHS REGISTERED DEATHS % COVERED 2000 18,912,079 226945 45402 20 2001 19,422,705 233072 51639 22 2002 19,947,118 239365 49530 21 2003 20,485,690 204857 47492 23 2004 21,038,804 210388 50625 24 2005 21,606,852 216069 52079 24 2006 22,190,237 221902 51841 23 2007 22,789,373 227,894 54,234 24 8
No of Deaths Trend of Registered Deaths in Ghana 9 Trend of Registered Deaths 2000-2007 300,000 250,000 200,000 150,000 100,000 50,000 0 2000 2001 2002 2003 2004 2005 2006 2007 YEAR Expected deaths Registered deaths
Major success factors: Building partnerships Public education and sensitization Capacity building i 10
challenges Major challenges include: Low utilization of vital statistics for policy decisions Limited Access to registration facilities Low public knowledge about importance of registration Inadequate staff Inability to attract and retain highly qualified personnel due to low remuneration and poor service conditions Inadequate funding for the Registry, Difficulty in motivating registration volunteers Lack of logistics including accommodation, vehicles, requisite statistical software and programmes. Absence of training opportunities for sector staff Weak monitoring and supervision mechanisms. 11
Way forward- what we expect from various partners PARTNER AREA OF COLLABORATION MINISTRY OF LOCAL GOVT. RURAL DEV. &ENVIRONMENT GHANA STATISTICAL SERVICE GHANA HEALTH SERVICE CENTRE FOR HEALTH INFORMATION MANAGEMENT MOH, HMN PROGRAMME MIDWIVES/TBAs Policy issues, Technical guidance, supervision Technical support, Analysis of data collected, Training CHNs- Notification of births, assist with data collection Medical Officers- Collect and complete Medical Certificate of Cause of Deaths from BDR Annual CHPW, IMCH campaigns Accommodating Births &Deaths registration offices in all health facilities Analysis of Medical Certificates of Cause of Deaths Technical and logistic support Improve generation of mortality statistics Pilot of verbal autopsy system Notification of births /deaths 12
Way forward- what we expect from various partners PARTNER AREA OF COLLABORATION Passport office/national Identification Authority/SSNIT/Electoral Commission/ DVLA GHANA EDUCATION SERVICE UNICEF demand birth/death certificates to access services Make birth certificate enrollment requirement right from KG to tertiary level Technical and logistic support, advocacy PLAN GHANA Technical and logistic support, advocacy EMBASSIES MINISTRY OF PUBLIC SECTOR REFORM MINISTRY OF WOMEN AND CHILDREN S AFFIARS/DEPT OF CHILDREN Technical and logistic support. Birth/death cert. requirement to access service Verification of documents with BDR Logistical support, assist to improve service delivery, support computerization programme Advocacy, sensitization of public, Dissemination 13
Way forward- what we expect from various partners PARTNER AREA OF COLLABORATION GIS/AENEAS PROGRAMME DEPARTMENT OF SOCIAL WELFARE CHRISTIAN COUNCIL/ISLAMIC COUNCIL Cooperate to counter document fraud Logistic support, Training, support for computerization On legal issues concerning adoptions, registration of abandoned children etc Public education GHANA POLICE SERVICE SEXTONS LA/ OSU/ AWUDOME CEMETERIES LOCAL GOVT AUTHORITY (DISTRICT ASSEMBLY) Registration of unnatural deaths Coroner inquest cases Deaths occurring outside medical facilities Collect and use Burial Registers Demand Burial Permits before burial Submission of burial returns to Registry Registration of all burial grounds Control of burial grounds PRIVATE FUNERAL HOMES Demand proof of registration before 14 release of corpses.
15 THANK YOU MERCI SANTE ME DAA SE