Research Article: Evaluation of approaches to strengthen civil registration and vital statistics systems: A systematic review and synthesis of policies in 25 countries

Date Published: September 27, 2019

Publisher: Public Library of Science

Author(s): Amitabh Bipin Suthar, Aleya Khalifa, Sherry Yin, Kristen Wenz, Doris Ma Fat, Samuel Lantei Mills, Erin Nichols, Carla AbouZahr, Srdjan Mrkic, Margaret E Kruk

Abstract: BackgroundCivil registration and vital statistics (CRVS) systems play a key role in upholding human rights and generating data for health and good governance. They also can help monitor progress in achieving the United Nations Sustainable Development Goals. Although many countries have made substantial progress in strengthening their CRVS systems, most low- and middle-income countries still have underdeveloped systems. The objective of this systematic review is to identify national policies that can help countries strengthen their systems.Methods and findingsThe ABI/INFORM, Embase, JSTOR, PubMed, and WHO Index Medicus databases were systematically searched for policies to improve birth and/or death registration on 24 January 2017. Global stakeholders were also contacted for relevant grey literature. For the purposes of this review, policies were categorised as supply, demand, incentive, penalty, or combination (i.e., at least two of the preceding policy approaches). Quantitative results on changes in vital event registration rates were presented for individual comparative articles. Qualitative systematic review methodology, including meta-ethnography, was used for qualitative syntheses on operational considerations encompassing acceptability to recipients and staff, human resource requirements, information technology or infrastructure requirements, costs to the health system, unintended effects, facilitators, and barriers. This study is registered with PROSPERO, number CRD42018085768. Thirty-five articles documenting experience in implementing policies to improve birth and/or death registration were identified. Although 25 countries representing all global regions (Africa, the Americas, Southeast Asia, the Western Pacific, Europe, and the Eastern Mediterranean) were reflected, there were limited countries from the Eastern Mediterranean and Europe regions. Twenty-four articles reported policy effects on birth and/or death registration. Twenty-one of the 24 articles found that the change in registration rate after the policy was positive, with two supply and one penalty articles being the exceptions. The qualitative syntheses identified 15 operational considerations across all policy categories. Human and financial resource requirements were not quantified. The primary limitation of this systematic review was the threat of publication bias wherein many countries may not have documented their experience; this threat is most concerning for policies that had neutral or negative effects.ConclusionsOur systematic review suggests that combination policy approaches, consisting of at least a supply and demand component, were consistently associated with improved registration rates in different geographical contexts. Operational considerations should be interpreted based on health system, governance, and sociocultural context. More evaluations and research are needed from the Eastern Mediterranean and Europe regions. Further research and evaluation are also needed to estimate the human and financial resource requirements required for different policies.

Partial Text: Civil registration is defined as the continuous, permanent, compulsory, and universal recording of the occurrence and characteristics of vital events in accordance with the legal requirements in each nation [1]. Vital events captured in civil registration and vital statistics (CRVS) systems include the registration of births, deaths (including cause of death), marriages, adoptions, and divorces [1]. Civil registration and supporting legal documentation provide individuals with proof of legal identity, help establish their right to acquire nationality, allow individuals to exercise a broad range of rights, and facilitate access to essential services including social welfare, education, health, and legal protection [2]. Systematic compilation of civil registration data into vital statistics also provides the demographic information necessary for good governance [3]. For example, birth and death data can help monitor population growth and movement and inform fiscal policy. Within the health sector, functioning CRVS systems with a medically certified cause of death both provide an individual with the legal documents they need to access health, inheritance, and legal protection and the country with the data needed to estimate national and subnational burden of disease, the impact of different disease programmes, and the cost-effectiveness of disease interventions [4]. Birth and death registration data are also essential to inform health service needs and coverage. These functions are critical to monitoring progress in achieving the United Nations Sustainable Development Goals (SDGs) [5].

This systematic review indicates that new policies have the potential to have positive long-term effects on improving birth and death registration rates. However, there are a variety of considerations needed to interpret these data correctly. For example, an intervention implemented at a subnational scale may face different operational issues and a different direction of effect when implemented nationally. One example of this is use of community-based registration services [47,58,64]. This type of policy would be useful to fill a geographic void in rural settings but may prove redundant in many urban settings. Furthermore, in areas with poor telecommunication platforms and connectivity, mobile registration fills a void; however, in facilities that have computers with connectivity, it may prove redundant [44].



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