By Rodela Khan and Ashley Frederes
Colombia has made great strides in strengthening its Civil Registration and Vital Statistics (CRVS) system and has attained a high completeness of recording births and deaths. Now, the government is seeking to close the remaining gaps in the system to protect the health and rights of everyone in the country.
In March 2018, with support from the Bloomberg Philanthropies Data for Health Initiative, the government launched a strategy to increase notifications of rural births and deaths to local governments. The text message (SMS) platform, called Colombia Rural Vital, was launched so that community leaders in 14 predominantly Indigenous and Afro-descendant municipalities could alert the occurrence of a birth or a death in their community. This proactive platform reports community-based vital events that otherwise would go unrecorded by municipal health institutions. If a death occurs, the health institution follows up with the surviving family members and conducts a ‘verbal autopsy’ – also called a ‘post-mortem caregiver interview’ – to identify a probable cause of death.
The active participation of community leaders – including local police officers, leaders of community action boards, indigenous leaders and midwives – is crucial for the success of this program, and trainings emphasize the importance of local leadership, ownership, and sustainability of the work through capacity and awareness building. Since March 2018, a total of 939 community leaders (622 female, 317 male) have been trained across the 14 municipalities.
Vital events occurring outside of health institutions often slip through the cracks. Using existing technology to create a mechanism to capture these events enables the health sector and the community to better share information with one another. It also means that resource-limited settings using basic mobile phones will have the ability to implement this program in the future.
As of October 2018, 661 vital events (479 births and 182 deaths) that occurred between 2017-2018 across the 14 municipalities have been detected and reported to the national database of registered births and deaths, known as RUAF-ND. From the reported deaths, a total of 39 verbal autopsies have been completed with the probable cause of death assigned. The process to confirm the remaining vital events continues by the local municipalities teams. Compared to historical data, an increase of 11% in community-based deaths have been recorded in the 14 municipalities after the introduction of the Colombia Rural Vital strategy.
For countries to allocate appropriate resources and take an informed approach to planning and implementing population health programs, they need critical public health data. Data for Health-supported efforts are improving the capture of community-based vital events and applying verbal autopsy to determine the probable cause of death, so that the government of Colombia will be able to develop informed public health policies and reduce current health inequities between urban, rural and ethnic minority communities.
The quality of the vital events reported using the Colombia Rural Vital platform will be reviewed in the next months. This evaluation will guide the Ministry of Health and Social Protection in the scale-up and implementation of this SMS notification and verbal autopsy system throughout Colombia, in municipalities similar to those in the 14 demonstration areas.
Counting the Uncounted is a blog series that examines topics related to civil registration and vital statistics. The blog series is a part of the Bloomberg Philanthropies Data for Health Initiative. The views expressed are not necessarily those of Bloomberg Philanthropies. Partners in the Initiative include: WHO, the U.S. Centers for Disease Control and Prevention (CDC) and the CDC Foundation, the University of Melbourne, and Johns Hopkins University’s Bloomberg School of Public Health. For more information visit: Bloomberg Philanthropies Data for Health Initiative.