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Vital Stories

Outdated Legal Frameworks Leave Millions Without a Legal Identity. Here’s How Four Countries Took Action.

Welcome to Counting the Uncounted: a CRVS Blog

Vital Strategies is pleased to launch “Counting the Uncounted,” a blog devoted to all things CRVS (civil registration and vital statistics).  Nearly a billion people live and die without any official trace of their existence. Countries use CRVS systems to record vital events, including births, deaths, marriages and divorces. If you’re here, you are part of a growing movement to ensure that every birth and death is counted. At Vital Strategies, our goal is to improve the quality and completeness of CRVS systems so that no one is left behind. Through our blog, we will share results and insights from our work in countries around the world, and we will address issues ranging from emerging obstacles to implementing CRVS improvements to the optimal design of a 21st century CRVS system. It is time that we make people count by counting people.

We look forward to your feedback! Please send us an email at: Ashley Frederes and Philip Setel

Failure to strengthen the civil registration and vital statistics (CRVS) systems in developing countries has been assailed as one of the greatest development failures of the 20th century.[1] Millions of births and deaths go unrecorded each year, leaving vulnerable populations without a legal identity and governments in the dark on key demographic and health data for their people.[2] Since 2015, the Bloomberg Philanthropies Data for Health Initiative has provided technical assistance to 20 low- and middle-income countries and cities to collect and use critical public health data with a focus on increasing birth and death registration and improving the quality of cause-of-death data.[3]

With the functions of CRVS systems divided amongst government ministries, there often isn’t enough coordination, and roles and responsibilities are poorly defined. Proper legislation can solve this. Many developing countries have outdated legal frameworks that are relics of their colonial pasts, and do not explicitly require universal civil registration or do not permit the use of new technologies to strengthen the CRVS system.  It is important that governments properly establish their CRVS legislative frameworks given the multiplicity of stakeholders; the complexity of registration processes; legal implications of certified vital events; the need for complete registration to enable effective identity management; and population and health statistics derived from CRVS data. A comprehensive legislative framework aligned with best practices is a precondition for CRVS systems designed to leave no one behind.[4]

As an implementing partner of the Data for Health initiative, Vital Strategies developed the Legal and Regulatory Review toolkit[5] to address this gap. Through the initiative, we have helped a number of countries review their CRVS legislation and identify legislative obstacles for reform based on international best practices.

In Ghana, the country’s health sector—the single largest source of vital events data—was unable to share data with the Ghana Births and Deaths Registry until recently, denying the country a wealth of vital events notification data. To address system shortcomings, a legal review resulted in a memorandum of understanding between the Ghana Health Service and the Births and Deaths Registry. The MOU permits the Ghana Health Service to notify the Births and Deaths Registry of all vital events occurring at health facilities, as well as home-based vital events identified by community health workers. This has now allowed the civil registrar to identify the number and location of many births and deaths that are not registered and has contributed to an increase in registrations.

A lack of rules governing medical certification of cause of death was another challenge in Ghana, which led to confusion of roles and responsibilities and poor certification practices. Vital Strategies is providing ongoing technical assistance to the Department of Health to develop rules for medically certifying causes of death that are consistent with international best practice. These practices include delineating institutional and physician responsibilities, developing precise definitions, transmitting death certificates, and monitoring and compliance.

In Rwanda, the government had noticed that many births and deaths known to the health sector were not being registered by the National Identification Agency, its civil registration authority. To fill this gap, the government enacted new regulations to authorize health facilities as civil registration points, establish home-based care practitioners as official vital event notifiers for community-based births and deaths, and create a governing regulation on data sharing and CRVS system integration among CRVS stakeholders. In Tanzania, this legal review process has led to a government decision to overhaul the current birth and death law by developing a new law that is currently in parliament for approval.

In Cambodia, Vital Strategies is supporting the General Department of Identification under the Ministry of Interior with new civil registration and identification legislation.[6] This legislation will support the country’s National Strategic Plan for Identification by promoting universal and continuous registration of all vital events occurring in Cambodia. It will also uphold key human rights principles to ensure that everyone residing in the country has a legal identity and the means to prove their legal identity.[7]

A strong legal framework is the foundation of a well-functioning CRVS system, and is a necessary step toward achieving universal, permanent, and continuous registration coverage. Undertaking a CRVS legal review to ensure compliance with international best practices is an effective means to catalyze improved efficiency, security and demand for CRVS services. It also provides a unique opportunity for frequently siloed stakeholders to work cooperatively to identify strategies and solutions to resolving mutual challenges.

Based on Data for Health country applications to date, the majority of identified legal obstacles can be resolved quickly under existing authority, and do not require extended adoption of new legislation through parliamentary or congressional approval.

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. For more information visit:  Bloomberg Philanthropies Data for Health Initiative.