Putting Tigers in CHWs Tanks_Nichols_5.3.12Presentation Transcript
CHWs and their Role inCivil Registration and Vital Statistics Erin K. Nichols, PhD, MPH National Center for Health Statistics International Statistics Program CORE Group Spring Meeting - 3 May 2012 National Center for Health Statistics International Statistics Program
Overview Civil registration & vital statistics (CR/VS) systems and their challenges Efforts to improve CR/VS systems globally The role of CHWs as vital events reporting & registration agents Your experience
Civil Registration System A system government uses to record vital events as required by laws or regulations of the country• Main purpose – To establish the legal documents required by law• Goal – To record all vital events occurring in the Community volunteer country as they occur gathering information in the Northern Region of Ghana.
Vital Statistics System The process of collecting, compiling & analyzing information from vital events filed through the civil registration system• Main purpose – Presentation of vital event data in statistical form• Goal – To have accurate data from all vital events Health Metrics Network occurring in the country
Uses of Vital Records CR/VS Data Census Surveys + Complete data + Complete data + Smaller number of + Continuous data + Broader scope observations + Data are fully + Well recognized & + Customizable representative supported by + Low cost/ surveyAdvantages + Low cost to governments + Closer monitoring; maintain better data quality + Small area data + Can be representative - Expensive up front - Not continuous - Not continuous cost; many - Many resources - Only estimates resources required required - Expensive for - Limited scope - Higher cost continual surveysDisadvantages - Requires inter- - Difficult to monitor; - Inability to produce ministerial lower data quality small area cooperation estimates - Lack of in-depth information
The Challenge: 48 million infants are not registered each year (~ 40%) 38 million deaths are not registered (2/3 of all deaths globally) 85 countries have zero or unreliable cause of death information an additional 52 countries have low-quality data
Previous International Efforts to Strengthen CR/VS Systems • Setting standards to improve VS comparability • International collection & publication of data • Strengthening national statistical systems – Not a government priority – Lack of recognition as key component of development
Strengthening National Systems• Increase coverage of vital events registration• Improve quality of cause of death information Making a passive system ACTIVE
Strengthening National Systems• Increase coverage of vital events registration• Improve quality of cause of death information Making a passive system ACTIVE CHWs to reach every household
What Has Changed? Most countries are now more developed Mobile technology is eliminating previous communication problems National ID systems require birth, death info. Focus on unique advantages of CR/VS: • Identification – via birth registration • Continuous data flow • Small area data • Cause of death information • Inexpensive data source
Creating Demand for Vital Statistics Millennium Development Goals # 4 (child mortality) & # 5 (maternal mortality) Best measured via vital statistics
Improving CR/VS Systems:Create Demand by Requiring Certificates for Government Services Birth certificates now required by Kenya Ministry of Education to sit for exams at end of secondary school
Improving CR/VS Systems: Mobile Technology Applications Create registration-related apps: Order a copy of your/ your child’s birth certificate Enquire re status of certificate requestDevices such as smart phones canprovide real-time data accessfrom remote areas. WHO.
Improving CR/VS Systems: MOROCCO TUNISIA HMN/MoVE Collaboration ALGERIA LIBYA EGYPT Rd MAURITANIA MALI Sea Collaboration NIGER with other ERITREA SENEGALTHE CHAD SUDANGAMBIA DJIBOUTI BURKINA GUINEA BISSAU GUINEA COTE BENIN TOGO NIGERIA CENTRAL ETHIOPIA groups leverages SIERRA DTVOIRE GHANA LEONE AFRICAN REPUBLIC LIBERIA CAMEROON efforts & UGANDA DEMOCRATIC SOMALIA EQUATORIAL REP. OF REPUBLIC KENYA GUINEA THE GABON OF THE CONGO CONGO (ZAIRE) budgets, improv RWANDA BURUNDI ANGOLA TANZANIA MALAWI es project ANGOLA ZAMBIA quality MOZAMBIQUE MADAGASCAR NAMIBIA ZIMBABWE BOTSWANA SWAZILAND LESOTHO SOUTH AFRICA
The Role of CHWs Reporting occurrence of births and deaths Registering births and deaths into national system Conducting verbal autopsies Conducting local level data use and action meetings Health Metrics Network
For Successful Linkages Connect CHWs to the public sector: paid employees connected to a legal system Support strong linkages between government sectors involved in CR/VS Take advantage of advances in IT Others?
Types of CHW Program Involvement CHWs reporting and/or registering vital events to be included in the national CR/VS system CHWs reporting vital events for local use Can these data be connected to a national CR/VS system? Programs evaluating the quality of vital events data collected by CHWs
Your Experience Location Organization Collaborators Description of project Contact information – Name – Email address – Project website, if available
Kenya – Homa Bay X CDC/MOH/ Improving CR/VS coverage using DCR mobile IT; VA on mobile devices National integration Local collection Data quality assessmentLocation Organization DescriptionKenya – Homa Bay CDC/MOH/DCR Improve CR/VS coverage with mobile IT; VA on mobile devicesKenya – Naivasha WHO/HMN/MOH/DCR Improving CR/VS coverage using mobile ITEthiopia – Koraro MVP/MOH Expansion of ChildCount+ ; VA on mobile devicesMalawi – Zomba IIP-JHU/NSO/UM Test methods for measuring U5 mortality; assess data quality
Erin K. NicholsE-mail: email@example.com Web: http://www.cdc.govSam Notzon, Director – International Statistics ProgramE-mail: firstname.lastname@example.orgThe findings and conclusions in this report are those of the authors and do not necessarily represent the officialposition of the Centers for Disease Control and Prevention. National Center for Health Statistics International Statistics Program