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Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
Putting Tigers in CHWs Tanks_Nichols_5.3.12
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Putting Tigers in CHWs Tanks_Nichols_5.3.12

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  • The Universal Declaration of Human Rights proclaims that everyone has the right to a nationality.  This right is ensured by functioning civil registration and vital statistics (CR/VS) systems, which provide essential input for the assessment and monitoring of population health status and for efficient health intervention planning.  -UNICEF supports this human right in efforts to improve coverage of birth registration
  • Reference: Handbook on Training in Civil Registration and Vital Statistics Systems, Series F, No. 84, United Nations, New York, 2002, Module 1In public health- the vital events we’re most concerned with are births and deathsUnited Nations Definition: “the continuous, permanent, compulsory and universal recording of the occurrence and characteristics of vital events pertaining to the population as provided through decree or regulation in accordance with the legal requirements in each country.” It is important to emphasize that the civil registration system is based on laws and regulations.
  • Reference: Principles and Recommendations for a Vital Statistics System, Revision 2, United Nations, New York, 2001, Chapter I.B.United Nations Definition: “the total process of (a) collecting information by civil registration or enumeration on the frequency of occurrence of specified and defined vital events, as well as relevant characteristics of the events themselves and of the person or person concerned, and (b) compiling, processing, analyzing, evaluating, presenting and disseminating these data in statistical form.”Emphasize that the main source of vital statistics is the Civil Registration System.In cases where the Civil Registration System does not provide complete coverage of a country, vital statistics data may be compiled for some cities or other geographic areas where coverage is good.However, the ultimate goal should be to have complete coverage of all vital events occurring in the country through the Civil Registration System.
  • Reference: Handbook on Training in Civil Registration and Vital Statistics Systems, Series F, No. 84, United Nations, New York, 2002, Module 1These are examples of some uses of vital records. The slide is not meant to include all uses.
  • SOURCES: WHO/UQ.Notes: Here’s a map depicting the quality of globally available information on causes of death…
  • Sources: Mahapatra. Notes: Setting standards: UN Principles & Recommendations for a Vital Statistics System; WHO definitions for live birth and fetal death; ICD system; International Form of Medical Certification of Cause of Death;Physician and coder training;Verbal autopsyWhile international efforts have led to some success in the first two areas, there has been a collective inability to make orsustain improvements at the country level. This failure has been attributed to first, governments not making civil registration systems a priority, and second, development partners not recognizing these systems as key components of development infrastructure. Most of the country projects financed by development partners up to now have focused on poverty measurement and economic statistics, rather than CR systems and what is needed to develop and sustain them. Of the few projects focused on developing CR systems in developing countries, most have not been maintained by the relevant government agency after the outside funding ended.
  • MDG program is an excellent means of convincing decision-makers to invest in civil registration and vital statistics.
  • Most discussions of mobile technology focus on how it can be used by data collectors. But we need to think about how it can be used by consumers as well. Kenyans could use an app to avoid traveling to their district registration office to order a birth certificate. Other possibilities: app allowing user to ask registration office if requested certificate is ready to be picked up.
  • CDC working with Statistics South Africa on automated cause of death coding software. Potential for collaboration with FIC Collaborating Centre in Cape Town.
  • Exploring the role of CHWs in CR/VS systems; is this an appropriate role to add to their responsibilities? In what settings is this appropriate? We’re making an effort to answer these questions by reaching out to those involved with CHW programs and to facilitate a discussion on the feasibility of deploying CHWs as vital events reporting and registration agents and on the necessary criteria for successfully linking locally-collected vital events data into a national CR/VS system. Define difference between reporters and registrars
  • Exploring the role of CHWs in CR/VS systems; is this an appropriate role to add to their responsibilities? In what settings is this appropriate? We’re making an effort to answer these questions by reaching out to those involved with CHW programs and to facilitate a discussion on the feasibility of deploying CHWs as vital events reporting and registration agents and on the necessary criteria for successfully linking locally-collected vital events data into a national CR/VS system. Define difference between reporters and registrars
  • Transcript

    • 1. 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
    • 2. 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
    • 3. 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.
    • 4. 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
    • 5. 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
    • 6. 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
    • 7. WHO, 2007
    • 8. 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
    • 9. Strengthening National Systems• Increase coverage of vital events registration• Improve quality of cause of death information Making a passive system ACTIVE
    • 10. 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
    • 11. 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
    • 12. Creating Demand for Vital Statistics Millennium Development Goals # 4 (child mortality) & # 5 (maternal mortality)  Best measured via vital statistics
    • 13. 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
    • 14. 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.
    • 15. 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
    • 16. Improving CR/VS Systems: Establish Regional Training SitesTo promote South-South technical assistance
    • 17. 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
    • 18. 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?
    • 19. 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
    • 20. Your Experience Location Organization Collaborators Description of project Contact information – Name – Email address – Project website, if available
    • 21. 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
    • 22. Erin K. NicholsE-mail: igd1@cdc.gov Web: http://www.cdc.govSam Notzon, Director – International Statistics ProgramE-mail: fcn2@cdc.govThe 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

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