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Tanzania – Bridging the gap: Linking CRVS to health facilities

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Presentation by Bhaskar Mishra (UNICEF) at the international conference on innovations in Civil Registration and Vital Statistics (CRVS) systems - Ottawa on 27-28 February 2018. See more at http://crvsinnovations.net

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Tanzania – Bridging the gap: Linking CRVS to health facilities

  1. 1. Health in the Context of Inclusive Development CRVS Innovations Conference Ottawa, Canada February 27–28, 2018 Tanzania – Bridging the Gap: Linking CRVS to Health Facilities
  2. 2. Services from HFs Low notification and certification rates • Of the 5,542 births taking place every day, only 637 births get registered • Adds a backlog of 204 births every hour Missed opportunities… Bridging the Gap: Linking CRVS to Health Facilities – UNICEF | for every child
  3. 3. HFs – about 7800 Hospitals – 263 Health Centres – 744 Dispensaries/Clinics – 6,833 Average per region – 300 Average per council – 44 Average per ward – 2 Average per village – 0.4 % share of private owned facilities – 26.3 Health Facilities in Tanzania Mainland
  4. 4. • Dates back to 1917- Proclamation No. 15 of 1917 • Births and Deaths Registration Act, cap 108, 1920 • Registration compulsory for non-Africans only • Compulsory registration for natives started through Government Notices gradually in 1980s • Health Facilities and the Village Executive Officers(VEOs) mandated to notify events • Registration made compulsory for natives throughout Tanzania in 2009 • Majority of VEOs not even know about this responsibility • Notifications at HFs incomplete and suffer from issues of awareness, commitment, supplies • Decentralized birth registration system started in 2013; currently in 9 regions • Decentralized death registration to start in one district in March 2018 Birth and Death registration in Tanzania A BRIEF HISTORY Bridging the Gap: Linking CRVS to Health Facilities – UNICEF | for every child
  5. 5. BARRIERS Distance Cost Low awareness Low demand for certificates Cultural issues – delay in naming a baby/ registration of baby of a unwed mother GAPS Low notification Low registration Low certification No data on Vital Statistics from CRVS Huge backlog for children 1-17 years Barriers and Gaps Bridging the Gap: Linking CRVS to Health Facilities – UNICEF | for every child
  6. 6. Distance: Registration and certification closer to the community • capitalize on the existing contact points • reduce the distance by more than 20 times Cost: Substantially cut down the indirect costs • at no additional cost or a minimal cost if tagged with vaccination/health checkup Notification: Simplify the process of notification • no notification for institutional births (63%) • Vaccination and health cards for others Registration and certification: ‘One step, One visit’ process • completed at birth or within 6 weeks Cause of Death (COD): Trained physicians and coders can help improve cause of death data Bridging the Gaps What HFs can do: Bridging the Gap: Linking CRVS to Health Facilities – UNICEF | for every child
  7. 7. Data capturing at source: Improve quality; availability on real-time; feed into health systems Socio-cultural issues: • Mothers counselled during ANCs visits to be ready with names of babies • Unwed mothers informed about the registration process Awareness: Importance of registration; process – where, when and how Demand: Checking the birth registration status at vaccination/health check-up Clear the backlog for 1-4 years: a natural contact point Bridging the Gaps What HFs can do: Bridging the Gap: Linking CRVS to Health Facilities – UNICEF | for every child
  8. 8. • HFs, only the first contact point for registration and certification • Can’t undertake post registration work such as search, demand for additional copies of certificates, corrections, changes • HFs to be mapped to the nearest Ward Executive Offices for these activities What HFs can’t do: Bridging the Gap: Linking CRVS to Health Facilities – UNICEF | for every child
  9. 9. Child registered at birth Child registered at 6 weeks at local HF Child registered in community between 0-6 weeks New Birth Registration Process Child is born Birth in a HF?Yes No Name given? Child attends RCH? R&C completed in Maternity Ward R&C completed in RCH Ward R&C at WEO Yes No Bridging the Gap: Linking CRVS to Health Facilities – UNICEF | for every child Yes No
  10. 10. HFs remain critical in setting up a well-functioning CRVS system • proximity to the community - 5-6 KMs • better coverage of health services – almost universal antenatal and vaccination coverage • not so high burden of birth and death registration • 2.6 million events - 2.1 million births and 0.5 million deaths • 18 events every month – 75% of births and 15% of deaths get registered at HFs • 29 events every month - if all the events were to get registered at HFs • health system gets data on real-time • effective linkage with the Ward Offices for post registration work Way Forward Bridging the Gap: Linking CRVS to Health Facilities – UNICEF | for every child
  11. 11. Thank you

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