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Civil registration as a social determinant of health


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Presentation by Sana Naffa (CoE/IDRC) at the international conference on innovations in Civil Registration and Vital Statistics (CRVS) systems - Ottawa on 27-28 February 2018. See more at

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Civil registration as a social determinant of health

  1. 1. Innovation Conference-IDRC Ottawa –Canada Wednesday, February 28, 2018 Sana Naffa Senior Program Officer –Centre of Excellence Sources: Commission on Social Determinants of Health Final Report, 2008 Civil Registration as a Social Determinants of Health
  2. 2. Presentation Outline  Definition and concept of the Social Determinants of health (SDH), and inequity- Global perspective  Global Strategies & International experiences  WHY? And How to address and tackle the Civil Registration as a global and country level SDH  The Way forward 2
  3. 3. Life Expectancy 3
  4. 4. What are the social determinants of health?  “The social determinants of health refer to both specific features and pathways by which societal conditions affect health and that potentially can be altered by informed action.”  Source: Krieger N. A glossary for social epidemiology. J Epidemiology Community Health 2001; 55:693-700 Two categories of social determinants:  structural – fundamental structures of social hierarchy  intermediate - socially determined conditions in which people are born, grow, live, work and age 4
  5. 5. Health inequity: A multidimensional problem  Geographical disparities : differences between different geographical areas.  Gender inequity : systematic differences in health between men and women determined economically, socially or culturally (not biologically or physiologically).  Ethnic inequalities : between different ethnic groups.  Socioeconomic inequalities : based on social, economic, political, cultural, linguistic and others (marginalised groups). 5
  6. 6. What are the Social Determinants of Health? 6 Source: Commission on Social Determinants of Health Final Report, 2008
  7. 7. Social Determinants of Health Conceptual Framework 7 Distribution of health & well-being •Material circumstances •Social Cohesion •Psychological factors •Behaviors •Biological factors Social Position Education Occupation Income Gender Ethnicity/Race Health care system Socioeconomic and Political context Governance Policy (Macroeconomic, social, health) Cultural and societal norms and values Social Determinants of Health and Health inequalities Source: Commission on Social Determinants of Health Final Report, 2008
  8. 8. WHY to address the Civil Registration as a priority SDH • Civil registration (CR) is defined by the United Nations as the universal, continuous, permanent and compulsory recording of vital events provided through decree or regulation in accordance with the legal requirements of each country (1) • Multi-dimensional issue • Legal framework • Governance /policy /macroeconomic social & health • Cultural and societal norms and values • Social position /education/occupation/income/ gender/ethnic-race • Health care system factors /material circumstances
  9. 9. Why to address Civil Registration as a SDH • Civil Registration, certification and Identity as a basic human rights allows individuals to have access to services such as health, education, social protection • Civil Registration quality data builds up robust Vital Statistics reports which leads the planning and development agenda at country level • Civil Registration & Vital Statistics processes are shared responsibility by a number of sectors, which goes beyond the boundaries of any government department • Innovative approaches such as the Intersectoral Action to address the CRVS as a SDH brings unique opportunity to tackle challenges.
  10. 10. How to address the Civil Registration and Vital Statistics Systems as SDH: Strategies Global Level: priority area for SDG within International Community  Regional Level: CRVS Regional programs address Civil Registration & Vital Statistics as a priority for achieving SDG’s, equity and inclusiveness for better health outcomes Country Level: Intersectoral Action Committee for strengthening Civil Registration and Vital Statistics.
  11. 11. The Final Report of CSDH Focuses on inequalities in health that are avoidable, and therefore inequitable; Accepts that addressing such inequities is a matter of fairness and social justice; Is prompted to act by evidence that a social gradient in health exists in all countries; Recommends three areas for action to close this gap: 1. the conditions in which people are born, live, grow, work and age; 2. the structural drivers of those conditions at the global, national and local level; 3. monitoring, training and research 11
  12. 12. Global and Regional Strategies Civil Registration Equity in all Policies Good Global Governance Gender Equity Political Empower ment Market Responsi bility Fair Financing
  13. 13. Country level strategy: Intersectoral Action 1. Self Assessment 2. Engagement of concerned sectors 3. Area of concern 4. Select engagement approach 5. Develop a strategy 6. Use a framework 7. Strengthen governance Structures 8. Enhance Community Participation 9. Choose other good practices 10. Monitor & Evaluate 13 WHO. (2011) Intersectoral Action on Health
  14. 14. Country Level Strategies • Assessment phase: situation analysis and strategic planning, or Mapping of CRVS governance, policies, processes, outcomes. • Identifying key problems/bottlenecks in CRVS systems at country level • Establish a national committee composed of concerned sectors/partners • Develop a strategy & framework for action • Implement strategies and plans • Strengthen systems and structures • Engage communities • Monitor and evaluate.
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