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Strengthening CRVS systems through the RMNCAH-N agenda


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Presentation by Maletela Tuoane-Nkhasi (World Bank) 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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Strengthening CRVS systems through the RMNCAH-N agenda

  1. 1. Strengthening CRVS Systems through the RMNCAH-N* agenda *Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition CRVS Innovations Conference, Ottawa, Canada: February 27–28, 2018
  2. 2. GFF objective: bridging the funding gap for the health of women, adolescents, & children The combined effect would prevent 24- 38 million deaths by 2030
  3. 3. Results ► Better sustainable RMNCAH-N outcomes  Strengthening systems to sustain RMNCAH-N outcomes ► Increased value-for-money and total volume of financing from:  Domestic resources  Financing from IDA and IBRD  External Financing  Private sector resources ► Impoverishment prevented in case of illness
  4. 4. financingandimplementing Accelerate progress now on the health and wellbeing of women, children, and adolescents Drive longer- term, transformation al changes to health systems, particularly on financing 2. Coordinated Countryownershipandleadership ► Identifying priority investments to achieve RMNCAH outcomes ► Identifying priority health financing reforms ► Getting more results from existing resources and increasing financing from:  Domestic government resources  IDA/IBRD financing  Aligned external financing  Private sector resources ► Strengthening systems to track progress, learn, and course-correct 1. Prioritizing 3. Learning 2. Coordinated financingandimplementing How the GFF drives results
  5. 5. Why is CRVS a priority for the GFF? ► Many GFF-supported countries have inadequate monitoring and evaluation systems ► CRVS is linked to a broader GFF agenda on improving data for decision-making  CRVS best source of continuous and up-to-date information on births, deaths and causes of death  Data available at national and sub-national levels  Provides reliable data on age for accurate estimation of RMNCAH-N indicators (e.g. stunting, neonatal mortality)  Critical in monitoring country progress towards the SDGs ► CRVS is a previously under-funded data source  Funding from Global Affairs Canada specifically earmarked for CRVS strengthening ► Protection of basic human rights of women, children and adolescents
  6. 6. GFF Countries The 26 countries account for 59% of the total financing gap across all GFF countries 67 low and lower- middle income countries eligible
  7. 7. Prioritizing CRVS in RMNCAH-N Investment Cases Focus area Country Expanding CR services Increase civil registration service points + mobile registration Cameroon, DRC, Kenya, Uganda Recruit additional staff Liberia Use health facilities/schools for birth registration Kenya, DRC Advocacy and awareness creation DRC, Liberia Recording of causes of death and application of ICD Kenya, Mozambique, Uganda Revision of legislative framework Cameroon, Guinea, Liberia, DRC Computerization, digitization, maintenance of databases Cameroon, DRC, Guinea, Kenya, Liberia, Sierra Leone Interoperability of systems (mainly CRVS & DHIS) Cameroon, Guinea, Mozambique Stakeholder engagements and coordination Guinea, Kenya, Liberia, Sierra Leone, DRC
  8. 8. Financing CRVS activities within the RMNCAH-N agenda ► Financing sources  Domestic resources  GFF Trust Fund, operationally linked to IDA  Other external sources (e.g. GAVI) ► Incentives for strengthening CRVS  Program for results  Performance-based financing ► Integrating CRVS in RMNCAH  Utilizing health services  Innovations in health projects
  9. 9. Program for results (P4R) • Improve death and cause-of-death reporting in health facilities  Disbursement-Linked indicator (DLI) to strengthen CRVS and DHIS systems to improve health systems responses.  DLI 11:  Deaths certified in health facilities  & ICD-10 coded  & reported in the Health Information System  & sent to the Civil Registry for registration Mozambique
  10. 10. Performance-based financing(PBF) • Implement PBF at community, health facility and district levels  Registrations are made for each delivery  Maternal death audits are conducted  Training for the PBF program (incl. birth and death registration & maternal death autopsies Cameroon • Implement PBF at secondary level, linked to the CRVS system  Birth and death registrations  Maternal and neonatal deaths audits Liberia
  11. 11. Maternal and child health services • Train county managers and national referral hospitals on MCH strategy during supportive supervision visits • MCH strategy: MCH clinics and outpatient departments to register all births Kenya • Train vaccinators & others on birth registration services • Integrate birth registration with childhood immunization services Liberia
  12. 12. Using community health structures • Use of Community Health Assistants to carry out recording of births and deaths in communities • Priority: maternal and neonatal deaths within the community Liberia • Capacity building workshops to sensitize community health workers in reporting births and deaths to registration agents Kenya
  13. 13. CRVS pilots in RMNCAH-N projects • Introduce 4x4 vehicle for mobile registration in Arid and Semi-arid Land & neighboring areas • Prioritize areas with high volumes of birth and low registration coverage Kenya • Introduce registration truck for mobile registration and community sensitization Uganda • Pilot birth and death notification system at community level Ethiopia
  14. 14. Electronic systems within RMNCAH-N projects • Convert from paper-based to electronic registration systemEthiopia • Design death registration module & integrate with birth registration system • Develop a customized DHIS module for reporting cause-of-death and ICD coding Uganda • Develop integrated civil registration management information system Liberia • Reinforce the HMIS system, linked to the CRVS system & PBF portal Cameroon
  15. 15. Challenges ► Lack of coordination:  Among development partners  Within government: – Resulting in parallel systems – Institutional arrangements in registration processes (Notification / Registration / Certificate issuance) ► Competing priorities in different sectors (e.g. health, ID management systems) ► Lack of proper prioritization of CRVS activities ► “Urgent” need for data
  16. 16. Lessons from GFF RMNCAH-N processes ► Government ownership and leadership ► Prioritization of activities ► Improving efficiency  One-step civil registration process  Integrated national systems & existing initiatives (e.g. maternal & perinatal / neonatal death surveillance & review) ► Financing  Increasing domestic resources for CRVS  Use of IDA and IBRD for CRVS  Coordinated and aligned external support for CRVS  Engagements with the private sector ► Results monitoring
  17. 17. Thank you Learn more