Civil registration & vital statistics systems

 

 

Birth certificate

 

Civil registration and vital statistics CRVS)

The United Nations (UN) defines civil registration as 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.’

Vital events are key events in the lives of individuals and include: births, deaths, foetal deaths, marriages, registered partnerships, divorces, annulments, judicial separations, legal dissolution of registered partnerships, adoptions, legitimations and recognitions.

A civil registration and vital statistics (CRVS) system combines the registration of vital events and the production of reports of vital statistics based on the occurrence of these events.

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Why CRVS?

The Sustainable Development Goals (SDGs) present new challenges for country data systems in terms of scope and depth, with indicators of cause-specific mortality and disaggregation to identify the most vulnerable populations. Within the SDGs, CRVS is both a target in its own right (Goal 16) and necessary to monitor key outcome indicators. Twelve of the 17 SDGs require CRVS data to measure their indicators many of which relate to health.

Major efforts and commitments are underway to strengthen CRVS systems particularly in Africa, Asia and the Pacific countries and regions. At the same time, donors and development partners have intensified their support to countries and development of guidance and training materials on CRVS. These initiatives could significantly enhance policymaking based on sound and comprehensive statistics of fertility and mortality.

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Benefits of CRVS

Benefits to individuals and families

CRVS provides:

  • Registration of infants at birth records key elements of identity and family relationships, entitlement to nationality, access to economic and social services, such as health care, child protection and benefits, schooling, qualification, and employment.
  • Proof of identity enables people to claim citizenship, inheritance and insurance benefits, spousal pensions, and compensation following, for example, occupational accidents or military action.
  • Proof of age supports authorities provide child protection and prosecute perpetrators of child trafficking, sexual offenses, child marriage and child labour.
  • Proof of marriage and divorce facilitates female heads of household to access services, such as education and health.
  • Proof of marriage can protect women’s rights of access to and guardianship of children and in proving entitlement to inheritance, spousal benefits and nationality or legal residency in a country.
  • Registration of deaths is essential to claim inheritance, insurance, and survivor and spousal benefits, and citizenship by descent.

Benefits to policy makers

CRVS provides:

  • Up-to-date demographic and healhealth indicators such as fertility rates, population growth rates, life expectancy, death rates by age, sex, location and cause, and neonatal, infant and child mortality rates.
  • A continuous flow of vital statistics from the smallest administrative divisions to the national level.
  • Continuous registration of deaths and their causes can guide policies to reduce premature mortality.
  • Timely data about areas of population change can inform resource allocation, for example to plan immunization programmes.

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How do CRVS systems work?

Overview

How a civil registration and vital statistics system works

How a civil registration and vital statistics system works. Adapted from UN Principles and Recommendations for a Vital Statistics System, Third edition, 2014

Organization and governance

There is no standard template for a national CRVS system. Each country has its own way of structuring and managing its system, depending on its socio-economic and administrative history, cultural norms and practices, and specific policy, administrative and statistical needs.

Key agencies with responsibilities for aspects of the CRVS system include the office of the registrar general, the ministries or departments responsible for justice, the interior, national identification and health, and the national statistics office.

The agency responsible for national identification systems is an essential partner, along with the agency overseeing information, communications and technology (ICT), given the growing role of ICT in facilitating all aspects of the CRVS system. Because a single agency or ministry cannot successfully handle all aspects of CRVS, the UN advises establishment of a national coordinating mechanism. The lead or anchor ministry or agency works with other ministries, agencies, and development partners to oversee development and coordination of CRVS.

For CRVS to operate effectively, governments must establish national systems within a legal framework, organized around essential functions, capable of producing vital statistics. The UN recommends that the basic components of a civil registration law includes:

  • Protection of confidentiality of personal data;
  • Ensuring that data can be shared securely between approved departments for quality assurance; and
  • Production of vital statistics in compliance with the Fundamental Principles of Official Statistics.

In accordance with international standards, birth and death registration should be free of charge, or incur a low fee for late registration.

The ten CRVS Milestones

The Bloomberg Data for Health Initiative has proposed and used the Ten CRVS Milestones framework which describes the milestones that a well-functioning CRVS system should aim to achieve.

Ten key milestones for civil registration and vital statistics systems (adapted from Muñoz et al.)

Civil Registration

Vital statistics

1. Notification: informant shares the occurrence of a vital event with the civil registry
2. Registration: registrar officially registers the vital event
3. Validation: registrar checks the documentation and validates the information
4. Certification: registrar issues an official certificate
5. Sharing: registry shares information about the vital event with other government departments
6. Archiving: registry stores and maintains the  information to permit retrieval of vital event details as neede
7. Statistical compilation: statistician aggregates and tabulates the information
8. Quality control: statistician performs standard data quality checks
9. Generation of vital statistics: office produces national and regional tabulations  with key disaggregations
10. Dissemination: office publishes and disseminates vital statistics reports to users, electronically and in hard copy

Production of vital statistics

The UN has defined a minimum set of legal and statistical variables that the CRVS system should collect for each event. The usual demographic rates and indicators that analysts calculate from the vital statistics data include:

Births: Crude birth rate, sex ratio at birth, total fertility rate, age specific fertility rate.

Deaths: Crude death rate, infant mortality rate, child mortality rate, neonatal mortality rate, post-neonatal mortality rate, maternal mortality ratio, age-specific mortality rate, cause-specific mortality rate.

Many of these rates require knowledge of the mid-year size of the population at risk which can be estimated from the most recent census.

Examples of vital statistics reports with demographic indicators computed from civil registration data are available at these sites.

Ascertainment of cause of death

A major advantage of a CRVS system compared to other sources of mortality data is that it generates up-to-date data on mortality and cause of death.

When it functions effectively, a CRVS system captures medically determined cause for each death. For this to happen:

  • The national law must explicitly state that a physician or other person with the requisite medical training should certify the cause of death; all deaths must have a medical certificate of underlying cause of death (MCCD).
  • The cause of death must be classified and statistically coded in line with the International Classification of Diseases (ICD).
  • The underlying cause of death – the condition that initiated the sequence of events that ended in death – should be shared with the agency that compiles cause-of-death data, usually the national statistics agency or ministry of health.

Meeting these conditions is feasible in situations where most deaths occur in a medical setting or, if at home, under the care of a medical attendant. In reality, this is the exception rather than the rule in most parts of the world.

Even where physicians certify cause of death, they may lack the knowledge and training to do so correctly. As a result, many deaths are attributed to so called garbage or unusable codes, such as: symptoms, signs and ill‐defined conditions; injuries undetermined whether intentional or unintentional; ill‐defined cancers; and ill‐defined cardiovascular diseases that are of little utility to guide public heath decision making.

In 2017, WHO produced estimates of the quality of cause of death statistics assessing a combination of registration completeness and quality of cause of death reporting. Forty-nine countries, representing 23 per cent of the world’s population produced high-quality cause-of-death data, and most were in Europe and the Americas. Of the 47 countries in the WHO African region, only four (Cape Verde, Egypt, Mauritius and South Africa) provided acceptable quality cause-of-death data.

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Conditions for CRVS to function

The Regional Action Framework in Asia and the Pacific and the Africa Programme for Accelerated Improvement in CRVS systems offer similar recommendations on key actions needed, as summarised here:

  • Political commitment  to bring together all stakeholders to improve CRVS and to ensure that CRVS systems are adequately resourced and are designed to be inclusive and responsive.
  • Public engagement and participation. Health, education and other public services, as well as the media, social workers and civil society, can play important roles in informing the public about the value of CRVS and encouraging them to register vital events.
  • Coordination A coordination committee can help ensure stakeholders understand their roles and responsibilities and work in harmonised and mutually supportive ways. Coordination also assists in using the same definitions, terminologies, and ensuring databases are interoperable.
  • The legal framework should be up-to-date, fit for purpose and in conformity with international best practice standards, as defined by the UN.
  • Infrastructure and resources should be sufficient, appropriately staffed and well-distributed across the country, with registration points within a reasonable distance for each person in the population. Innovative approaches such as digital registration can facilitate civil registration in remote areas and hard-to-reach and marginalized populations.
  • Innovations in operational procedures and practices should be introduced to streamline essential CRVS functions. These may include digital collection, maintenance and dissemination of data, online civil registration and service delivery. Advances in technology simplify and reduce the cost of secure storage and protection of civil registration archives from natural disasters, war and cyberattacks. These must be applied within a sound legal and institutional framework, with appropriate operational procedures and practices consistently applied.
  • Production, sharing and dissemination of vital statistics is essential so that users have rapid access to essential data and key indicators. New data management technologies make it easier to overcome technical and logistical challenges in data compilation, quality assurance, analysis and dissemination. Visualization techniques are useful in generating summary reports on key issues and facilitate increased use of CRVS for policy and planning.

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CRVS performance monitoring

The United Nations Statistics Division proposes that the quality of a CRVS system be assessed using:

  • The level of completeness of registration, for example the proportion of the number of births or deaths that are actually registered.
  • The correctness/accuracy of the information collected.
  • The availability of the data collected for use.
  • The timeliness in registration of vital events.

Most attempts to assess performance of CRVS systems have focused on registration completeness. In general:

  • Indirect methods indicate whether incompleteness or inaccuracies exist.
  • Direct methods not only assess the coverage and accuracy of data but also point to likely sources of the problems.

Direct and indirect techniques are available to evaluate the completeness and accuracy of vital statistics data. Two technical resources are useful: United Nations. Handbook of vital statistics systems and methods, vol. I: Legal, organizational and technical aspects; and United Nations. Manual X: indirect techniques for demographic estimation.

Tracking completeness of registration can help in timely identification of problems such as leakage of data that should be transferred between institutions or levels of administration, performance of local registrars, or a drop-off in reporting of events by the general public.

Knowledge of completeness of registration for different geographic areas covered by a CRVS system can provide evidence to target improvements. Ongoing monitoring can identify unusual seasonal patterns of mortality in specific age groups, for example associated with climatic conditions.

Usability score

WHO calculates a summary quality indicator or usability score for mortality data by combining completeness and garbage coding, calculated as:

Percentage Usable = Completeness (%) * (1 ‐ Proportion Garbage)

Vital Statistics Performance Index (VSPI)

Additional quality criteria include accuracy, timeliness and dissemination. Researchers have developed a summary measure of CRVS performance, the Vital Statistics Performance Index (VSPI). The VSPI comprises six components:

  1. Completeness of death reporting (estimated using a combination of indirect methods and statistical modelling).
  2. Quality of cause of death reporting (assessed in terms of the proportion of all death ascribed to non-specific causes).
  3. Level of cause-specific detail (number of separate categories of cause of death); internal consistency (biological plausibility of cause of death reports).
  4. Quality of age and sex reporting.
  5. Data availability or timeliness.

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Challenges

Many births and deaths are not registered because CRVS systems rely on families and individuals to come to the registration office. Families face multiple barriers. They may be unaware of the legal requirement to register births and deaths and the benefits of doing so. They may face financial and opportunity costs and administrative hurdles in registering. For example, the requirement to bring witnesses, or long queues and delays at registration offices. Marginalised ethnic or religious groups may not want to register  because of perceived discrimination.

Should the individual die prior to the registration of his or her birth, the death may not be reported. This results in underestimation of infant or child mortality.Experience around the world shows that deaths are less likely to be registered than births. In low- and middle-income countries, particularly in remote and rural areas, for families may bury deceased relatives in their own burial plots, without formal permission. This is less common in urban areas, where public health regulations requiring safe disposal of bodies are in place and enforced. Apart from the burial permit, incentives to register deaths are limited, particularly for families with little inheritance or insurance benefits for survivors.

The UN Statistics Division estimates that, at the end of 2014, only 62 per cent of the world’s countries, territories and areas registered at least 90 per cent of births, and only 57 per cent registered at least 90 per cent of deaths. UNICEF estimates that, globally in 2017, nearly one third of children under five years old had never been registered; in the least developed countries fully two thirds of children under five-years old had never been registered.

The registration of deaths is usually considerably lower than birth registration.  The United States based Institute for Health Metrics and Evaluation estimates that in 2013, the most recent year for which data were available, global death registration increased from 28 per cent in 1970 to 45 per cent in 2013, that is, by only 17 per cent in 43 years. The majority of the world’s people live in countries where the quality of cause of death data is inadequate to permit monitoring progress towards the Sustainable Development Goals.

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Additional resources

The complete chapter on which we based this page:

Cover of The Palgrave Handbook of Global Health Data methods for Policy and Practice

COVID-19 resources

Coronavirus COVID-19

⇒ How are cases and deaths counted?

AbouZahr C, What is the true human toll of COVID 19 for better answers to his critical question strengthen civil registration systems?

Lopez A. Data around COVID-19 is a mess and here’s why that matters

The World Health Organization has issued these International guidelines for certification and classification (Coding) of COVID-19 as cause of death.

The United Nations Statistics Division provides an overview of how each country’s registration system is dealing with the COVID situation. Impact of COVID-19: Maintaining Civil Registration and Vital Statistics during the COVID-19 pandemic.

The United Nations has also issued these recommendations Maintaining Civil Registration and Vital Statistics during the COVID-19 pandemic.

Other resources

AbouZahr C., Mathenge G., Brøndsted Sejersen T., Macfarlane S.B. (2019) Civil Registration and Vital Statistics: A Unique Source of Data for Policy. In: Macfarlane S., AbouZahr C. (eds) The Palgrave Handbook of Global Health Data Methods for Policy and Practice. Palgrave Macmillan, London.

WHO survey of reported mortality statistics. In 2005, WHO sent a questionnaire to the Member States, asking various questions on their civil registration system, certification and coding practices as well as other relevant information. A total of 84 countries responded to the questionnaire and the results were compiled into three tables.

The CRVS legal review toolkit offers a comprehensive evaluation of civil registration as it relates to vital statistics, focusing on registration of births, deaths, and foetal deaths, as well as certifying causes of death.

Handbook on Civil Registration and Vital Statistics Systems: Management, Operation and Maintenance, Revision 1

Handbook on Civil Registration and Vital sSatistics and identity management systems: Communication for development

A passport to protection.  A guide to birth registration programming

United Nations Department of Economic and Social Affairs. United Nations principles and recommendations for a vital statistics system Revision 3 2014

National Center for Health Statistics. Training Course on Civil Registration and Vital Statistics Systems, Participant’s Notes – September 2015

United Nations. Manual X: indirect techniques for demographic estimation. New York: United Nations, 1983.

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