Have you ever tried to register a birth, a death or maybe your own marriage? Unfortunately, many of these vital events in Asia and the Pacific remain unregistered often with dire consequences for individuals, families and communities. Civil registration can be a labyrinth to navigate, comprising of multiple stages with many bureaucratic hurdles. Such complex systems discourage individuals from either commencing or completing the arduous registration process.
But what if the process of registering a birth or death could be made less stressful for a new parent or a grieving relative? As an implementing partner of the Bloomberg Philanthropies Data for Health Initiative, ESCAP has been working with selected countries in the region to improve their Civil Registration and Vital Statistics (CRVS) systems using the CRVS Systems Improvement Framework. This framework provides the tools for a participatory approach to identify bottlenecks and solutions to streamline registration processes. The framework has now been used in Niue, Maldives, Nauru, Fiji, Vanuatu, Samoa, and Turkmenistan.
In many cases, people are not aware of the legal timeframes for registering vital events, leading to late registration of births often at school enrolment age, which often means having to pay additional late registration fees or the submission of additional documentation. People living overseas may be unable to visit a civil registration office to register the event where they live. Vital events should always be registered in the country where they occur and also included in the vital statistics of that country. Lack of systems for recording overseas vital events in many countries means that records are not updated, and in some cases, events may be double counted.
So why is registering a vital event so complex? In many countries, notification of a birth or death occurs at a health facility, but an individual must then register the event at a civil registration office. This multi-stage process means several trips to different offices for family members, which can be expensive and time-consuming, especially for those in remote areas. Additionally, births or deaths occurring outside of health facilities frequently remain unregistered.
Civil registration processes are not only cumbersome for people attempting to register an event, but also for staff engaged in the process. Paper-based registration forms slow down the transfer of information between health facilities and civil registration offices and sometimes staff must (re)enter personal information by hand. Where digital civil registration systems are used, staff often encounter obstacles in leveraging the potential benefits due to outdated ICT hardware and software, as well as limited internet connectivity. This ‘system’ may be something as simple as a spreadsheet or an MS Access database. It is hardly surprising that this process is time-consuming for already understaffed facilities, often resulting in long queues at registration offices, not to mention the increased scope for errors or misplaced forms. In many countries, replacing lost forms or changing a mistake is akin to reaching a dead end in the registration labyrinth!
The lack of training and inconsistent forms for coding causes of death in line with the International Classification of Diseases (ICD) is also an issue. This means that accurate statistics on causes of death cannot be utilized by government agencies for future planning. Additionally, in many countries, the sharing of data may not be possible among government agencies due to regulations or the absence of integrated digital data systems. This means important data is not utilized to its full potential.
Once the main obstacles for registering a birth or death have been identified, stakeholders are able to develop redesigned civil registration processes. Although CRVS Business Process Improvement aims to encourage longer-term sustainable solutions to strengthen CRVS systems, (e.g., changing legislation, developing digitized platforms, improving interoperability, integrity and efficiency), ‘quick win’ solutions also constitute an important outcome of this work. These facilitate immediate improvements that require minimal investment (e.g. amending a field on a registration form) to minimize the burden on families and combat the lack of awareness about the importance of registering vital events. ‘Quick win’ solutions may be used as an advocacy tool for increasing future resources for CRVS system improvements. Examples of longer-term sustainable solutions have included the development of online registration forms, appointment booking systems, SMS mobile messaging communications and development of standard operating procedures for civil registry staff.
The process of implementing a simplified CRVS system is iterative, monitoring progress until complete and timely civil registration is achieved in the Asia and Pacific region as outlined in the Ministerial Declaration to "Get every one in the picture' in Asia and the Pacific. A smooth experience encourages people to register events, increasing registration completeness alongside accuracy and timeliness of vital statistics, supporting the achievement of the 2030 Agenda for Sustainable Development where no one is left behind.
