STAKEHOLDER’S MEETING ON BIRTHS AND DEATHS REGISTRATION UNDER THE HEALTH INFORMATION SYSTEM

DATE; 27TH JULY, 2008

1 Overview of the Births and Deaths Registration System

Presented By

Kingsley Asare Addo

2 BACKGROUND OF BIRTHS AND DEATHS REGISTRATION IN GHANA – Vital registration started in the Gold Coast in 1888- when the cemeteries ordinance was passed to regulate the interment of deceased persons in certain areas of the colony. – 1912- Birth registration was introduced following enactment of Births, Deaths and Burials Ordinance – Birth registration introduced.(1912-1926 registration placed under Medical department)

3 Background cont’d

• 1965 – the Registration of Births and Deaths Act , 1965, (Act 301) was passed to replace the ordinance of 1926 and The Births and Deaths Registry was established to handle and develop the vital registration system in the country. • The Act 301 makes provision for the compulsory registration of births and deaths in all parts of the country and is applicable to the entire population of Ghana, irrespective of race, or country of origin. The Act also provides for the registration of foetal deaths and seeks among other things to: • Promote public health in the country. • Extend births and deaths registration facilities to the entire population of the country • Establish an efficient system of births and deaths registration records for the citizenry • Obtain vital statistics data which are adequate and efficient enough for deriving reliable demographic estimates to support public health planning, • and for policy formulation at various levels of governance and for development planning in the country.

4 • 1888- not assigned to any specific government agency • 1895- attached to the sanitary branch of the department of medical services • 1912-1926- placed under the Medical Department • 1948-1960- Registrar General’s Department. • 1965- Births and Deaths Registry established within the Ministry of Local Government to handle data collection aspects of registration while the Central Bureau of Statistics (CBS) handled data processing. • 1972- Registry assigned to the Ministry of Finance and Economic Planning under the direct supervision of the Government Statistician. • 1984*- in line with govt’ decentralisation programme Registry reverted to the Ministry of Local Government.

5 Operational Structure

Central Registry Office- Accra

Regional Registration Offices- 10

District Registration offices- 138

Registries and centres- 374

6 NUMBER OF REGISTRIES REGION 1965 1970 1975 1995 2007 ALL 36 175 256 386 374 REGIONS WESTERN 7 20 25 32 32 CENTRAL 5 24 33 44 43 GT. ACCRA 3 9 17 52 46 EASTERN 7 34 53 56 50 VOLTA 2 17 29 48 48 ASHANTI 5 30 38 52 49 B. AHAFO 3 14 26 38 37 NORTHERN 2 17 20 28 30 U/EAST 2 10 15 16 18 U/WEST 20 21

7 STRENGTHS 1 Mandate derived from legislation Births and Deaths Registration Act, 1965( Act 301) 2 Presence in 10 regions and 138 districts in Ghana 3 Stock of information on registered births and deaths dating back to 1912

Weaknesses 1 Inadequate staff 2 Ineffective monitoring and supervision 3 Inability to publish timely reports 4 Late capture of events 5 Redundancy of data due to multiple registration of events 6 Low coverage of events especially in rural areas

8 Opportunities

1. Increasing public awareness about importance of registration 2. Increased collaboration with stakeholders including the DA’s, MOH, GHS, Unicef, Plan Ghana, UNFPA, GSS the GIS and others 3. Enforcing demand of registration documents by agencies such as the Passport office, GES, SSNIT, DVLA, EC, NIA, the Banks etc 4. Linking births and deaths registration to the National Identification System

9 Threats

1. Inability to attract and retain highly qualified staff 2. Absence of required logistics and equipment ( Need for permanent office buildings and vehicles for Head, regional and district offices) 3. Poor remuneration sometimes engendering corruption 4. Fraudulent acquisition and use of birth certificates 5. Burials without registration

10 Efforts to Strengthen Registration System

• In a bid to expand and achieve universal coverage, series of activities have been undertaken. The main areas of concern are: • Building Partnerships • Awareness Creation/Public Education • Capacity Building

11 Building Partnerships

• Collaboration with partners to collect and disseminate information about births and deaths registration. Key partners include; GHS, MOH, GSS, DAs, MOWAC, Unicef, Plan Ghana, UNFPA, GIS.

• - 1000 CHNs trained to administer births and deaths registration forms • - 565 out of 1250 volunteers trained with unicef support (rest to be trained this year)

• -792 unit committee members trained in Ashanti, Brong Ahafo, Northern ( MLGRD&E support)

• Participation in annual CHPW with GHS since 2004 and in the IMCH campaign

12 Pilot of Community Population Register (partnership with Plan Ghana, GSS, GHS, DAs, Unfpa)

• The Community Population Register is designed to serve as a population register at the local level. It makes provision for the continuous recording and updating of information on every individual in the population of a community. It is a system of data collection in which details of names, sex, date of birth, educational level, marital status, immunization status, occupation, literacy status etc. of persons residing in the community are recorded and regularly updated with the occurrence of births, deaths and movements. • Its efficient implementation would : Facilitate the timely reporting of births and deaths for registration in the various communities. • Generate community- based data that would prove beneficial for planning at the community level during inter-censal periods. • Provide records that can be used as checks in the review of electoral registers and of social security records. • Facilitate the issuing of National Identity Cards. • Provide an effective means for the evaluation of decennial censuses.

13 CPRP cont’d

CPRs piloted in - 12 communities - Mfantsiman district( Essarkyir, Ebiram, Krofu, Ekumfi-Twa) - Awutu Effutu Senya( Fianko) - Agona (Kwesitwikwaa, Mensakrom) - Twifu-Heman-Lower Denkyira (Denkyira Wawase) - Kommenda-Edina- Eguafo-Abrem (Amissano) - Ajumako-Enyan-Essiam (Owane) - Abura-Asebu-Kwamankese( Kwamankese) - 4 communities - (), Birim-South district (Ayirebi), Akuapem North (Twum Guaso), Manya-Krobo () Upper West region- 5 communities Wa Municipal (Boli), Wa West( Lassia-Tuolu), Wa East (Kundugu), Sissala East(Bugubelle), Sissala West( Fielmuo)

The programme will be scaled-up to cover more communities with availability of funds.

14 Capacity Building

• Refresher training for all staff on new SOP ongoing • Client service units have been established to improve service delivery • New service charter • Community volunteers engaged in areas with weak official presence to capture events • There is the urgent need for –  Recruitment of new staff to fill various categories in t he Registry  Training internal and external for existing staff. (ICT, Computer literacy, Statistics & Demography, Management)  Setting up of well equipped statistics and data processing units at h’qrs, regional offices  Construction of office accommodation for regional and district levels  Vehicles for all regions and districts, motor bikes/bicycles for local level operatives.  Construction of a new headquarters building.

15 Awareness Creation/ Public Education • Launch of public Education Campaign- June 2003 • Production and airing of TV adverts, Participation in radio and television discussion programmes (9 media programmes btn August and December last year) • Community Durbars (held in Denkyira Wawase (THLD), Mensakrom (Agona), Amissano(KEEA), Owane(AEE), Ekumfi-Twa (Mfantsiman), Kwamankese(AAK, Kokrobite, Bortianor Madina (Greater Accra) • Institution of Annual BDR Day celebration (2004) • Annual Press briefing sessions by Minister Publicity Road Shows by UBR Goodwill Ambassador (Mr. David Dontoh )(Visited all regional capitals and 4 districts in the northern Volta region) • Free Registration of infants

16 Results • Partnerships- - Involvement of CHNs and Community Volunteers in data collection has enhanced registration in hither-to hard-to- reach areas - Participation in CHPW and IMCH campaigns have led to significant increases in birth registration coverage - CPRP - Community Population Registers working successfully in 21 communities across three regions in the country - Enabled the early reporting and registration of births and deaths. - Community level population information available to facilitate planning and other uses at the local level

17 Results cont’d

• Verification of documents between BDR,the Passport Office and some Embassies helped to reduce the use of fraudulent registration documents( a lot more will be achieved under the AENEAS Programme with the GIS). • Situational analysis conducted as part of HMN programme has enabled the review and improvement in content of registration forms.

18 Results cont’d • AWARENESS CREATION • There is a gradual but notable level of awareness about the importance and benefits of births and deaths registration among the general public • Significant increase in birth registration coverage

19 Registered birth (0-12 months only) 2000-2007

POPULATIO EXPECTED REGISTERED REGION N BIRTHS BIRTHS % COVERED 2000 18,912,079 756,483 236,335 31

2001 19,422,705 776,908 211,081 27

2002 19,947,118 797,885 138,151 17

2003 20,485,690 819,428 239,919 29 ALL REGION 2004 21,038,804 841,552 430,127 51 S 2005 21,606,852 713,026 476,251 67

2006 22,190,237 732,278 391,841 54

2007 22,789,373 752,049 466,129 62

2008 23,404,686 772,355

20 Trend of infant birth registration(0-12 months only)

Registered Births 0-12 months . 2000-2007

900,000

841,552 819,428 800,000 797,885 776,908 756,483 752,049 732,278 713,026 700,000

600,000

500,000 476,251 466,129 430,127 400,000 391,841

300,000

236,335 239,919 200,000 211,081

138,151 100,000

0 2000 2001 2002 2003 2004 2005 2006 2007

EXPECTED BIRTHS REGISTERED BIRTHS

21 REGISTERD DEATHS IN GHANA 2000- 2007

EXPECTED REGISTERED YEAR POPULATION DEATHS DEATHS % COVERED

2000 18,912,079 226945 45402 20

2001 19,422,705 233072 51639 22

2002 19,947,118 239365 49530 21

2003 20,485,690 204857 47492 23

2004 21,038,804 210388 50625 24

2005 21,606,852 216069 52079 24

2006 22,190,237 221902 51841 23

2007 22,789,373 227,894 54,234 24

22 Trend of Registered Deaths in Ghana

Trend of Registered Deaths 2000-2007

300,000

250,000

200,000

150,000 No of Deaths of No

100,000

50,000

0 2000 2001 2002 2003 2004 2005 2006 2007 YEAR

Expected deaths Registered deaths

23 Computerisation of registration system • To facilitate the capture, storage, processing and retrieval of information on births and deaths in the country, computers have been introduced into the operations of the Registry  A server which will hold the database information has been installed at the headquarters.  Registration forms have been redesigned to make them machine readable.  Information on registered events will now be scanned into the database to facilitate processing, storage and retrieval  Scanning will be done at the headquarters until such time that the regional and district offices will be properly housed, equipped and linked through WAN to the national server.  Information will then be fed directly from the districts into the central database.  Interface between Registry and major stakeholders  The Registry will launch its website by the close of 2008 to provide information and relevant material to the general public.

24 challenges

• Major challenges include:

• Limited Access to registration facilities • Low public knowledge about importance of registration • Inadequate staff • Inability to attract and retain highly qualified personnel due to low remuneration and poor service conditions • Inadequate funding for the Registry, • Difficulty in motivating registration volunteers • Lack of logistics including accommodation, vehicles, requisite statistical software and programmes. • Absence of training opportunities for sector staff • Weak monitoring and supervision mechanisms.

25 The Staff Situation

REGION POPULATION NO. OF NO OF STAFF REQUIRED NO. OF (2000 POPN. REGISTRIES MINIMUM VEHICLES CENSUS) STAFF ALL REGIONS 18,912,079 374 339 3782 7 H/ OFFICE 0 0 43 - 3 WESTERN 1,924,577 32 30 385 1 CENTRAL 1,593,823 43 37 319 1 GT. ACCRA 2,905,726 46 62 421 1 EASTERN 2,106,696 50 40 421 0 VOLTA 1,635,421 48 24 327 0 ASHANTI 3,612,950 49 35 723 1 B/AHAFO 1,815,408 37 22 363 0 NORTHERN 1,820,806 30 14 364 0 U/EAST 920,089 18 12 184 0 U/WEST 576,583 21 20 115 0 26 Way forward- what we expect from various partners

PARTNER AREA OF COLLABORATION

MINISTRY OF LOCAL GOVT. RURAL DEV. Policy issues, Technical guidance, supervision &ENVIRONMENT

GHANA STATISTICAL SERVICE Technical support, Analysis of data collected, Training

GHANA HEALTH SERVICE CHNs- Notification of births, assist with data collection Medical Officers- Collect and complete Medical Certificate of Cause of Deaths from BDR Annual CHPW, IMCH campaigns Accommodating Births &Deaths registration offices in all health facilities CENTRE FOR HEALTH INFORMATION Analysis of Medical Certificates of Cause of MANAGEMENT Deaths

MOH, HMN PROGRAMME Technical and logistic support Improve generation of mortality statistics Pilot of verbal autopsy system MIDWIVES/TBAs Notification of births /deaths

27 Way forward- what we expect from various partners PARTNER AREA OF COLLABORATION

Passport office/National Identification demand birth/death certificates to access Authority/SSNIT/Electoral Commission/ services DVLA GHANA EDUCATION SERVICE Make birth certificate enrollment requirement right from KG to tertiary level

UNICEF Technical and logistic support, advocacy

PLAN GHANA Technical and logistic support, advocacy

EMBASSIES Technical and logistic support. Birth/death cert. requirement to access service Verification of documents with BDR MINISTRY OF PUBLIC SECTOR REFORM Logistical support, assist to improve service delivery, support computerization programme

MINISTRY OF WOMEN AND CHILDREN’S Advocacy, sensitization of public, Dissemination AFFIARS/DEPT OF CHILDREN 28 Way forward- what we expect from various partners PARTNER AREA OF COLLABORATION

GIS/AENEAS PROGRAMME Cooperate to counter document fraud Logistic support, Training, support for computerization DEPARTMENT OF SOCIAL WELFARE On legal issues concerning adoptions, registration of abandoned children etc CHRISTIAN COUNCIL/ISLAMIC COUNCIL Public education

GHANA POLICE SERVICE Registration of unnatural deaths Coroner inquest cases Deaths occurring outside medical facilities SEXTONS LA/ OSU/ AWUDOME Collect and use Burial Registers CEMETERIES Demand Burial Permits before burial Submission of burial returns to Registry ACCRA METROPOLTAN ASSEMBLY Registration of all burial grounds Control of burial grounds

PRIVATE FUNERAL HOMES Demand proof of registration before 29 release of corpses. Way forward- what we expect from various partners

PARTNER AREA OF COLLABORATION

CONTROLLER AND ACCOUNTANT Provision of registration material (Value GENERAL’S DEPATMENT Books), Budgetary support MINISTRY OF FINANCE AND ECONOMIC Budgetary support PLANING

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–THANK YOU

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