Evaluation of approaches to strengthen civil registration and vital statistics systems: A systematic review and synthesis of policies in 25 countries

Abstract

Background Civil registration and vital statistics (CRVS) systems play a key role in upholding human rights and generating data for health and good governance. They also can help monitor progress in achieving the United Nations Sustainable Development Goals. Although many countries have made substantial progress in strengthening their CRVS systems, most lowand middle-income countries still have underdeveloped systems. The objective of this systematic review is to identify national policies that can help countries strengthen their systems. Methods and findings The ABI/INFORM, Embase, JSTOR, PubMed, and WHO Index Medicus databases were systematically searched for policies to improve birth and/or death registration on 24 January 2017. Global stakeholders were also contacted for relevant grey literature. For the purposes of this review, policies were categorised as supply, demand, incentive, penalty, or combination (i.e., at least two of the preceding policy approaches). Quantitative results on changes in vital event registration rates were presented for individual comparative articles. Qualitative systematic review methodology, including meta-ethnography, was used for qualitative syntheses on operational considerations encompassing acceptability to recipients and staff, human resource requirements, information technology or infrastructure requirements, costs to the health system, unintended effects, facilitators, and barriers. This study is registered with PROSPERO, number CRD42018085768. Thirty-five articles documenting experience in implementing policies to improve birth and/or death registration were identified. Although

Are inequities decreasing? Birth registration for children under five in low-income and middle-income countries, 1999–2016

“…Further work is needed to untangle the policies and initiatives underpinning these changes, including whether this is the unintended effects of the status quo or a result of policies that were aiming to improve averages or specifically reduce inequities. A brief review of the literature indicates that the following factors can improve birth registration: reducing registration fees; linking registration to the health and education systems; expanding welfare and social protection; strengthening the design of the CRVS system (e.g., through process mapping and digitisation); harmonising parallel identification systems and removing policies and laws which (1) require the marriage certificates of parents to register a child, (2) require a father to be present and (3) discriminate against ethnic minorities especially in the context of providing nationality 11 52–58…”

Measuring inequalities of development at the sub-national level: From the human development index to the human life indicator

“…The reason for choosing this setting is that it has the longest available run of sub-national life tables upon which to perform the analysis and present data for both contemporary states as well as change over time. In other words, it allows us to see the most that could be possible if we apply HLI as a complimentary development indicator from today onwards-especially in the context of ever more countries developing Civil Registration and Vital Statistics [CRVS] systems [32]. In doing so, we hope to answer the following questions: empirically, what does the HLI tell us about sub-national differences in development (and, by definition, mortality and inequality) in the United States.…”

“…However, in recent years the recognition of the need to develop and improve such systems for a variety of reasons, including monitoring the SDGs has been strongly recognized [47,48]. In response, more and more countries are actively developing policies to develop their CRVS systems [32]. Similarly, with UN support, census systems are being expanded throughout the world [49,50,51].…”

Decentralization of birth registration to Local Government in Tanzania: the association with completeness of birth registration and certification

“…awareness campaigns) and incentive (e.g. policies to encourage registration) components [8]. In Ethiopia, some factors that increased birth registration included registration facilities that charged lower fees for birth certificates, had shorter waiting times and more proximate to residents [9].…”