improving vital statistics sri lanka health sector...
TRANSCRIPT
KUMARI VINODHANI NAVARATNE
PUBLIC HEALTH SPECIALIST
WORLD BANK SRI LANKA OFFICE
Improving Vital statistics through the Civil Registration System in
Sri Lanka
Health Sector Development Project
Out line
Introduction to Sri Lanka
Background to vital statistics system
Back ground to the SL HSDP
Process of engaging to develop VS
Results
What can we learn from this experience
Sri Lanka
•Multi ethnic and multi religious country
•Population: 20 million
•Pop density: 300/km2
•Per capita : US $ 1600, high debt ratio
•Effects of Civil war
Sri Lanka
Life Expectancy : 75 yearsCrude Birth Rate: 19 per 1000 popCrude Death rate: 5.9 per 1000 popHigh literacy rate > 90%
Health Sector Sri Lanka
Free health care to all, no referral system2.5% of GDP is spent on healthHas 60000 public sector beds in 9 levels of hospitals, 47% in specialist hospitals8000 private sector beds Curative care services and Preventive care services provided through 2 networks
1000 health institutions (415 CDs provides only OPD)324 preventive health areas
Sri Lanka Health Status
Major achievements: Maternal and Child Health (skilled ANC 95%)
Communicable diseases (Immunization coverage > 95%)
Challenges include:Increasing NCD burden (> 60% of deaths)
Re-emerging and emerging Diseases (Dengue, Leptospirosis, Tuberculosis)
Un resolved – Malnutrition (17% LBW, 22% underweight)
Civil Registration system generated Vital Statistics
Has been in existence from 1867
Fully GOSL owned, under Ministry of Public Administration and not devolved
Paper based
No modernization efforts until 2005
Annual Mortality report 8 years behind
Death and Birth coverage 94%
Quality of Cause of Death data: 42%
Why did the Health team from the Bank want to improve CR/VS system?
The NCD burden is increasing
NCD cause specific death data was poor
Under reporting of maternal deaths
Under reporting of still births, neo natal deaths
So, birth and death registration and Cause of Death reporting needed changes
Approach
Bank team approached the Vital Statistics Unit of the RG Department
The Head of the unit was very interested to use the Banks resources to improve the system
Over about 3 months detailed discussions were conducted to better understand the changes needed to improve the system.
Implementation plan was developed by the VS unit in close collaboration with us.
Approach
During this time, the Bank team also discussed with the MOH data unit on the advantages of reliable Vital Statistics data for an important data user of the country.
It was agreed that VS should be included in the HSDP.
Project design and fund flowCentral Bank
Special Dollar A/C 1
MOH sub components
Treasury / MOF
Project Office
Central Bank Special Dollar A/C 2
Central BankSpecial Dollar A/C 3
Finance Commissio
n
Vital Statistics
sub component
Provincial Component
Census Dept DHS
Vital Statistics Subcomponent
Objective of this sub component was to:
Provide birth and mortality statistics of good quality and in time, to data users
Vital Statistics sub component
Specific objectives were to improve:
Coverage and completeness of birth and death registration
Accuracy and quality of cause of death data
Timeliness of death registration and reporting
Efficiency and operations of the VS unit
Results
Completeness and coverage improvements
Issue: Death and Birth registration had a coverage of only around 94%
The Birth and Death registration act amended to address gaps in the original Act of 1867
Results
Improvements to accuracy and quality of data
Issue: only 55% of all deaths are medically certifiedMore reliable and higher quality reporting formats developed, tested and rolled out across country
Simple Verbal autopsy forms introduced for home deaths
Large scale training provided to all 1000 registrars to use new forms
Follow up quality improvement training to poorly performing Registrars
Results
Timeliness of mortality data reporting
Issue: the VS unit had more than 8 years of backlog in publishing the annual mortality report and during tsunami 2004/5 data was lost.
Backlog up to end of 2005 cleared. Mortality data available.
Mortality data for 2006 completed. COD in progress
Mortality data for 2007 and 2008 are progressing
Results
Improve efficiency and operations of VS unit
Issue: Major GOSL budget restrictions, complicated old design formats, centralized coding, poor infrastructure for staff, lack of transport facilities
Basic infrastructure support completed; exposure to USA and Australia country systems
Decentralized 33 scanning centres coring the entire country created and functioning
Facilities for coding and relevant software for digitalizing data and simplified reporting through pre-formatted reports
Automatic coding possibility studied
What can we learn from working with the VS unit?
Health projects can incorporate VS improvement under evidence base improvements; even if initiated by the Bank side
Small allocations can do a lot of changes on the ground (in HSDP US $ 0.75 million out of a 60 million project)
Good understanding of the local VS situation and building on the current situation is better than ideal changes.
Lessons learnt….
As these VS units are outside of health ministries, careful understanding of the existing institutional arrangements are required for smooth implementation
Proactive interventions and redesigning may be required to cross implementation hurdles from both sides.
It is always great to have a committed champion from the government side
Future engagement
This component has opened out continuing and new areas and a solid relationship for engagement in the future
Cause of death quality improvement measures through introduction of a more comprehensive Verbal autopsy form
Making data more user friendly through the use of technology
Summary
SL and its health status
VS unit and the current status
Summary of the project design
Results achieved through the VS sub component
Lessons learnt
Thank you