4th National CRVS Steering Committee Meeting.

Well Functioning CRVS and Way Forward.

Dr. S. M. Mursalin Technical Adviser – Technical Support Unit (TSU) Ministry of Planning, Development & Reforms Islamabad

Presentation Outline

CRVS Orientation & Dimensions.

CRVS Implementation Steps.

Way Forward & Issues to be resolved by National Steering Committee Meeting.

Vital Events

It is the occurrence of a live births, deaths (with

cause), fetal death (defined as the death of a fetus

before birth), marriage, divorce, legal separation,

adoption, recognition of parenthood, migration

Vital Events …including…

As defined by the United Nations:

“The total process of collecting information by

civil registration or enumeration on the frequency of

occurrence of specified and defined vital events and

of compiling, processing, analyzing,

evaluating, presenting and disseminating these data in

some statistical form”.

Vital Registration System

Civil Registration

• Coordination

• Process

• Legal framework

• Advocacy – policy-makers, communities

• Incentives

• Resources & capacities – infrastructure, financial and

human resources, training

Vital Statistics

• Birth Regd. Coverage & completeness

• Cause of death

• Analysis of data

• Data quality – Timeliness

– Accuracy

• Data dissemination and use

Major Areas of Intervention

Two Major Outputs of CRVS…

Legal documents, such as a birth certificate

Vital statistics, such as leading causes of death

Qualities of Vital Statistics.

Accurate

High coverage and completeness

Low levels of missing data

Have COD Information

Consistency between Vital Statistics and Demo Indicators.

Relevant

Comparable overtime.

Comparable across locations.

Timely.

Produced regularly

Have little time between collection and publication

Accessible

Produced in a number of different media formats

Provide information about the data. (i.e.collection methods,

definitions, potential errors etc.)

Pakistan Vision 2025.

By 2025, all people in Pakistan will benefit from universal and responsive CRVS systems that facilitate the realization of their rights and support good governance, health and development.

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CRVS and Sustainable Development Goals (SDGS)

a) A well-functioning civil registration and vital statistics system is critical in monitoring country progress towards the Sustainable Development Goals

b) 17 SDG GOALS & 169 TARGETS

c) More than one-third (45) of these indicators will require data from a CRVS system.

d) Tracking progress on the SDGs requires the collection, processing, analysis and dissemination of an unprecedented amount of data and statistics at sub national, national, regional and global levels.

Monitoring of SDG Indicators is Dependent on Effective CRVS.

Maternal mortality rate Under five mortality rate Neonatal mortality rate. Infant mortality rate Mortality rate due to unintentional poisoning Mortality rate attributed to cardiovascular,

cancer, diabetes or chronic respiratory diseases. Death rate due to road traffic accidents Suicide Mortality Rate

SDG Indicators Dependent on Effective CRVS.

Number of deaths affected by disaster Number of victims of international homicide Adolescent birth rate Proportion of births attended by skilled health

personnel Proportion of births delivered in a health

facility. Malnutrition in Children < 5 Years. Universal Health Coverage. Provide Legal to all including birth registeration.

More than 100 low income countries still do not have functioning systems that can support registration of births and other vital events.

Almost 230 million children (<5) are not registered

across the world. Estimated 20 Million Children <5 stand un-registered

in Pakistan.

CRVS Global Facts

Political (and financial) commitment from the government (can never be donor driven).

Assessment of current status and practices – Rapid assessment is done to raise awareness and advocacy for CRVS

– Comprehensive assessment Using WHO/UQ Assessment

– Indepth Province-wise Assessment

Devising Strong Coordination Mechanism (National/ Provincial Steering Committees Formed and Meetings.

National/Provincial Strategic Plans. – Developed with priorities, timeline and costing involving all relevant stake holders

Potential CRVS Roadmap

Ensuring Hospital Reporting (To be achieved) – Complete reporting by hospitals of births and deaths

– Causes of death using the ICD 10.

Community Reporting (To be strengthened) – Most deaths and births occur at home, outside health facilities

– Community reporting of birth and deaths, e.g. LHWs and with electronic devices

– Verbal autopsy if death in community.

CRVS Strengthening Components (2/3)

Improving Quality and Use of Data (To be achieved) – Data quality assessment and improvement is critical

– Vital statistics from Civil Registration need to be produced , disseminated and analysed regularly

Use of Demographic Surveillance (To be initiated) – Till large scale system is developed health and demographic surveillance sites

can be used to obtain intermediate data

– Many countries have such HDSS (India, China )

Use of Vital Statistics for Planning & Decision making

CRVS Strengthening Components (3/3)

Legal framework

Registration infrastructure and resources

Organization and functioning

Completeness of registration

Data storage and transmission

ICD compliance

Quality of cause-of-death data

ICD coding practices

Coder qualification

Data quality checks

Data access, dissemination and use © Health Information Systems Knowledge Hub, University of Queensland, 2012

Subject Areas Covered in CRVS Assessment

Rapid Assessment – Results- Dec. 2013

Weak System

• Like many countries in the region, Pakistan do not have well functioning systems

• Birth registration and death registration levels are very low. (< 40% and < 5% respectively)

• There is little vital statistics generated from the civil registration systems.

• Cause of death information is not available, or of poor quality (from hospitals but not using ICD).

CRVS Assessment - Snapshot

1. Review of the current legislation for Uniform National CRVS law.

2. Technology upgrade synergy among partners for data processing.

3. A central body be identified to collect, processing and disseminate data.

4. Uniform Standard Vital Certificates & Fee criteria..

5. Explicit TORs, Nominations for CRVS Steering Committees, Technical

Groups.

6. Strengthening of LB Systems and Synergies with National Registration

(NADRA) and Health Departments. Role of District Administration.

7. Need for implementation of ICD-10 coding in hospitals for COD.

Possibilities of including private practitioners for CRVS/ death

registration.

8. CRVS be enhanced to estimate essential health and demographic

indicators.

CRVS Assessment - Recommendations

Reasons for Successful CRVS in Sri Lanka

Robust, simple, clearly defined registration System – free of charge

Sound Legal Framework

Sound Administrative Structure

Public Demand, Trust and Willingness to Participate

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Birth Registration = 100%

Deaths Registration = 90%

Historical Overview in Pakistan.

• CRVS Rapid Assessment – (Dec 2012 – March 2013)

• CRVS Comprehensive Assessment - (June - August 2013)

• National CRVS Stakeholders Meeting – (March 20-21, 2014)

• Nomination of Steering and Coordination Committee (Sep 9, 2014)

• First National Steering Committee Meeting – (Nov. 18, 2014)

• Second National Steering Committee Meeting - (Apr- 03, 2015)

• Third National Steering Committee Meeting (March 17, 2016)

• National Progress Review Meeting on CRVS – (October 5-7, 2016)

• Establishment of Technical Support Unit for CRVS (Oct 2017).

Notification of National CRVS Steering Committee

Headed by: Federal Minister for Planning Development and Reform.

Secretariat: Health Section, Ministry of Planning Development and Reforms, ISB

Notification: 9th September, 2014.

Members:

Ministry of Planning, Development and Reforms Ministry of National Health Services and Regulation. Ministry of Interior (NADRA). Ministry of Law and Justice. Ministry of Information Technology . Pakistan Bureau of Statistics. Provincial P&D Departments. Provincial Departments of Health(s). Provincial Local Government and Rural Development Development Partners.

Technical Support Unit for CRVS.

Overall Technical Coordination for CRVS Development &

Promotion.

Facilitate organization of National /Provincial Steering Committee

Meetings and follow-up actions.

Facilitate Assessment Studies, Surveys, Research desired for CRVS

implementation.

Facilitate Strategic Planning Process for CRVS.

Gather innovative answers to CRVS issues and barriers.

Promote capacity building for multiple CRVS disciplines.

Promote inter agency and stakeholder’s coordination

Points for Discussions.?

How to promote existing coordination mechanisms for development of workable strategies.

What steps are taken to transform the recommendations/ decisions of earlier meetings and what still desired ?

What roles could be distributed among CRVS Players -Federal/Provincial/ Partners.

How to achieve broader political, institutional and financial support.

What additional inputs or capacities are desired to accelerate the implementation process.