1. CHWs and their Role in
Civil Registration and Vital Statistics
Erin K. Nichols, PhD, MPH
National Center for Health Statistics
International Statistics Program
CORE Group Spring Meeting - 3 May 2012
National Center for Health Statistics
International Statistics Program

2. Overview
 Civil registration & vital statistics (CR/VS)
systems and their challenges
 Efforts to improve CR/VS systems globally
 The role of CHWs as vital events reporting &
registration agents
 Your experience

4. Civil Registration System
A system government uses to record vital
events as required by laws or regulations of the
country
• Main purpose – To establish
the legal documents
required by law
• Goal – To record all vital
events occurring in the
Community volunteer
country as they occur gathering information in the
Northern Region of Ghana.

5. Vital Statistics System
The process of collecting, compiling & analyzing
information from vital events filed through the
civil registration system
• Main purpose –
Presentation of vital event
data in statistical form
• Goal – To have accurate
data from all vital events Health Metrics Network
occurring in the country

6. Uses of Vital Records
CR/VS Data Census Surveys
+ Complete data + Complete data + Smaller number of
+ Continuous data + Broader scope observations
+ Data are fully + Well recognized & + Customizable
representative supported by + Low cost/ survey
Advantages
+ Low cost to governments + Closer monitoring;
maintain better data quality
+ Small area data + Can be
representative
- Expensive up front - Not continuous - Not continuous
cost; many - Many resources - Only estimates
resources required required - Expensive for
- Limited scope - Higher cost continual surveys
Disadvantages
- Requires inter- - Difficult to monitor; - Inability to produce
ministerial lower data quality small area
cooperation estimates
- Lack of in-depth
information

7. The Challenge:
 48 million infants are not registered
each year (~ 40%)
 38 million deaths are not registered
(2/3 of all deaths globally)
 85 countries have zero or unreliable
cause of death information
 an additional 52 countries have low-quality data

8. WHO, 2007

9. Previous International Efforts to
Strengthen CR/VS Systems
• Setting standards to improve VS
comparability
• International collection &
publication of data
• Strengthening national statistical
systems
– Not a government priority
– Lack of recognition as key
component of development

10. Strengthening National Systems
• Increase coverage of vital events
registration
• Improve quality of cause of death
information
Making a passive system ACTIVE

11. Strengthening National Systems
• Increase coverage of vital events
registration
• Improve quality of cause of death
information
Making a passive system ACTIVE
CHWs to reach every household

12. What Has Changed?
 Most countries are now more developed
 Mobile technology is eliminating previous
communication problems
 National ID systems require birth, death info.
 Focus on unique advantages of CR/VS:
• Identification – via birth registration
• Continuous data flow
• Small area data
• Cause of death information
• Inexpensive data source

13. Creating Demand for Vital Statistics
Millennium Development Goals
# 4 (child mortality) &
# 5 (maternal mortality)
 Best measured via vital statistics

14. Improving CR/VS Systems:
Create Demand by Requiring Certificates
for Government Services
Birth certificates
now required by
Kenya Ministry
of Education to
sit for exams at
end of secondary
school

15. Improving CR/VS Systems:
Mobile Technology Applications
Create registration-related apps:
 Order a copy of your/ your
child’s birth certificate
 Enquire re status of certificate
request
Devices such as smart phones can
provide real-time data access
from remote areas. WHO.

16. Improving CR/VS Systems:
MOROCCO
TUNISIA HMN/MoVE Collaboration
ALGERIA
LIBYA EGYPT
Rd
MAURITANIA
MALI
Sea
Collaboration
NIGER
with other
ERITREA
SENEGAL
THE CHAD SUDAN
GAMBIA DJIBOUTI
BURKINA
GUINEA
BISSAU
GUINEA
COTE
BENIN
TOGO
NIGERIA
CENTRAL
ETHIOPIA
groups
leverages
SIERRA DTVOIRE GHANA
LEONE AFRICAN
REPUBLIC
LIBERIA
CAMEROON
efforts &
UGANDA
DEMOCRATIC SOMALIA
EQUATORIAL REP. OF REPUBLIC KENYA
GUINEA THE
GABON OF THE CONGO
CONGO
(ZAIRE)
budgets, improv
RWANDA
BURUNDI
ANGOLA TANZANIA
MALAWI
es project
ANGOLA
ZAMBIA quality
MOZAMBIQUE MADAGASCAR
NAMIBIA ZIMBABWE
BOTSWANA
SWAZILAND
LESOTHO
SOUTH
AFRICA

17. Improving CR/VS Systems:
Establish Regional Training Sites
To promote South-South technical assistance

18. The Role of CHWs
 Reporting occurrence of births and deaths
 Registering births and deaths into national
system
 Conducting verbal
autopsies
 Conducting local level
data use and action
meetings
Health Metrics Network

19. For Successful Linkages
 Connect CHWs to the public sector: paid
employees connected to a legal system
 Support strong linkages between
government sectors involved in CR/VS
 Take advantage of advances in IT
 Others?

20. Types of CHW Program Involvement
 CHWs reporting and/or registering vital events
to be included in the national CR/VS system
 CHWs reporting vital events for local use
 Can these data be connected to a national CR/VS
system?
 Programs evaluating the quality of vital events
data collected by CHWs

21. Your Experience
 Location
 Organization
 Collaborators
 Description of project
 Contact information
– Name
– Email address
– Project website, if available

22. Kenya – Homa Bay X
CDC/MOH/ Improving CR/VS coverage using
DCR mobile IT; VA on mobile devices
National integration
Local collection
Data quality assessment
Location Organization Description
Kenya – Homa Bay CDC/MOH/DCR Improve CR/VS coverage with mobile IT; VA on mobile devices
Kenya – Naivasha WHO/HMN/MOH/DCR Improving CR/VS coverage using mobile IT
Ethiopia – Koraro MVP/MOH Expansion of ChildCount+ ; VA on mobile devices
Malawi – Zomba IIP-JHU/NSO/UM Test methods for measuring U5 mortality; assess data quality

23. Erin K. Nichols
E-mail: igd1@cdc.gov Web: http://www.cdc.gov
Sam Notzon, Director – International Statistics Program
E-mail: fcn2@cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
National Center for Health Statistics
International Statistics Program