Civil Registration And Vital Statistics System Research Articles

Estimation of national and subnational all-cause mortality indicators in Nepal, 2017

BackgroundDespite the civil registration and vital statistics (CRVS) system in Nepal operating for several decades, it has not been used to produce routine mortality statistics. Instead, mortality statistics rely on irregular surveys and censuses that primarily focus on child mortality. To fill this knowledge gap, this study estimates levels and subnational differentials in mortality across all ages in Nepal, primarily using CRVS data adjusted for incompleteness.MethodsWe analyzed death registration data (offline or paper-based) and CRVS survey reported death data, estimating the true crude death rate (CDR) and number of deaths by sex and year for each province and ecological belt. The estimated true number of deaths for 2017 was used with an extension of the empirical completeness method to estimate the adult mortality (45q15) and life expectancy at birth by sex and subnational level. Plausibility of subnational mortality estimates was assessed against poverty head count rates.ResultsAdult mortality in Nepal for 2017 is estimated to be 159 per 1000 for males and 116 for females, while life expectancy was estimated as 69.7 years for males and 73.9 years for females. Subnationally, male adult mortality ranges from 129 per 1000 in Madhesh to 224 in Karnali and female adult mortality from 89 per 1000 in Province 1 to 159 in Sudurpashchim. Similarly, male life expectancy is between 64.9 years in Karnali and 71.8 years in Madhesh and female male life expectancy between 69.6 years in Sudurpashchim and 77.0 years in Province 1. Mountain ecological belt and Sudurpashchim and Karnali provinces have high mortality and high poverty levels, whereas Terai and Hill ecological belts and Province 1, Madhesh, and Bagmati and Gandaki provinces have low mortality and poverty levels.ConclusionsThis is the first use of CRVS system data in Nepal to estimate national and subnational mortality levels and differentials. The national results are plausible when compared with Global Burden of Disease and United Nations World Population Prospects estimates. Understanding of the reasons for inequalities in mortality in Nepal should focus on improving cause of death data and further strengthening CRVS data.

Strengthening causes of death identification through community-based verbal autopsy during the COVID-19 pandemic

IntroductionIndonesia has not optimally provided complete and reliable civil registration and vital statistics (CRVS). Death certification is one of the elements of the CRVS system. Reliable data on death rates and causes serve as the basis for building a strong evidence base for public health policy, planning, monitoring, and evaluation. This study aims to implement an approach to identifying the cause of death through verbal autopsy by empowering community health workers during the pandemic.MethodThis study is implementation research with the empowerment of the community, in this case, health cadres and health facilitators/workers, to identify the cause of death through a mobile-based verbal autopsy. This implementation research consisted of four main activities: community-based verbal autopsy, mobile-based verbal autopsy development, data collection, and analysis of the suspected causes of death using InterVA-5.ResultFrom October to November 2020, a total of 143 respondents were willing to do a verbal autopsy interview (response rate of 58%). Of 143 respondents, most of them were women (112 or 78.3%), was the child of the deceased (61 or 42.7%) and lived with the deceased until before he/she died (120 or 83.9%). Based on the characteristics of the deceased, of 143 deceased, 78 (54.5%) were male, 134 (93.7%) were adults, 100 (69.9%) died at home, and 119 (83.2%) did not have a death certificate stating the cause of death. The cause of death of 143 deceased mainly was infectious disease (92 or 64.3%), followed by non-communicable disease (39 or 27.3%), external factors (5 or 3.5%), and unknown factors (4 or 2.8%). In sequence, the top five suspected causes of death are acute respiratory infection, including pneumonia (72 or 50.3%), other and unspecified infectious disease (18 or 12.6%), other and unspecified cardiac disease (17 or 11.9%), acute cardiac disease (4 or 2.8%), and Digestive neoplasms (4 or 2.8%).ConclusionThe findings showed that the mobile-based verbal autopsy using a community-based mechanism was feasible during the COVID-19 pandemic.

How has COVID-19 impacted the civil registration and vital statistics system in Loreto, Perú? Evidence using process mapping and qualitative analysis

ObjectivesAccurate civil registration and vital statistics (CRVS) systems are the primary data source to measure the impact of the COVID-19 pandemic on mortality. This study assesses how the pandemic impacted...

Have inequalities in completeness of death registration between states in India narrowed during two decades of civil registration system strengthening?

BackgroundIn India the number of registered deaths increased substantially in recent years, improving the potential of the civil registration and vital statistics (CRVS) system to be the primary source of mortality data and providing more families of decedents with the benefits of possessing a death certificate. This study aims to identify whether inequalities in the completeness of death registration between states in India, including by sex, have narrowed during this period of CRVS system strengthening.MethodsData used in this study are registered deaths by state and year from 2000 to 2018 (and by sex from 2009 to 2018) reported in the Civil Registration Reports published by the Office of Registrar General of India. Completeness of death registration is calculated using the empirical completeness method. Levels and trends inequalities in completeness are measured in each state a socio-economic indicator – the Socio-Demographic Index (SDI).ResultsEstimated completeness of death registration in India increased from 58% in 2000 to 81% in 2018. Male completeness rose from 60% in 2009 to 85% in 2018 and was much higher than female completeness, which increased from 54 to 74% in the same period. Completeness remained very low in some states, particularly from the eastern (e.g. Bihar) and north-eastern regions. However, in states from the northern region (e.g. Uttar Pradesh) completeness increased significantly from a low level. There was a narrowing of inequalities in completeness according to the SDI during the period, however large inequalities between states remain.ConclusionsThe increase in completeness of death registration in India is a substantial achievement and increases the potential of the death registration system as a routine source of mortality data. Although narrowing of inequalities in completeness demonstrates that the benefits of higher levels of death registration have spread to relatively poorer states of India in recent years, the continued low completeness in some states and for females are concerning. The Indian CRVS system also needs to increase the number of registered deaths with age at death reported to improve their usability for mortality statistics.

Adult death registration in Matlab, rural Bangladesh: completeness, correlates, and obstacles

Civil registration of vital events such as deaths and births is a key part of the process of securing rights and benefits for individuals worldwide. It also enables the production of vital statistics for local planning of social services. In many low- and lower-middle-income countries, however, civil registration and vital statistics (CRVS) systems do not adequately register significant numbers of births and, especially, deaths. In this study, we aim to estimate the completeness of adult death registration (for age 15 and older) in the Matlab health and demographic surveillance system (HDSS) area in Bangladesh and to identify reasons for (not) registering deaths in the national CRVS system. We conducted a sample survey of 2538 households and recorded 571 adult deaths that had occurred in the 3 years preceding the survey. Only 17% of these deaths were registered in the national CRVS system, with large gender differences in registration rates (male = 26% vs. female = 5%). Respondents who reported that a recent death in the household was registered indicated that the primary reasons for registration were to secure an inheritance and to access social services. The main reasons cited for not registering a death were lack of knowledge about CRVS and not perceiving the benefits of death registration. Information campaigns to raise awareness of death registration, as well as stronger incentives to register deaths, may be needed to improve the completeness of death registration in Bangladesh.

Maternal Mortality in Georgia: Incidence, Causes and Level of Underreporting: A National Reproductive Age Mortality Study 2014.

IntroductionAccurate data on maternal mortality are essential for assessing progress towards Sustainable Development Goals (SDG).The aim of the study was to determine the incidence and causes of maternal deaths in Georgia, then explore the potential for improvement of quality of maternal health care. The study’s secondary aims were to identify the level of underreporting of maternal deaths in Georgian vital statistics over 1 year (2012) and to compare these results with previous data from 2006. The study findings allow to support the country in developing evidence-based policies and tracking progress towards meeting SDG targets.MethodsA national Reproductive Age Mortality Survey (RAMOS) was conducted in Georgia in 2014–15. Multiple data sources were used to identify deaths of women aged 15–49 years between January and December 2012. All deaths in women of reproductive age were investigated through verbal autopsy (VA) diagnoses. Deaths in women during pregnancy or one-year postpartum were further investigated by conducting interviews and medical record reviews at the last medical facility which provided health care for the woman during her fatal condition. A specialist panel reviewed these cases and assigned underlining causes of deaths.ResultsWe found that 98% of deaths among women of reproductive age were registered by Georgia's civil registration and vital statistics system (CRVS). A total of 918 deaths met the study inclusion criteria. Thirty-six (4.1%) women died during pregnancy or within one-year postpartum. Among these 36 deaths, 23 (63.8%) were maternal deaths, 15 early (either during pregnancy or 42 days postpartum) and eight late (43–365 days postpartum) deaths (65.2% vs 34.8%). The remaining 13 of 36 deaths were coincidental deaths. Fourteen maternal deaths were reported by official statistics and nine deaths were not included in these statistics. Thus, the underreporting rate was 39%. Direct obstetric causes accounted for 73.9% (n=17) of maternal deaths, whereas 26.1% (n=6) were indirect. The leading causes of direct maternal deaths were infection (21.7%), hemorrhage (17.4%), pulmonary embolism (13.0%), and pregnancy-induced hypertension (8.7%). The RAMOS study calculated a maternal mortality ratio (early maternal deaths) of 26.3 per 100,000 live births compared with the official figure of 22.8 per 100,000 live births.DiscussionsRegistration of early maternal deaths significantly improved since last survey in 2008, while indirect and late maternal deaths continue to be unrecognized, as reflected in official Georgian statistics. The difference between RAMOS study findings and officially reported maternal mortality rates is minimal, showing improvements in detection of maternal deaths by the national maternal mortality surveillance system. The greatest number of direct obstetric deaths occur in the first week postpartum, which likely reflects deficiencies in quality of care.

Addressing critical knowledge and capacity gaps to sustain CRVS system development

BackgroundImproving civil registration and vital statistics (CRVS) systems requires strengthening the capacity of the CRVS workforce. The improvement of data collection and diagnostic practices must be accompanied by efforts to ensure that the workforce has the skills and knowledge to assess the quality of, and analyse, CRVS data using demographic and epidemiological techniques. While longer-term measures to improve data collection practices must continue to be implemented, it is important to build capacity in the cautious use of imperfect data. However, a lack of training programmes, guidelines and tools make capacity shortages a common issue in CRVS systems. As such, any strategy to build capacity should be underpinned by (1) a repository of knowledge and body of evidence on CRVS, and (2) targeted strategies to train the CRVS workforce.Main textDuring the 4 years of the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne, an extensive repository of knowledge and practical tools to support CRVS system improvements was developed for use by various audiences and stakeholders (the ‘CRVS Knowledge Gateway’). Complementing this has been a targeted strategy to build CRVS capacity in countries that comprised two approaches – in-country or regional training and a visiting Fellowship Program. These approaches address the need to build competence in countries to collect, analyse and effectively use good quality birth and death data, and a longer-term need to ensure that local staff in countries possess the comprehensive knowledge of CRVS strategies and practices necessary to ensure sustainable CRVS development.ConclusionThe Knowledge Gateway is a dynamic, useful and long-lasting repository of CRVS knowledge for countries and development partners to use to formulate and evaluate CRVS development strategies. Capacity-building through in-country or regional training and the University of Melbourne D4H Fellowship Program will ensure that CRVS capacity and knowledge is developed and maintained, facilitating improvements in CRVS data systems that can be used by policymakers to support better decision-making in health.

Where there is no hospital: improving the notification of community deaths

BackgroundGlobally, an estimated two-thirds of all deaths occur in the community, the majority of which are not attended by a physician and remain unregistered. Identifying and registering these deaths in civil registration and vital statistics (CRVS) systems, and ascertaining the cause of death, is thus a critical challenge to ensure that policy benefits from reliable evidence on mortality levels and patterns in populations. In contrast to traditional processes for registration, death notification can be faster and more efficient at informing responsible government agencies about the event and at triggering a verbal autopsy for ascertaining cause of death. Thus, innovative approaches to death notification, tailored to suit the setting, can improve the availability and quality of information on community deaths in CRVS systems.Improving the notification of community deathsHere, we present case studies in four countries (Bangladesh, Colombia, Myanmar and Papua New Guinea) that were part of the initial phases of the Bloomberg Data for Health Initiative at the University of Melbourne, each of which faces unique challenges to community death registration. The approaches taken promote improved notification of community deaths through a combination of interventions, including integration with the health sector, using various notifying agents and methods, and the application of information and communication technologies. One key factor for success has been the smoothing of processes linking notification, registration and initiation of a verbal autopsy interview. The processes implemented champion more active notification systems in relation to the passive systems commonly in place in these countries.ConclusionsThe case studies demonstrate the significant potential for improving death reporting through the implementation of notification practices tailored to a country’s specific circumstances, including geography, cultural factors, structure of the existing CRVS system, and available human, information and communication technology resources. Strategic deployment of some, or all, of these innovations can result in rapid improvements to death notification systems and should be trialled in other settings.

Evaluation of civil registration and vital statistics system in the Maldives: Focus on mortality statistics

An efficient Civil Registration and Vital Statistics (CRVS) system is a development imperative. Data on death registration and causes of death are important for measuring health outcomes. This paper evaluates the completeness and quality of data on death registration and causes of death (CoD) based on analysis of the registration records on death and causes of death for the period 2009–2018. Using established methods and approaches, we observed that CRVS system performed well on death registration completeness, quality of age and sex reporting. However, the quality of cause of death data was poor with 50% of the International Classification of Diseases (ICD) codes classified as “major garbage codes” and significant time lag was observed in the transmission and production of vital statistics. The CRVS system in Maldives is complete with all deaths occurring within its territory registered and causes of death recorded. The two areas that require attention are the time taken for publication of vital statistics and quality of cause of death reporting. Appropriate re-engineering of the existing business process can build real-time mortality data, and regular quality assessment of death certificates with feedback to health facilities can bring sustained improvements in quality of vital statistics.

Strategic yet delicate: the dilemma of involving health workers in facilitating birth registration in Indonesia

BackgroundBirth registration provides the basis for population data. Previous studies have examined that collaboration between the health sector and civil registration can help improve birth registration rate. However, there was a little exploration into health workers’ understanding of civil registration and vital statistics (CRVS) and their perceived role in it. This study aims to fill this gap by focusing on the perspective of both health personnel in a managerial position and those who are involved in direct service provision to the community. Finally, we discussed the opportunities and challenges to strengthen the birth registration presented by health workers’ diverse views.MethodThis study uses a qualitative approach through semi-structured in-depth interviews with 23 provincial to village health personnel in Pangkajene Kepulauan (Pangkep) district of South Sulawesi province. The participants were selected through consultation with the Department of Planning and the head of the Department of Health at provincial and district level based on the relevance of their position with CRVS. At the frontline level, the informants were identified using a snowballing technique and recommendation from community members.ResultsThis study finds that at the village level, health workers perceive CRVS as important since it supports them in delivering healthcare to community members. They see identification document like birth certificate as crucial for healthcare seekers to access the government’s health insurance and with that, proper and affordable treatment. Some health workers have been facilitating birth registration on a discretionary basis. Local health officials agree that accurate birth data lead to effective planning and financing for healthcare services and insurance. Despite the positive perception of birth registration, the majority of health workers do not want the additional burden for registering births. Health officials, however, are more open to taking some responsibilities.ConclusionThis study concludes that the level of health workers’ understanding and appreciation of the CRVS system provides opportunities to engage them systematically in birth registration. It recommends that institutionalizing health workers’ participation in birth registration must consider their current workload, revision of legal instruments, capacity building plan, and operable linkage with civil registration authority.

Economic analysis of producing vital statistics using civil registration data in Lao People\u2019s Democratic Republic

The government of Lao People’s Democratic Republic (PDR) is currently in the preparation stage of a 5-year project that will establish an electronic civil registration and vital statistics (CRVS) system. The authors of this paper adapted a framework for economic analysis developed by Jimenez-Soto et al. (Jimenez-Soto et al., PLoS ONE 9(8): e106234, 2014) to assess the cost-effectiveness of producing vital statistics in Lao PDR using data from a complete electronic CRVS system, compared to using data from other sources, such as the 2015 Population and Housing Census and the 2017 Lao Social Indicator Survey (LSIS). Of 20 types of vital statistics (including birth statistics, fertility rates, and death statistics), a complete and accurate CRVS system can produce all 20 of these vital statistics, while the 2015 Census can produce 17, and the 2017 LSIS and the current civil registration system can produce 4 each. A cost-effectiveness analysis of different data sources for producing vital statistics over a 20-year projection showed that a complete and accurate CRVS system ranked best, followed by population census and population-based survey. In addition to enabling vital statistics to be produced cost-effectively, a robust civil registration system would also support improving the efficiency of public service delivery, leading to further cost savings for the country.

A multisectoral institutional arrangements approach to integrating civil registration, vital statistics, and identity management systems

This paper reviews the essential components of a recommended institutional arrangements framework of integrated civil registration and vital statistics (CRVS) and civil identification systems. CRVS typically involves several ministries and institutions, including health institutions that notify the occurrence of births and deaths; the judicial system that records the occurrence of marriages, divorces, and adoptions; the national statistics office that produces vital statistics reports; and the civil registry, to name a few. Considering the many stakeholders and close collaborations involved, it is important to establish clear institutional arrangements—“the policies, practices and systems that allow for effective functioning of an organization or group” (United Nations Development Programme, Capacity development: a UNDP primer. New York: United Nations Development Programme, 2009). An example of a component of institutional arrangements is the establishment of a multisectoral national CRVS coordination committee consisting of representatives from key stakeholder groups that can facilitate participatory decision-making and continuous communication. Another important component of institutional arrangements is to create a linkage between CRVS and the national identity management system using unique identification numbers, enabling continuously updated vital events data to be accessible to the civil identification agency. By using birth registration in the civil registry to trigger the generation of a new identification and death registration to close it, this link accounts for the flow of people into and out of the identification management system. Expanding this data link to enable interoperability between different databases belonging to various ministries and agencies can enhance the efficiency of public and private services, save resources, and improve the quality of national statistics which are useful for monitoring the national development goals and the Sustainable Development Goals. Examples from countries that have successfully implemented the recommended components of an integrated CRVS and national identity management system are presented in the paper.

Human Rights Practitioners Cannot Be Left Behind: Engaging in Civil Registration and Vital Statistics (CRVS) Systems Thinking for Country Implementation of the Sustainable Development Goal Agenda

With the support of the private sector, civil society, philanthropic organizations and communities, governments from developed and developing nations around the world are scaling up their implementation efforts for achieving the bold and transformative vision of the 2030 Agenda for Sustainable Development. The importance of death registration and certification, and the power of cause of death data, is increasingly discussed in high-level multilateral and bilateral forums in relation to country monitoring and measurement of the 17 Sustainable Development Goals (SDGs), which were agreed upon by the UN member states at a high-level summit in September 2015 to replace the Millennium Development Goals on their December 2015 expiration. Routinely, however, human rights and development practitioners are removed from these important multi-stakeholder conversations on civil registration and vital statistics (CRVS) system strengthening occurring at global, national, and subnational levels. This article will therefore explain why such practitioners might not have traditionally engaged in CRVS-related discussion in the past but must urgently engage now. Indeed, both the positives and negatives of SDG–CRVS system improvement, combined with the escalating need for human rights-based approaches to data and technology, will necessitate involvement from human rights advocates and scholars worldwide in the coming decade and beyond.

Validation of verbal autopsy methods for assessment of child mortality in sub-Saharan Africa and the policy implication: a rapid review.

Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and InterVA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making.

Data for the Sustainable Development Goals: Metrics for Evaluating Civil Registration and Vital Statistics Systems Data Relevance and Production Capacity, Illustrations with Nigeria

Three issues impinging on the potential use of Civil Registration and Vital Statistics (CRVS) data for the Sustainable Development Goals (SDGs) are analysed in the paper. These include CRVS data relevance, content and data production capacity of CRVS systems. The paper adopts a ‘data type’ approach to relevance and capacity and proposes two metrics based on a graded qualitative evaluation (GQE) methodology. One is a data-relevance metric for evaluating the relevance of CRVS data types to the SDGs. The second is a National Statistical Systems (NSS) data type production capacity metric used for evaluating the data production capacity of CRVS systems. CRVS data instrument analysis and the CRVS data production capacity are exemplified with the Nigerian CRVS system. Relevance assessment results suggest that CRVS systems can provide data relevant to 25% of the SDGs. However the SDG data contribution of CRVS depends on the ‘data type’ capacity of National CRVS systems. As the capacity assessment shows, the Nigerian CRVS system has ‘nominal’ capacity to produce all CRVS data types (fertility, mortality, migration, nuptiality and socio-economic) and ‘active’ and ‘latent’ capacities to provide data for some 21 SDG targets. However, it currently lacks ‘effective’ capacity to produce any of the data types for the SDGs. The paper has implications for goal setting and prioritization in evolving strategies to enhance the development of CRVS/NSS systems’ data capacities, especially in developing countries.

Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations

ABSTRACT Background: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics, and it will still be some time before they can provide physician-certified COD for every death. Proposals: Verbal autopsy (VA) is a method to ascertain the probable COD and, although imperfect, it is the best alternative in the absence of medical certification. There is extensive experience with VA in research settings but only a few examples of its use on a large scale. Data collection using electronic questionnaires on mobile devices and computer algorithms to analyse responses and estimate probable COD have increased the potential for VA to be routinely applied in CRVS systems. However, a number of CRVS and health system integration issues should be considered in planning, piloting and implementing a system-wide intervention such as VA. These include addressing the multiplicity of stakeholders and sub-systems involved, integration with existing CRVS work processes and information flows, linking VA results to civil registration records, information technology requirements and data quality assurance. Conclusions: Integrating VA within CRVS systems is not simply a technical undertaking. It will have profound system-wide effects that should be carefully considered when planning for an effective implementation. This paper identifies and discusses the major system-level issues and emerging practices, provides a planning checklist of system-level considerations and proposes an overview for how VA can be integrated into routine CRVS systems.

Civil Registration and Vital Statistics, Emergencies, and International Law: Understanding the Intersection.

Civil registration and vital statistics (CRVS) systems are typically run by governments to record every birth, adoption, death, marriage, and divorce that occurs among a country's population. Registration of vital events provides individuals with a formal relationship with the State and each other, and is the foundation of a person's identity, nationality, and legal status. At a population level, vital statistics are essential for effective planning and implementation of policies and services. Globally, strong CRVS systems are increasingly recognised as a crucial backbone for redressing health inequities and as a priority in strengthening global health and development efforts. Many countries, however, currently lack adequate and reliable CRVS systems, leaving many people vulnerable to statelessness, limited access to important government services (such as education and health services), and effective legal protection. Public health and humanitarian emergencies in such contexts can expose those already disadvantaged and marginalised to heightened risk. CRVS systems weakened by crises make registration difficult or impossible and unregistered people may be displaced or separated from their families, exacerbating their susceptibility. The presence of a strong CRVS system, therefore, can facilitate effective and cost-effective emergency responses, help prevent exploitation of individuals (particularly women and children), and help to rebuild communities post-crisis. This article will consequently review the international legal mandates that exist to strengthen CRVS systems globally, with particular view to public health and humanitarian emergencies. Identity and citizenship, and the socio-political contexts in which these concepts co-exist, are inevitably interconnected with CRVS. This can create potential for CRVS systems and data to be exploited as a political instrument. Grounding CRVS strengthening in a single binding, human rights law instrument is a potential way forward.

The Nigerian Civil Registration and Vital Statistics System: Contexts, Institutions, Operation

Civil Registration and Vital Statistics (CRVS) Systems are playing increasing roles in national and global data infrastructure, facilitating the achievement of key developmental goals. The performance of CRVS systems in many developing countries including Nigeria is sub optimal and information on their structure and operations scanty. This paper characterizes the statutory, institutional, and operational elements and social contexts of the Nigerian CRVS System. It includes a context analysis of the system and a review of improvement strategies and interventions. The paper shows that the Nigerian CRVS System is built on viable statutory and institutional platforms—the constitutional enshrinement of: universal, compulsory and continuous civil registration and, a central registration institution—the National Population Commission (NPC). NPC has registration hierarchy and infrastructure deployed at every level of political administration and mechanisms for efficient coordination of registration and production of vital statistics on live-births, deaths and stillbirths amongst other vital events. The major weaknesses of the system include inadequate financing and deployment of registration facilities, conflicting statutes and institutional arrangements for the registration of key events like death and stillbirths. Other weaknesses include intra-organizational conflicts in resource allocation and weak ICT infrastructure within the NPC. These are compounded by overarching contextual issues namely registration unfriendly sociocultural norms, weak national data infrastructure, systemic corruption, poverty and undeveloped civic culture. Domestic initiatives and interventions to improve the system have focused on birth registration, while multilateral interventions have only made a modest impact on the system. Thus, holistic in-country improvement initiatives supported with robust interventions are imperative to overcome weaknesses in the Nigerian CRVS system. However fundamental improvements in CRVS systems in developing countries like Nigeria may likely only follow sustainable solutions to overarching contextual issues especially poor infrastructure, weak institutions, poverty and systemic corruption.