Vital Statistics in Tunisia Republic of Tunisia Ministry of Health National Institute of Public Health Vital Statistics in Tunisia Workshop on the Operation of Civil Registration, Vital Statistics and Identity Management Systems and the Production of Vital Statistics Reports for the Eastern Mediterranean Region Countries Tunisa 26- 30 March 2018

Death registration (03 days from the date of death) Vital Statistics Death registration (03 days from the date of death) Birth registration (10 days from the date of delivery) Marriage registration (30 days from the date of the marriage contract) Population pyramid complies with norms Divorce registration (10 days from the date of divorce)

Role of health institutions Population pyramid complies with norms

Role of health institutions -Notification to civil office: Product the certificate of birth -Confirmation of the death event -Identify causes of death -Product the death certificate Population pyramid complies with norms

Population Pyramid Total population (1000): 11446.3 Population pyramid complies with norms Source: National Institute of Statistics-Tunisia -2015

Birth registration coverage Population pyramid complies with norms Source: National Institute of Statistics-Tunisia -2015

Births by place Population pyramid complies with norms Source: Tunisian Health Examination Survey-National Institute of Health-2016

Lawful framework (1) The Tunisian legislation required already the production of a certificate of death attesting of the death and delivered by a doctor to obtain the license to bury: The decree includes 5 articles: 1: The medical death certificate must be in conformity with the model annexed to the present decree. 2: The certifying physician must fill totality the certificate and seal the confidential part reserved for the causes of death without hiding the shutter reserved for the registry office.

Lawful framework (2) 3: The physician gives the certificate to the family which transmits it to the registry office of the local community of the place of death. In the case of an unknown corpse and if there is nobody to attend to him, the certificate is given to the president of the municipality or to the governor from the territory depending of the place of death. 4: The registry office keep the part of the certificate reserved to him and dispatch to the services of the Ministry of the Public Health the remaining part. 5: The Ministers of Justice, of the Interior and of Public Health are charged, each one in what relates to it, of the execution of this decree. .

Development of medical causes Information circuit Authorization to bury Municipality NI P H Development of medical causes of death statistics 96% 2015 3: The physician gives the certificate to the family which transmits it to the registry office of the local community of the place of death. In the case of an unknown corpse and if there is nobody to attend to him, the certificate is given to the president of the municipality or to the governor from the territory depending of the place of death. 4: The registry office keep the part of the certificate reserved to him and dispatch to the services of the Ministry of the Public Health the remaining part. certificate NIS 39% 2013 General mortality statistics

Deaths Source: National Institute of Statistics-Tunisia -2013 the distribution of deaths meets the standards Source: National Institute of Statistics-Tunisia -2013

Place of deaths Source: National Institute of Health-2013

Certification and registration of deaths Urbain % CI 95% Rural National % of all deaths which are medically certified 99,1% [98,3-99,9] 91,3% [87,8-94,7] 96,4% [95,1-97,7] % of all registered deaths which are medically certified 99,5% [98,8-99,8] 98,6% [97,3-99,9] 99,2% [98,5-99,8] Source: Tunisian Health Examination Survey-National Institute of Health-2016

10 leading causes of death Source : National Institute of Public Health-2013

ANACONDA Results Tunisian data_ 2013

Vital statistics performance index

How should we react Completeness Data quality

Workshops for Registry Staff +++ Workshops for Physicians Actions Workshops for Registry Staff +++ Sensitize the vital statistics staff; Make the use of the CD mandatory in the registration of deaths according to the relevant model (regulations required for civil services to systematically refuse all other models of death certificates). Workshops for Physicians +++ Sensitize physicians about the need to correctly complete all data required by the model, including causes of death (awareness and death certification practices and the use of ICD.10); Ensure the availability of CDs in public and private health facilities. Focal point for each governorate/ pilot comitee / technical comitee Feedback http://www.insp.rns.tn/index.php?option=com_content&view=section&id=26&Itemid=224

Proposal for integral reform Electronic system of notification of causes of death : This information system makes it possible to collect complete data on observed deaths at real-time in particular maternal and neonatal deaths and can be generalized on all vital events, in particular births.

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