1. Strategies for Improving Civil Registration and Vital Statistics system in Tanzania 5 th December 2014 Victoria Philbert Mushi

2. Introduction In Tanzania, like in many other developing countries, most citizens have come into this world and left without leaving a trace on official records. The main reason has been weak law and operational framework for compulsory, universal, continuous and permanent of recording of vital events in the country. In the absence of a fully-functioning civil registration system, citizens have remained unrecorded and hence unrecognized by the state.

3. A reliable CRVS system is a basic component of good governance. The information collected through the civil registration system allows to identify a subset of the population requiring intervention or services, such as health care, education, social protection, as well as humanitarian response in emergency situations. Eventually, the systematically registered vital events can facilitate access to essential public services that every individual is entitled to enjoy.

4. In Tanzania, civil registration systems are the responsibility of ministry of Justice and Constitutional Affairs.RITA being the executive Agency under that ministry is entrusted, among other things, to ensure on behalf of the nation that all births and deaths occurring in Tanzania Mainland are accurately recorded at the earliest opportunity. However, the rate or percentage of registration home deaths has remained very low.The sticking problem still remained that registration is yet to reach down to the villages, which is the ultimate level for the registration to become universal in practice. Currently the registration centres are situated at the district headquarters, not lower.

5. Home Deaths Reporting of death information is an important component of the overall information of civil registration and vital statistics. Majority of developing countries including Tanzania, lack the appropriate system and mechanism of capturing data of deaths information. The information on cause of death has an important role to play; in legal, administrative and statistical uses, however, this is still a challenge for home deaths where Civil Registrars are not experts on medical field. In 1967, the Twentieth World Health Assembly demanded the causes of death to be entered on the medical certificate of cause of death and defined it as, “all those diseases, morbid conditions or injuries which either resulted in or contributed to death and the circumstances of the accident or violence which produced any such injuries”. The purpose of the definition is to ensure that all the relevant information is recorded and that the certifier does not select some conditions for entry and reject others. The definition does not include symptoms and modes of dying. May be this is the reason why Health Facilities does not certify deaths upon arrival or death at home

6. Research and study on the reporting of cause of death through verbal Autopsy and get experience from other countries Training of the staff to provide knowledge and skills necessary for the efficient performance. The law and regulations governing the vital statistics system should clearly link the production of vital statistics with the civil registration system. In other words, the necessary basic data for vital statistics should originate from the civil registration system (RITA) and continuously feed the vital statistics system at NBS CURRENT DEATH AT HOME REGISTRATION PROCESS DEATHS OUTSIDE HEALTH FACILITIES REFUGEES,IDPs, NOMADS ETC NOT RECOGNISED BY LAW District Administrative Secretary(DAS) ABROAD NOT REGISTERED RITA National Bureu of Statistics (NBS) AND OTHER STAKEHOLDERS NO COLLABORATION VEO issue introductory letter to relative WEO issue introductory letter Deaths from Natural Causes Deaths from Natural Causes DAS register and issue certificate and send return to RITA HQ quartely RITA receive filled forms and archive Health facility for postmortem Deaths from unnatural causes Police Informant report Death to the nearest WEO

7. Major bottlenecks in the current business process. According to the business process above, the following are the bottlenecks Registration is centralized. Lack of awareness by the public No proper procedure of reporting causes of deaths Traditional and religious norms System of registration is manual No recording of deaths abroad or special group of population such as Refugees, IDPs, etc No collaboration and coordination with Statistical bureau and other stakeholders

8. PROPOSED DEATH AT HOME REGISTRATION PROCESS DEATHS OUTSIDE HEALTH FACILITIES District Executive Director(DED) DEATH ABROAD RITA SYSTEMS OF KEY STAKEHOLDERS- NBS, MOHSW,NIDA,N EC Relative / Head of institution declares death to the nearest WEO/HF for registration and certification WEO/Informant complete Form/VERBAL AUTOPSY Deaths within Military Camp, Refugees, IDPs,Communal dwellings, etc Registration and Certification Deaths on SHIP MOFA receive the filled register from the registration center and send to RITA Registration and Certification Embassy/Informant Complete Form Deaths from Natural Causes Deaths from Natural Causes DED receive the filled form from the registration center and send to RITA HQ NBS desk at RITA Database System Analyze data and disseminate Ship Captain issue notification RITA receive filled forms and archive Health Facility for postmortem If error found return to service point Error verification? Quarter Report Deaths from other causes Police Informant report Death to the nearest WEO

9. Strategies to Improve CRV …..”One of the best ways to help the living is by counting the dead-Prabat Jha” Helping the living however, cannot stop at counting the dead. We we must proceed to establish who died and what they died of. Therefore it is important to come up with effective and planned strategies for improvement of the same

10. Inorder to have an efficient and complete CRVS, data should flow this way

11. Where do we want to go? The vision that will guide all actions and activities of the CR functions of RITA in improving Home Deaths is “All home deaths are counted”. It is an answer to the question: Where do we want to be in future. taking cognizance of the current state of the system and points out the direction how all home deaths should captured.

12. The mission for improvement of home Deaths strategic plan is: “ Helping the living however, cannot stop at counting the dead. We must proceed to establish who died and what they died of to safeguard rights of all and inform evidence-based decisions f.” The mission statement defines the fundamental purpose of registering home deaths, describing why it should exist and what has to be done to achieve the vision of the strategy.

13. RITA is striving to achieve full registrations of Births and Deaths in Tanzania Mainland’ and that the institution now has a history of proactive initiatives to improve the registration system with the ultimate objective of reaching down as far as possible to the grassroots of the Tanzania community in the villages and urban areas

14. The following are the strategies to Improve CRVS To re look the Law and decentralize registration to the grass root level Establish and enhance interoperable ICT infrastructure and systems Invest in multi-sectoral CRVS skills and capabilities icluding researches and training on use of verbal autopsy.

15. Collaboration and coordination with other cr departments and statistic bureau. Roll out new roles and responsibilities for CRVS management Advocate and promote awareness to the public on the importance of registering home deaths and the importance of giving out proper information to help come up with probable cause of death.

16. Thank you