1. THE CIVIL REGISTRATION SYSTEM IN GHANA/COORDINATION AMONG THE REGISTRATION, STATISTICS AND HEALTH SECTORS Presented by Kingsley Asare Addo Principal Assistant Registrar Ghana 1

2. Background to vital registration in Ghana  1888-Vital registration started in in the Gold Coast (now Ghana) - regulated by Cemeteries Ordinance  1912-Births, Deaths and Burials Ordinance enacted to replace law of 1888- birth registration introduced  1965- Registration of Births and Deaths Act passed to: -ensure compulsory and universal registration of births/deaths in Ghana -Promote public health in the country. -Establish an efficient system of births and deaths registration records for the citizenry -Obtain vital statistics data which are adequate and efficient enough for deriving reliable demographic estimates to support public health planning, for policy formulation at various levels of governance and for development planning in the country 2

3. Birth Registration Process 3 Live Births occurring in Hospitals/Health Facilities Public Hospitals Private Hospitals Medical Certification ( Road to Health Card) Clinics (Doctor/Midwife/ Child Welfare Clinic) Maternity Homes PARENTS/ RELATIVE BIRTHS AND DEATHS REGISTRY GHANA STATISTICAL SERVICE (Birth Certificate) Live Births Occurring outside Health Facilities Home CHN TBA PARENT/RELATIVE Others CV Abandoned Children Police Social Welfare Children’s Home

4. Death Registration Process 4  Deaths occurring in Hospitals /Health facilities  Public Hospitals  Private Hospitals Medical Certification (Medical Certificate of Cause of Death)  Clinics (Doctor)   RELATIVE Cemetery  (Burial Permit)  BIRTHS AND DEATHS REGISTRY Ghana Statistical Service  Deaths occurring outside health facilities  Home  Police Coroner RELATIVE  (Coroner’s Inquest Report)  Others  Community  Volunteer  Cemetery

5. Operational Structure 227 Registries and reporting centres at the community level 170 District offices 10 Regional Offices Supervise registration in regions National data organised and disseminated from here Central Registry Office Regional Registration Office District Registration Office Regional Registration office District Registration Office 5 registry Reporting centre registry

6. The Staff Situation REGIONPOPULATION ( 2000 POPN. CENSUS ) NO. OF REGISTRIES NO OF STAFFADDITIONAL STAFF REQUIRED NO. OF VEHICLES ALL REGIONS18,912,07939733937827 H/ OFFICE0043-3 WESTERN1,924,57734303851 CENTRAL1,593,82345373191 GT. ACCRA2,905,72654624211 EASTERN2,106,69653404210 VOLTA1,635,42149243270 ASHANTI3,612,95053357231 B/AHAFO1,815,40840223630 NORTHERN1,820,80630143640 U/EAST920,08918121840 U/WEST576,58321201150 6

7. Partnerships and linkages 7 BIRTHS AND DEATHS REGISTRY Hospitals, clinics CHPS, CHN, DSS (Community Events) Volunteer, TBA, Chiefs STATISTICAL SERVICE Police, Coroner Social Welfare District level planning Regional Level planning National Level planning National identification Education, passport, social security Employment, electoral commission d

8. Registered births (0-12 months only) 2000-2008 REGION POPULATIO NEXPECTED BIRTHSREGISTERED BIRTHS% COVERED ALL REGION S 200018,912,079756,483236,33531 200119,422,705776,908211,08127 200219,947,118797,885138,15117 200320,485,690819,428239,91929 200421,038,804841,552430,12751 200521,606,852713,026476,25167 200622,190,237732,278391,84154 200722,789,373752,049466,12962 200823,404,686772,355 392,89851 8

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10. Coverage and completeness of system 10  Ghana’s popn. 2000 census = 18,912,029  Total popn with registration facilities= 4,609,523  Coverage of registration = 25%  Completeness of registration  YearBirth(%)Death(%)  20003120  20012722  200217Average21 Average  20032923  200451 49%24 25%  20056724  20065423  20076224  20085122

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12. Registered deaths (within 12 months of occurrence only) 2000- 2008 REGION POPULATIONEXPECTED DEATHSREGISTERED DEATHS % COVERED ALL REGIONS 200018,912,079226,94545,40220 200119,422,705233,07251,63922 200219,947,118239,36549,53021 200320,485,690204,85747,49223 200421,038,804210,33850,62524 200521,606,852216,06952,07924 200622,190,237221,90251,84123 200722,789,373227,89454,23424 200823,404,686234,04752,38222 12

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14. Challenges 14 Major challenges include:  Low utilization of vital statistics for policy decisions  Limited Access to registration facilities  Low public knowledge about importance of registration  Inadequate staff  Inability to attract and retain highly qualified personnel due to low remuneration and poor service conditions  Inadequate funding for the Registry,  Difficulty in motivating registration volunteers  Lack of logistics including accommodation, vehicles, requisite statistical software and programmes.  Absence of training opportunities for sector staff  Weak monitoring and supervision mechanisms.

15. Strategies to improve coverage 15  BUILDING PARTNERSHIPS Collaboration with Ghana Health Service-participation in Child Health Promotion Campaign, Integrated Maternal and child health programmes, May & Nov. Every year - -Trained Community Health Workers (1,000) & Community Volunteers (1,250)to collect info. On vital events - - Collaboration with Ghana Statistical Service, District Assemblies & Plan Ghana to pilot a Community Population Register Programme in 4 regions.

16. Strategies to improve coverage cont’d 16  AWARENESS CREATION - Public education initiated-use of radio, TV & press - Community Durbars - Mobile registration -UBR Campaign- led by “Goodwill Ambassador” for birth registration  - “Births and Deaths Registration Day” celebration instituted in Ghana – 1 st September every year since 2004

17. Improving quality of data 17  Computerising data storage, management, analysis & retrieval  Early registration of vital events- community based operatives get first hand information of vital events  Capacity building for Registration staff- training in statistical data analysis, management and reporting  Development and use of Standard operating procedures country wide  Reviewed data capture documents to conform with international standards

18. Form Processing Environment

19. Way Forward 19  Make registration facilities accessible to rural populations by expanding community population register programme to cover more rural communities in Ghana  Step up and sustain public education on importance and benefits of vital registration  Strengthen collaboration with all stakeholders to achieve universal registration  Training and scaling up of verbal autopsy nation-wide

20. Way Forward cont’d 20  Pursue total computerisation of programme – link all regional offices to Central office through WAN in the short term and in the long term all district registration offices.  Capture backlog of data stock- 1912 to 2008  Interface with stakeholders-  Ghana Health Service  Ghana Statistical Service  Ministry Of Health,  National Identification Authority  Electoral Commission  Ghana Immigration Service  SSNIT, DVLA, etc 

21. Making vital registration relevant 21  Ghana will seek to improve on its vital registration system by: a) Increasing coverage of the registration machinery ( operationalising population registers in all communities) especially in rural areas b) Fine-tuning datacapture, processing, management, storage & retrieval c) Make vital registration data available for use by health institutions, researchers, policy makers, development planners.

22. 22  Thank You

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27. Clips from BDR day Celebration 2007 27