1. Civil Registration in Sultanate of Oman Dr. Medhat K. ElSayed Its Development and Potential Implications on Vital Statistics

2. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 2 Objectives Health System in Oman – Brief Development of Civil registration – birth and death notifications Reporting on Vital Events before and after Civil registration Status of Vital Events Data Implications on Mortality & Fertility Estimates

3. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 3 Health System in Oman Total area is 309.5 thousands Km 2 –3% Plans –15% Mountains –82% Wadis & Desert 8 Governorates / Regions (now 9) with 60 Wilayates (61) 10 Health Regions (now 11) Upper Middle Income Total Government Expenditure millions RO 4469.8 (≈US$11,579.8 millions) Per Capita GDP RO 5321.5 (≈US$13,786) Total Health Expenditure 3% of GDP Per Capita Health Expenditure RO 84 (≈US$214) Source: Monthly Statistical Bulletin, Ministry of National Economy, volume 18(4), April 30, 2007

4. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 4 Health System in Oman … cont Population is about 2.6 millions; of whom 1.9 millions are Omanis (27% Expatriates) About 95% of enumeration areas are less than 1000 and present only 17.6% of the total Population

5. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 5 Health System in Oman … cont Relatively young –38.9% below 15 years of age –11.9% below 5 yeas of age Relatively high fertility –TFR 3.14 per women 15049 –CBR 24.75 per 1000 population Low Death Rates –CDR 2.53 per 1000 population –Life Expectancy at Birth 74.3 years –IMR 10.28 per 1000 Live Births Natural Increase Rate 2.2% Expected to double in 30 years

6. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 6 Health System in Oman … cont Public Health System –Government finance and provide health care and health services –Public health expenditure accounts for 80% of total health expenditure –Public inpatient services 98%, public dental services 41% and public outpatient services 81% –Government provides 93% of hospitals and 97.6% of hospital beds –Public health services has 78% of doctors 92.5% of nurses and 85% of other paramedics Ministry of Health is the main health Care provider (49 H, 4549 B, 145 HC) Other health care providers: –Armed Forces Medical Services (AFMS) (3 H, 260 B, 31 C) –Royal Oman Police Medical Services (ROPMS) (1 H, 48 B, 3 C) –Sultan Qaboos Hospital (SQUH) (1 H, 307 B, 1 HC) –Diwan Medical Services (Diwan MS) (1 C) –Petroleum Development Oman Medical Services (PDOMS) (9 C) –Private Sector (5 H, 732 C) H: Hospital, B: Beds, HC: Health Center, C: Clinics

7. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 7 Health System in Oman … cont A modern state started with the Omani Renaissance in 1970 Interests to document births and deaths started gradually after 1970 During early 80’s age estimation for public employees Age may not be accurate for a considerable proportion of people above the age of 25 years

8. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 8 Health System in Oman … cont Estimates for fertility and mortality indicators were based on surveys and studies with indirect statistical methods and models Events taking place were notified and certificates issued but no compulsory registration –Public Health Institutions: Issue certificates –Private Health Institutions: Notification of event to MOH –Home events: Notification of event by community leader (Sheikh – Wali) to MOH Well established information system capturing service events –Deaths: hospital deaths, dead on arrival, A&E deaths –Births: hospital births, born before arrival

9. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 9 Health System in Oman … cont Coverage of events registered could not be properly assessed Estimates could not be segregated by important parameters as age and sex –Mortality Estimates Age –sex specific death rates to allow for a life table analysis Infant mortality Rate, Under 5 mortality Rate Life expectancy –Fertility Estimates Age specific fertility rate for male and female births separately to allow estimating reproduction rates

10. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 10 Mortality Estimates

11. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 11 Fertility Estimates

12. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 12 Development of Civil Registration A Royal Decree (66/99) to develop a civil status was made in October 1999 but implementation took place only in May 2004 The law has established the Directorate General of Civil Status (DGCS) at Royal Oman Police (ROP) –Develop the implementing regulations of the Law –Register civil status events Events: birth, death, marriage, divorce, citizenship, residence –Issue certificates –Issue ID Cards

13. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 13 Notification of Births and Deaths Registration is based on notifications of events Establishment of a System of notification of vital events –Identification of all possible sources of notifications –One notification system Birth & Death Notification Forms :Consider requirements of CS Law and health sector Notification path Birth and Death Notification forms were developed by a body established by Minister of Health –Notifications considered needs: administrative needs, health needs

14. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 14 Possible sources of Notifications Place of birth or deathSource of notifications MOH Hospitals & HCMOH health institutions AFMS Hospitals and dispensariesAFMS health institutions ROP Hospitals and dispensariesROP health institutions SQU hospital & HCSQU hospital Private hospitals & clinicsPrivate health institution HomeCommunity leader (Sheikh – Wali) Factors, companies, roads, transportationNearest health institution –with ROP Outside OmanOmani mission in country where event Notification of Births and Deaths … cont

15. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 15 Flow of Notifications Notification of Births and Deaths … cont MOH: Ministry of Health; AFMS: Armed Forces Medical Services; Prvt HI: Private Health Institutions; ROPMS: Royal Oman Police Medical Services; CL: community leaders; OM: Omani Missions MOH SQUH AFMS Prvt HI ROPMS C L O M DG CS Client Copy of notification forms from places other than MOH

16. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 16 Assessment of 2006 Data from Vital Events Notification Missing segregation information Pattern according to age Completeness (coverage)

17. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 17 Segregation of information Assessment of 2006 Data from Vital Events Notification … cont Gender unknown for 30% of notified deaths

18. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 18 Segregation information … cont Assessment of 2006 Data from Vital Events Notification … cont Unknown age of notified deaths

19. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 19 Segregation information … cont Assessment of 2006 Data from Vital Events Notification … cont Sex of newly born un reported

20. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 20 Segregation information … cont Assessment of 2006 Data from Vital Events Notification … cont Un-reporting age of mother for newly born

21. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 21 Pattern according to Age and Sex Assessment of 2006 Data from Vital Events Notification … cont

22. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 22 Completeness or Coverage Assessment of 2006 Data from Vital Events Notification … cont Males Coverage 98% Using Brass’s Growth Balance Method (preliminary analysis) Females Coverage 97%

23. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 23 Mortality Estimates 2006 Current estimate 2006 estimates using notifications of Vital events OmaniExpatOmaniExpat CDR - Overall2.48Not available2.91.2 CDR - MaleNot available 3.41.2 CDR- FemalesNot available 2.31.1 e 0 - Overall74.29Not available72.681.6 e 0 - MaleNot available 70.481.9 e 0 - FemalesNot available 74.981.2 ASDRProjectedNot availableavailable

24. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 24 Mortality Estimates … cont 2006 Current estimate 2006 estimates using notifications of Vital events OmaniExpatOmaniExpat IMR - Overall10.25Not available10.18.1 IMR - MaleNot available 119 IMR- FemalesNot available 9.27.1 U5MR - Overall11.02Not available12.812.9 U5MR - MaleNot available 13.813.5 U5MR - FemalesNot available 11.86

25. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 25 Fertility Estimates 2006 Current estimate 2006 estimates using notifications of Vital events OmaniExpatOmaniExpat CBR - Overall24.17Not available24.25.7 CBR - MaleNot available 24.63.7 CBR- FemalesNot available 23.713.4 TFR3.19Not available3.191.03 Sex ratio birthNot available 105.8101.7 GRR (females)Not available 1.550.51 NRRNot available 1.510.50

26. Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics 26 Obstacles and challenges Notifications by Community Leaders –Need to assess completeness –Data on notification forms need to be completed especially health related data –Cause of death is an issue to consider Burial permit –No burial permit is required –Can affect completeness of death registration Cultural believes and attitudes for registration –Age estimation has been practice for a long time –Changes in believes about importance for registration Cause of death data –Physician and coders need training –Deaths outside health facilities: DOA, A&ED, Notified by CL