Linking civil registration to the health system. Impact evaluation - PDF document

Linking civil registration to the health system. Impact evaluation study in Burkina Faso (evelinamartelli@gmail.com), 1 Evelina Martelli Maria Castiglioni (casti@stat.unipd.it), 2 (ansilves@istat.it), 3 Angela Silvestrini Francesco Di (francodido@gmail.com), 4 Domenicantonio Palmira Gianturco (miragianturco@gmail.com) 5 1 Community of Sant’Egidio, Rome, Italy 2 Department of Statistics, University of Padua, Italy 3 Istituto Nazionale di Statistica (ISTAT); Rome, Italy 4 Municipality of Rome, Italy 5 Community of Sant’Egidio, Rome, Italy Introduction Civil registration is the administrative tool to record occurrence and characteristic of major vital events (mainly births, marriages, and deaths). The primary function of civil registration is to provide individuals with those legal documents needed to officially establish identity, family relationships, and entitlement for rights. Particularly for children such documentation helps to protect them from exploitation and hardship. Furthermore, it produces benefits for the state through the link with other services, such as healthcare, election, tax, and others. Civil registration and Vital statistics (CRVS) systems are increasingly considered crucial for strengthening democracy, governance, and development. CRVS entail fundamental benefits for monitoring progress in basic human rights, including the development goals. The record of vital events is the major source for tracing fertility and mortality, moreover it helps to monitor population size and changes. 1 Compared to other evaluation systems, like censuses and surveys, civil registration in the long term is more accurate and cost effective thanks to its greater reliability and its characteristic of tracking changes over time. 2 National statistical systems of high income countries are progressively based on exploitation of administrative data of population 1 Setel P W, Macfarlane S B, Szreter S, Mikkelsen L, Jha P, Stout S, AbouZahr C, A scandal of invisibility: making everyone count by countig everyone, Lancet 2007 : published on line October 29. DOI:10.1016/S0140- 6736(07)61307- 5. 2 AbouZahr C, de Savigny D, Mikkelsen L, Setel P W, Lozano R, Lopez AD, Towards universal civil registration and vital statistics system: the time is now. Lancet 2015; published on line May 11. http://dx.doi.org/10.1016/S0140- 6736(15)60170-2. 1

registers, gradually replacing traditional censuses. Studies present evidence that well functioning CRVS are associated with better population health outcomes 3 and development. 4 The World Bank, the WHO, UNICEF, the UN, and its Regional Commissions, as long as other UN agencies and Pan African Institutions are very committed in ensuring that countries receive practical guidance on CRVS. Though several studies, reports, and articles stress the ultimate need for innovative approaches on CRVS strengthening in low income countries and for evidence of working strategies and approaches. Effective and sustainable methodologies are very urgently needed. Although evidence of the usefulness of well functioning CRVS systems has been demonstrated in many different fields, it has been noticed that “the lack of major progress in CRVS is probably the most critical development failure during the era of the Millennium Development Goals (MDGs)”. 5 The Community of Sant’Egidio started the Birth Registration for All Versus Oblivion (BRAVO!) Program in order to promote civil registration to safeguarding legal protection and fundamental rights especially for the most vulnerable children. BRAVO! is currently cooperating with the governments of Burkina Faso, Mozambique, and Malawi with the aim to realize universal, continuous, permanent, and compulsory civil registration systems. 6 One of the key areas of interventions is the effort to guarantee the sustainability of the system through universality of infant birth registration. To this end, BRAVO! supports the opening of new civil registration offices in health centres providing neonatal services. Up to now 10 registration centres have been opened in Mozambique, 12 in Malawi, and 13 in Burkina Faso. In 2015 the Community of Sant’Egidio started a prospective study with comparison with historical cohort in Burkina Faso to look over the outcomes of the linkage between civil registration and health care system at a decentralized level. Methods Study area Both the action of BRAVO! and the prospective study verifying its effectiveness are fully integrated within the framework of the Burkina Faso laws, regulations, and programmes. Burkina Faso’s legislation provides that every municipality has a principal civil registration centre (CPEC) right at the city hall. The mayor, in its duty of civil registrar, may create secondary civil registration centres (CSEC) in villages and health centres. The acts must be drawn up only in the municipality where the event occurred. In the CSEC only births and deaths can be registered for free in the prescribed period by law - i.e. 61 days. Delayed birth and death registration can occur upon payment of the advised fine only in the CPEC, following a judicial procedure by the local administrative court. 3 Philips D E, AbouZahr C, Lopez A D, Mikkelsen L, de Savigny D, Lozano R, Wilmoth J, Setel P W, Are well funcioning civil registration and vital statistics systems associated with better health outcomes? Lancet 2015; published on line May 11. http://dx.doi.org/10.1016/S0140-6736(15)60172-6. 4 Harbitz, Mia, and Bettina Boekle-Giufrida, ‘Democratic Governance, Citizenship, and Legal Identity’, Working Paper, Inter-American Development Bank, Washington, D.C., 2009. 5 Shibuya K, Gilmour S, Civil registration as a means to promote human security. Lancet 2015; published on line May11. http://dx.doi.org/10.1016/S0140-6736(15)60765-6. 6 United Nations (UN). Principles and recommendations for a vital statistics system, Revision 2. UN, 2001. 2

The prospective study 7 with comparison with historical cohort has been conducted in the Centre Ouest Region of Burkina Faso. The country was chosen because it is a low-income ($615 gross per capita income in 2015), landlocked Sub-Saharan country, where CRVS performance is not assessed by the Vital Statistics Performance Index (VSPI) due to the poor production of data. 8 Moreover, the area was chosen due to its low birth registration coverage: according to MICS IV, 2010, national birth registration rate among children 0-5 years old is 77%, in the Centre Ouest Region is 62%. 9 It is the second region for low child registration rates after the Sahel. The 2006 census detected an overall birth registration rate of 62 · 3%, with small variances between age classes, and with a difference of 12 points between women (lower) and men. 10 The implementation of special free of charge late registration campaigns has dramatically changed the situation. Particularly important was the national campaign promoted by the government in collaboration with the Community of Sant'Egidio in 2009: for 12 months teams of judges and civil registration agents visited every village and urban area in the country to offer free delayed registration of births to those lacking birth certificate. The 2014 multisectoral permanent inquiry 11 has shown that the overall birth certification (the possession of the birth certificate by the individual) rate is 79 · 2%, being that of men 4 · 7% higher than that of women. Also it pointed out that in the 40-49 age class there is the highest birth certification rate (92 · 1%), and in the 0-4 years the lowest (59 · 9%). Even among children under the age of five, birth registration is mostly done with late procedures, as demonstrated in a different context by a study on MICS data processing. 12 To improve civil registration system and make it a permanent one, it clearly means to create a system favouring timely registration of new-borns. Health data for the two studied municipalities show a high coverage of neonatal services, with a percentage of assisted deliveries of 73 · 3% and of immunization for tuberculosis and pentavalent first dose of 100%. 13 Moreover, they show that the target population for the health facilities is between 5,000 and 20,000 inhabitants, more than half the cases (52 · 5%) living less than 5 km from the centre and only one out of five (20 · 1%) living more than 10 km away from the centre. The distribution of health centres is certainly more widespread than other services provided by the State for early childhood. Study design 7 The study have been approved by the Comité d’ethique pour la recherche en santé of Burkina Faso, decision N° 2016- 5-063 del 4.5.2016 . 8 Mikkelsen L, Phillips D E, AbouZahr C, Setel P W, de Savigny D, Lozano R, lopez A D, A global assessment of civil registration and vital statistics systems: monitoring data quality and progress. Lancet 2015May 11. http://dx.doi.org/10.1016/S140-6736(15)60171-4. 9 EDSBF- MICS IV, 2010. 10 Institut national de la statistique et de la démographie (INSD), Recensement général de la population et de l’habitation (RGPH) de 2006 du Burkina Faso. 11 Institut national de la statistique et de la démographie (INSD), Enquête multisectorielle continue (EMC) 2014. Caractéristiques sociodémographiques de la population, novembre 2015. http://www.insd.bf/n/contenu/enquetes_recensements/Enq_EMC/Caract%e9ristiques_sociodemographiques_de_la_pop ulation.pdf 12 Makinde O A, Olapeju B, Ogbuoji O, Babalola S, Trends in the completeness of birth registration in Nigeria: 2002- 2010. Demographic Research 2016 Published August, 17, Vol. 35, Art. 12pp. 315-338. Published Online at: http://www.demographic-research.org/Volumes/Vol35/12/DOI: 10.4054/DemRes.2016.35.12. 13 District sanitaire de Réo, Plan d’Action 2016, Mai 2015. 3