Synthesis Report Review of Civil Registration and Vital Statistics Innovations in Eastern and Southern Africa Region: Digitization, processes, and ...
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© UNICEF/Crittle/Zambia
Synthesis Report
Review of Civil Registration and Vital Statistics
Innovations in Eastern and Southern Africa Region:
Digitization, processes, and strategies
UNICEF EASTERN AND SOUTHERN AFRICA
Acknowledgements T his report is the result of a collaborative process initiated in UNICEF ESARO by Sean Blaschke (Technology for Development Business Analyst) and Eri Mathers Suzuki (Child Protection Specialist), with support from Jean Francois Basse (Child Protection Advisor) and Deepak Bhaskaran (ICT and Innovation Chief). The report was written by Zoran Djokovic (Consultant for the eCRVS Review). Our warm thanks and appreciation go to all those who provided materials and thoughtful comments on successive drafts: Karin Heissler (UNICEF Ethiopia), Nikodimos Alemayehu (Ethiopia), Charles Otine (UNICEF Kenya), Monika Sandvik-Nylund (Kenya), Frauke de Kort (UNICEF Namibia), Ingrid Celeste Feris (UNICEF Namibia), Edina Kozma (Mozambique), Edith Wilhelmina Maria Morch-Binnema (Mozambique), Neidi de Carvalho (Mozambique), Jean Lieby (UNICEF South Sudan), Richard Ambayo Silas (UNICEF South Sudan), Bhaskar Mishra (UNICEF Tanzania), Maud Droogleever Fortuyn (UNICEF Tanzania), Nelson Rodriques (UNICEF Tanzania), Augustine Wassago (UNICEF Uganda), Birgithe Lund-Henriksen (UNICEF Uganda), Diclerk Asiimwe (UNICEF Uganda), Innocent Mofya (Zambia), Katlin Brasic (Zambia), Alfred Assey (UNICEF ESARO), Maria Muniz (UNICEF ESARO), Hawi Bedasa (UNICEF WCARO), Mirka Mattila (UNICEF WCARO), Milen Kidane (UNICEF Nigeria), Minu Limbu (UNICEF Nigeria), Benjamin Grubb (UNICEF EAPRO), Georgia Hill (UNICEF HQ), Kirsten de Marino (UNICEF HQ), Kristen Wenz (UNICEF HQ), and Remy Mwamba (UNICEF HQ), Chris Seebregts (Jembi), Linda Taylor (Jembi), Annina Wersun (Plan International), Edward Duffus (Plan International) and Martin Bratschi (Vital Strategies), Finally, none of this would have been possible without the support of our government counterparts in Ethiopia, Mozambique, Namibia, South Sudan, Tanzania, Uganda, and Zambia.
SY NTH ESIS R EPOR T
Table of contents
Abbreviation And Acronyms................................................................................................... 2
Executive Summary..................................................................................................................... 3
Bringing Registration Closer To The People Through Decentralization............... 3
Digitization..................................................................................................................................... 4
Section 1: Introduction.............................................................................................................. 6
Scope Of The Review...................................................................................................................... 6
Glossary Of Terms......................................................................................................................... 6
Section 2: Methodology............................................................................................................. 8
Section 3: Background............................................................................................................... 9
Section 4: Current Trends In Registration In Esar........................................................ 11
Decentralization As Means Of Eliminating Barriers To Registration....................... 11
The Role Of Local Authorities................................................................................................... 12
The Role Of Health Facilities.................................................................................................... 12
Skills And Qualifications Of Registration Officials........................................................ 13
Decentralization And Related Registration Integrity Risks......................................... 13
Increasing Demand Through Incentives As Alternative To Decentralization....... 15
Registration Of Children On The Move................................................................................. 15
Section 5: Digitization Of Registration Process............................................................. 17
Social Sector Benefits Of Digitization And Data Interoperability............................. 17
Leveraging “Register Once” Principle Through Interoperable Ict Platforms...... 17
Personal Unique Identification Number (Uin)..................................................................... 19
Best Practices On Business Process Mapping..................................................................... 19
Crvs Software Platform Models And Their Design......................................................... 20
Platforms For Digitizing Registration Data In The Field................................................ 21
Leveraging Mobile Networks For Birth Notification/Digitization.............................. 22
Digitization Of Existing Paper-Based Records.................................................................... 24
Intersections With Civil Identification................................................................................. 25
Section 6: RECOMMENDATIONS.................................................................................................... 27
Appendix: Country Case Studies............................................................................................. 28
Ethiopia............................................................................................................................................. 28
Mozambique.................................................................................................................................... 35
Namibia.............................................................................................................................................. 45
South Sudan.................................................................................................................................... 51
Tanzania............................................................................................................................................ 59
Uganda.............................................................................................................................................. 70
Zambia................................................................................................................................................ 77
1
SYNTHESIS REPORT
Abbreviation and acronyms
APAI - CRVS The Africa Programme on Accelerated Improvement of Civil
Registration and Vital Statistics
API Application programming interface
CRVS Civil registration and vital statistics
DHIS2 District Health Information System
ESAR Eastern and Southern Africa region
ESARO Eastern and Southern Africa Regional Office
GSM Global System for Mobile Telecommunications
ICT Information and communications technology
ID Identification
IT Information technology
KYC Know your customer
LTE Long-Term Evolution (4G mobile network standard)
VRS Vital Records System
MoU Memorandum of understanding
NITA National Information Technology Authority
NPRS National Population Register System
SMS Short Message Service
UIN Unique Identification Number
UNICEF United Nations Children’s Fund
UNDP United Nations Development Programme
UNFPA United Nations Population Fund
UNHCR Office of the United Nations High Commissioner for Refugees
USB Universal Serial Bus
USD United States Dollars
USSD Unstructured Supplementary Service Data
UXP Unified eXchange Platform
WHO World Health Organization
2
SY NTH ESIS R EPOR T
Executive summary
Across the Eastern and Southern African region, stakeholders, which in turn can improve access, facilitate
countries are applying both technological and non- new services, create new efficiencies, and lower
technological innovations to improve their civil operational costs to health, education, immigration, tax
registration and vital statistics (CRVS) systems. In and other government services.
line with recommendations from comprehensive
assessments of their national CRVS systems, these Guided by comprehensive assessments from the
countries have developed reform policies focusing on Africa Programme on Accelerated Improvement of
two distinct areas: Civil Registration and Vital Statistics (APAI-CRVS),
government ministries have developed elaborate
• increasing the number of registration points by national reform strategies. Adoption of new or reforming
decentralization of registration responsibilities to local existing legislation was the starting point for the reforms
authorities and health facilities; and and provided a legal basis for a range of institutional and
administrative processes defined in their action plans.
• improving business processes and the management The end result is demonstrated in significant progress
of existing registration records by shifting from paper- towards full digitization of CRVS systems and increasing
based manual business processes to a combination of coverage of vital events registration. Despite general
paper-based and digitized process. commitment to improving overall CRVS systems, the
focus of these reforms is largely directed towards
Digitization of registration records is not only seen as a increasing birth registration coverage and, to a lesser
way to improve CRVS business processes. It has also extent, death registration. Marriage registration, as well
been recognized to enable CRVS systems to share as other vital events, appear not to be a priority at this
anonymized identity data with other social sector stage
Bringing registration closer to the people through decentralization
Comprehensive assessments that precede CRVS involved in birth and death events to actively take part in
system reforms largely recommend decentralization the notification/ registration process.
to increase supply of registration services. These
assessments find that the distances individuals often In Tanzania, birth registration services at health care
need to travel to reach registration centres (generally facilities are provided right after birth or later, when
based in district centres) and the number of visits they mothers come with their children for immunization. The
need to take in order to complete the registration are importance of health facilities is further demonstrated in
often a significant financial burden. At the same time, the cases of Mozambique and Uganda, where the lack
the general population, especially in rural areas, finds of birth notification services at the health care facilities
obtaining a birth certificate provides little immediate is seen as one of the reasons why registration rates are
value. The long-term value of these certificates is not lower than anticipated.
often sufficiently understood.
Through delegation of some registration responsibilities
Generating demand through incentive
from central registration authorities to local authorities, schemes
as well as to local health facilities, the burden can be The decentralization process has been the key to
significantly reduced. UNICEF Tanzania, for example, strengthening CRVS systems on the registration supply
estimates that families registering the births of their side. However, creating stronger demand from the
children altogether save approximately US$24.8 million general population for registration is an area that offers a
a year, simply because there is no longer a need to lot of potential towards ensuring maximum registration
travel to district registration centres. Not only is birth completeness. Providing the first birth certificate free
notification delegated to the level of local communities, of charge, as shown in the United Republic of Tanzania
notification and certification are combined into one served as a major motivation for parents of children
process, enabling local communities to provide both under 5 years of age to complete birth registration late,
services as part of a single visit to the registration point. especially when this policy is combined with a high level
Coupled with the decision to issue the first registration of decentralization of registration services.
certificate free of charge, the United Republic of Tanzania
has succeeded in almost clearing its entire backlog of The great potential of financial incentive schemes
unregistered children under 5 years of age in the areas is equally evident in Namibia, where a scheme of
where these programmes are being implemented (see social grants linked with birth and death registration
Annex: Tanzania Field Report). contributed to a significant increase in the completeness
of birth registration and – even more dramatically – of
Decentralization is further achieved in many countries death registration. Namibia’s example also shows
in partnership with health authorities, often resulting in that where strong incentive schemes exist systems
the designation of health facilities as birth notification/ can operate successfully even if they are not highly
registration points. This enables health workers directly decentralized.
3
SYNTHESIS REPORT
Maintaining the legality and integrity of the are not being used to create several similar registration
records. Furthermore, verification of registration data
registration system and authorization of birth certificates occurs at district
The decentralization strategy has proved to be level. This verification helps prevent unauthorized
successful at driving the registration rates higher; distribution of certificates at local community level, as is
however, this policy poses many risks for the integrity the approach taken in the United Republic of Tanzania).
of the registration process. The capacity of registrars at
sub-national level is also an issue. Limited availability In spite of these concerns, in a situation where the
of resources – including lack of internet connectivity – CRVS system is weak, concerns linked with the lack of
creates additional challenges safeguards to registration integrity should not impede
the introduction of a decentralized registration system.
Ensuring strong oversight over the integrity of
registration process becomes much more difficult as Decentralization offers a wide range of opportunities
the number of registration points increases. Some for facilitation, and a better enabling environment
people might decide to register the same vital event for increasing the coverage rates of vital events. The
in several places or register the same newborn under protection of the rights of children that comes with
different names including in more than one registration birth registration should clearly take priority. With
centre. Where the value of completing registration is this approach in mind, the highest priority should be
perceived to be low among the general population, assigned to capturing information on the occurrence
this is generally not an issue for concern, but as the of the birth. Ensuring legal integrity should also remain
registration rates increase and the value of completing a priority but this should be seen as a process that is
registration increases the CRVS system can increasingly gradually introduced. As registration rates increase,
become a target of fraudsters. Generally, such concerns enforcement of documentary support requirements can
can be offset by the collection of identification data gradually be strengthened, but not at the expense of
from the parents and de-duplicating records in central lowering registration rates.
digitized system, to ensure that the same parents’ data
Digitization
The countries featuring in this review have all made process. In Namibia, the highly integrated digitized
strategic decisions to shift civil registration business system enabled the authorities to reveal multiple
processes from paper-based to digital registration data registrations of a single event at the point of registration,
collection, processing, keeping and sharing. Digitization or multiple registrations in the past of a single event.
is also one the key recommendations of comprehensive The introduction of a unique identifier further reduces
national CRVS assessments and holds a central place the likelihood of a single event being registered more
in strategic and action plans for improving national civil than once. Ensuring such a high level of safeguards is
registration systems. very hard, if not impossible, to achieve with paper-based
registration systems.
Digitized collection, processing and storage of
registration data provides a range of important benefits. CRVS integration in the national interoperable
Use of digital technologies has become a norm for
contemporary civil registers, enabling easier processing, ICT platforms
storage and sharing of registration records. In many Another significant benefit of digitized systems
European countries (such as Lithuania, the Netherlands comes from the ability to share registration data with
and Sweden, among others) vital events records are information and communications technology (ICT)
further aggregated into one central national database platforms of other public administration bodies. For
or national population register. This review shows that instance, birth and other civil registration records can
Namibia, Mozambique and the United Republic of be accessed directly during the process of issuing
Tanzania have also opted to take the same approach, identification documents or travel documents. The
to ensure that all registration records are aggregated information can be also extended to the authorities
in a single central database architecture. Registration responsible for maintaining of other functional registers.
points are equipped to capture registration data in digital As each person’s legal identity information changes
format, to communicate this data to the central register from birth until death, digitized CRVS systems enable
and to retrieve the data from the central register as all other public administration stakeholders to operate
required. with the most up-to-date legal identity information of
their customers and/or beneficiaries. Permanent and
This approach dramatically expands potential for continuous registration of vital life events as they occur
improving registration services. For instance, any positions CRVS systems as the primary source of up-
registration record can be retrieved instantly by any to-date information on legal identity. Once established,
registration point connected to the central database and extraction of vital statistics information is greatly
registration certificates can be printed. facilitated, and paper registration certificate will become
less important. Interoperability and interconnection
Centralized digital processing of registration records between government ICT platforms is the key
also greatly improves the integrity of the registration precondition for these concepts to become a reality.
4
SY NTH ESIS R EPOR T
Design of a digitized CRVS platform Ultimately, a long-term solution could be built around
an open source platform developed as a global good.
Decisions on the specifications of ICT platforms to
Examples of such an approach have been demonstrated
support a digitized CRVS system have long-term
in the health sector with the DHIS2 platform. This
consequences for the operating of the system. The
platform has alleviated a great deal of responsibility
review shows that in countries where digitization is
from health authorities when it comes to developing and
underway the authorities have opted either to develop
implementing Health Management Information System
in-house bespoke custom ICT solutions or to procure
programmes.
off-the-shelf proprietary ICT solutions.
At present, a similar open platform directed strictly to
Complex digital platforms are constantly the subject of
CRVS business processes is being discussed within
updates and improvements, in response to constant
the expert community with the goal of defining an
improvements of hardware and software technologies
OpenCRVS platform (www.opencrvs.org). Like in the
that offer new opportunities, and faster and more
case of DHIS2, such platform in the CRVS area would
affordable data processing. Procuring an entire system
alleviate the need to develop bespoke ICT systems,
as proprietary software leads to vendor lock-in, limits
expand the pool of commercially available modules
opportunities to update the system as requirements
built around this open source platform and provide
change over time and creates dependency on the
the authorities with an option to choose from different
external vendor for procuring system upgrades (which
products on the market when making system upgrades.
can ultimately come at unreasonably high costs).
Previous efforts to improve civil registration in the region
To avoid vendor lock-in, it is important that the
show that a stand-alone digitized CRVS system is always
intellectual ownership of the system is preserved by the
difficult to scale. Often, securing sufficient financing for
authorities owning the system. Intellectual ownership
standalone CRVS systems was seen disproportionally
is a precondition for planning and implementing future
costly and therefore neglected. Digitized CRVS systems
upgrades, as well as scaling up of the system. Even in
bring new value, as interoperability and interconnection
such circumstances, problems can arise if the developed
with other government systems position CRVS systems
software platforms remain bespoke and unique to the
as an important source of identity data for the issuance
national system. Maintaining such a system requires
of identification documents by social service providers
great commitment and strong ICT capacity on the side
such as health and immunization authorities, education
of the registration authorities, to ensure intellectual
authorities and social protection authorities. This makes
ownership and continuous upgrades.
the decision to scale up and invest in CRVS systems
a matter of building a sustainable national identity
The review shows that the need for strong in-house ICT
management system.
development capacity can be leveraged by strategically
relying on public-private partnerships in order to
outsource future upgrades to external partners, whether Risks linked with digitization
these are commercial companies, public institutes or Platforms for digital personal information processing
universities. Examples of practical implementation of must be built strictly for the purpose for which they
such partnership are further elaborated in annexed have been designed and as defined in the law. If this
country reports for Namibia, Uganda and the United is not the case, digital platforms offer a broad range
Republic of Tanzania. of opportunities for identity data misuse and can lead
to serious human rights violations. It is therefore
A new solution that is yet to be fully explored resolves paramount in the development of digitized CRVS
the problem of vendor lock-in and problems linked platforms – especially in cases where the data can
with bespoke ICT systems: this is designing of system be shared with other ICT systems – that the data
around modules, each of which is built around existing sharing takes place in a regulated environment built
ICT standards defined by relevant standard-setting on a robust regulatory framework for data and privacy
organizations. As long as the ICT component strictly protection. The regulatory framework should inform
meets the defined standards, the modules can be the development of the institutional framework for
developed internally, in cooperation with external data and privacy protection and define the duties and
partners or procured as an off-the-shelf product. responsibilities of the institutions defined as data
Furthermore, the ICT solution should be compliant processors.
with the existing or projected interoperability standards
defined in the existing government interoperability
framework strategy
5
SYNTHESIS REPORT
Section 1: Introduction
Civil registration and vital statistics (CRVS) systems Despite this unanimous recognition, civil registration
are essential in modern society. Civil registration systems are largely dysfunctional and incomplete
provides individuals with essential legal documents across most countries on the African continent. The
required to certify their legal identity – and in some births of around 95 million children under the age of 5
cases their nationality – and to enjoy fundamental, years in sub-Saharan Africa have never been recorded.
civil rights and access to social services. Compilation Possession of a birth certificate is even less common –
and analysis of vital statistics from civil registration are 120 million of the region’s children under age 5 do not
critical for estimating annual changes in population size have birth certificates. A rapidly growing child population
and structure, and for planning and monitoring social coupled with slow rates of change means that if current
programmes, such as health, education and population trends continue there could be close to 115 million
interventions. Comprehensive, accurate and timely vital unregistered children under age 5 in sub-Saharan Africa
statistics are also essential for monitoring and reporting by 2030. As such, a majority of the population remain
regularly on progress towards achieving the globally legally ‘invisible’ in the eyes of the state, denying
agreed development goals of the 2030 Agenda for them the right to be known and planned for by their
Sustainable Development. governments, access to fundamental opportunities and
services, as well as the ability to claim their rights or to
participate in governance processes.
Scope of the review
This review focuses on CRVS innovations, such as To this end the review looks into both technology- and
digitization, processes, and other strategies, in Ethiopia, non-technology-based solutions to improve CRVS
Mozambique, Namibia, South Sudan, Uganda, the systems. While priority is given to registration of birth
United Republic of Tanzania and Zambia with the view to and death, the review also addresses registration of
providing a detailed overview and analysis of innovative other types of vital life events. In addition, the review
approaches reforming vital live events registration focuses on innovative approaches to ensuring timely
processes to increase registration coverage. notification, declaration, validation and certification of
vital events.
The review has been developed to inform and to support
UNICEF, as well as the wider development community, The review has been conducted to contribute to
to advise, design, prioritize and coordinate future enhanced understanding of the solutions which have
development assistance policies, projects and funding added value from technological and programmatic
to support governments to build sustainable CRVS perspectives. It provides examples of strong evidence-
systems, to achieve universal coverage and to contribute based strategies related to innovation and technology
to other development outcomes, particularly in the areas and offers recommendations as to how UNICEF and
of health, education and social welfare/child protection. partners can better assist authorities to determine when
and where technological and programmatic innovations
The review is intended: can be effectively applied to improve birth and death
registration. The review analyses the registration process
• to strengthen existing investments where the CRVS with the aim of informing wider processes linked with
digitization process has already started or is mature, developing the capacity of authorities in the region to
as well as to guide UNICEF country offices and collect up-to-date and accurate personal information
partners that are just beginning this process, and and use it efficiently for the issuance of identification
documents, as well as the planning and delivery of
• to identify the enablers and the environment that state-guaranteed services.
must be in place (i.e. the maturity model) for countries
to be successful in this process.
Glossary of terms
As a United Nations operational definition, legal identity death certificate by the civil registration authority upon
is defined as the basic characteristics of an individual’s registration of death.1
identity – such as name, sex, place and date of birth
– conferred through registration and the issuance of a Civil registration is defined as the continuous,
certificate by an authorized civil registration authority permanent, compulsory and universal recording of the
following the occurrence of birth. In the absence of occurrence and characteristics of vital events pertaining
birth registration, legal identity may be conferred by a to the population, as provided through decree or
legally recognized identification authority; this system regulation in accordance with the legal requirements in
should be linked to the civil registration system to each country. Civil registration is carried out primarily for
ensure a holistic approach to legal identity from birth the purpose of establishing the documents provided by
to death. Legal identity is retired by the issuance of a the law.2
1 United Nations Statistical Commission – 50th Session; Side Event: Civil Registration, Vital Statistics and Identity Management New York, & March 2019,
https://unstats.un.org/unsd/statcom/50th-session/side-events/documents/20190307-1E-UNSD.pdf
2 Principles and Recommendations for a Vital Statistics System, United Nations publication Sales Number E.13.XVII.10, New York, 2014, paragraph 279.
6
SY NTH ESIS R EPOR T
Vital events are events concerning life and death of processing legal identity information, commonly referred
individuals, as well as their family and civil status. Vital to as the population register. For the purpose of this
events proper concern life and death and include live Guide, a population register is understood as a system
births, deaths and foetal deaths. Dual events are those that links different government ICT platforms operated
occurring simultaneously in the lives of two individuals by authorities authorized under the law to register and
which cannot occur again in the life of either individual manage legal identity information.
without a previous change to his or her status. Those
events include marriage, registered partnership, A legal identity system comprises verification,
separation, divorce, legal dissolution of registered registration, management, and conservation of personal
partnerships, and annulment of marriage. Finally, vertical data of citizens, as well as non-citizens on the state
family events are those involving a descendent; they territory, with the goal of establishing a unique legal
comprise adoption, legitimation and recognition.3 identity within the jurisdiction. An identity management
system includes data from the civil registration for each
Proof of legal identity is defined as a credential, such individual person, as well as other attributes such as a
as birth certificate, identity card, travel document or unique number and/or biometric data. This could include
digital identity credential that is recognized as proof of identification credentials issued by identity management
legal identity under national law and in accordance with agency serves as a basis for the verification of identity
emerging international norms and principles. (i.e., passport or national ID cards).
A population register is defined4 as “an individualized Functional registers are established or authorized by
data system, that is, a mechanism of continuous governments to ensure efficient delivery of services
recording, or of coordinated linkage, of selected and discharge components of their governing mandates.
information pertaining to each member of the resident These registers can, in general and generic terms, be
population of a country in such a way to provide the designated as “functional” registers as their purpose
possibility of determining up-to-date information is directly linked to the discharging of government
concerning the size and characteristics of that population responsibilities under a specific function. Personal
at selected time intervals.” The population register information in functional registers should reflect legal
is the product of a continuous process, in which identity as registered in the legal identity system.
notifications of certain events, which may have been
recorded originally in different administrative systems, Digitization is used in this text to describe the use of
are automatically linked on a current basis. The method digital technologies to change a business model and to
and sources of updating should cover all changes so provide added value in terms of running costs, sharing,
that the characteristics of individuals in the register storing and processing of CRVS records. It is further
remain current. Because of the nature of a population used to describe the process of changing paper based
register its organization, and also its operation, must CRVS records from analogue to digital form by means of
have a legal basis. Over time in many countries bespoke digital data entry of registration records or by means of
information and communications technology (ICT) digitally scanning paper registration records into digital
systems have been developed that within their own image files.
administrative systems link different ICT platforms
3 Principles and Recommendations for a Vital Statistics System, United Nations publication Sales Number E.13.XVII.10, New York, 2014, paragraph 2
4 Handbook on Civil Registration and Vital Statistics Systems: Management, Operation and Maintenance, Revision 1, United Nations, New York, 2018, available at:
https://unstats.un.org/unsd/demographic-social/Standards-and-Methods/files/Handbooks/crvs/crvs-mgt-E.pdf, para 65.
7
SYNTHESIS REPORT
Section 2: Methodology
The review was completed combining field in-depth on specific characteristics of the national CRVS system
assessment visits (Mozambique, Uganda and the United and its interaction with public service providers, looking
Republic of Tanzania) and desk assessments of CRVS specifically into: institutional set up, CRVS business
systems (Ethiopia, Namibia, South Sudan and Zambia). processes, management of registration records,
policy innovations, digitization of CRVS systems,
The core information for the review was collected interconnection and interoperability with other public
during field visits to Mozambique, Uganda and the administration actors, and registration of resident non-
United Republic of Tanzania. With the logistical support citizens.
of the respective UNICEF country offices, a range of
interviews were organized with relevant CRVS officials Desk assessment of CRVS systems in Namibia,
and other national stakeholders from: ministries of Ethiopia, South Sudan and Zambia was conducted
Health, ministries/agencies in charge of national remotely based on the information and documents
statistics and ICT infrastructure, local outposts such provided by the respective UNICEF Country Offices and
as district hospitals, town council clerks, sub-country UNICEF ESARO.
chiefs, and so on. Through on-site visits and interviews,
each field assessment visit information was collected
8SY NTH ESIS R EPOR T
Section 3: Background
For many decades, initiatives and efforts relating to rarely replicated between countries, and lack of
CRVS in Africa were dominated by isolated project- commitment at political levels translated into ineffective
based and ad hoc exercises. The situation has changed use of funding and poor donor support.
radically following the first Conference of African
Ministers Responsible for Civil Registration, held in Systematic and coordinated implementation of the
Addis Ababa on 13 and 14 August 2010. The Conference Africa Programme on Accelerated Improvement of Civil
stimulated a number of responses and actions, including Registration and Vital Statistics Systems (APAI - CRVS)
the institutionalization of the Conference of African since 2010 has helped to build significant momentum
Ministers as a permanent forum under the auspices of towards the improvement of civil registration and
the African Union Commission. vital statistics systems on the continent. Political
commitment at national level, coupled with regional
The Sustainable Development Goals give renewed technical and capacity-building support, have helped
momentum for improving CRVS systems. Two specific countries make a paradigm shift from a fragmented and
indicators highlight the need for registration. These ad hoc approach to more holistic and integrated efforts.
are indicator 16.9 “by 2030 provide legal identity for all In response, many African countries have conducted
including free birth registrations” and indicator 17.19.2: comprehensive assessments of their civil registration
“Proportion of countries that (a) have conducted at least and vital statistics systems, and some of them have
one population and housing census in the last 10 years; developed action plans to address gaps identified
and (b) have achieved 100 per cent birth registration and through the assessment and accelerated improvements
80 per cent death registration”. to their national civil registration and vital statistics
systems.
People may face multiple challenges in ensuring that
their identity is recognized by the state. These emerge United Nations agencies have also stepped up their
from the fact that even if legal identity is articulated as efforts to support states to improve administrative
a right, accessing proof of legal identity is a complex systems used to recognize and certify legal identity,
administrative process that requires registration both through improvements to CRVS systems and
of identity information and the issuance of official through national identification programmes. UNICEF
documentation. Birth registration is widely recognized has been traditionally seen as providing support for
as the first point in life when the state collects and improving birth registration systems in states with weak
legally recognizes the identity of a newborn. In the CRVS systems. These efforts are complemented by
absence of birth registration, issuance of identification the work of the World Health Organization (WHO) in
documents later in life also provides a framework for improving frameworks for death registration. In parallel
registration of legal identity. One of the characteristics the United Nations Population Fund (UNFPA) has
of a person’s identity is that over time it can be updated been also recognized as the agency that supports the
with new attributes, most often by changing one’s development of national demographic capacities. While
name or surname. Civil registration is widely recognized these agencies have traditionally focused on the CRVS
as the only framework that provides a comprehensive framework, the Word Bank through its Identification
approach for permanent and timely registration of vital for Development (ID4D) programme5 has made critical
life events and subsequent changes in personal legal progress in assisting states with the development of
identity information from birth until death. national identity document (ID) systems catering for
adult populations. Similar programmes have been also
Despite wide consensus on the value of civil implemented by the United Nations Development
registration, these systems are largely dysfunctional Programme (UNDP), in Sierra Leone and Malawi for
and incomplete across most countries on the African example. National identification programmes have
continent. As such, most of the population remain been implemented on the assumption that for their
legally ‘invisible’ in the eyes of the state, denying successful operation a strong link should be in place
them the right to be known and planned for by with a developed CRVS system. These efforts are
their governments, to have access to fundamental complemented by a variety of other initiatives aimed
opportunities and services, and to claim their rights or to to support the CRVS and legal identity, notably work to
participate in governance processes. develop an open source platform for CRVS (OpenCRVS).
Investments in reforming national CRVS systems prior The United Nations Legal Identity Agenda 2020–2030,
to 2010 were mostly project-based, ad hoc, agency- backed by the Deputy Secretary-General, was
based silo pilots, which were seldom taken to scale, launched to bring the United Nations development
were not financially sustainable for governments and system together in support of Member States building
did not lead to any significant improvements. Similarly, holistic, country-owned, sustainable civil registration,
global, regional and national efforts were uncoordinated vital statistics and identity management systems.
and fragmented, with common tools and platforms United Nations implementing partners will build on
5 http://id4d.worldbank.org/about-us
9SYNTHESIS REPORT
their collaborative advantage to provide knowledge coordinated United Nations system country-level action
and expertise to Member States in support of to strengthen civil registration, vital statistics and legal
implementation of nationally owned, holistic and identity systems.
interlinked civil registration, vital statistics and legal
identity systems. In parallel, many global initiatives have been initiated
that challenge the role of the state in recognizing legal
The United Nations Legal Identity Expert Group (LIEG), identity and advocate for digital systems that would
operating under the purview of the United Nations cater for a self-sovereign identity and its recognition
Sustainable Development Group’s Strategic Results as legal identity. For the foreseeable future state and
Group on SDG Implementation (which completed its national CRVS and identification systems continue to be
work in July 2019), spearheaded discussions on a joint N the only recognized framework for registration of legal
collaborative response of the United Nations system to identity and the gateway for accessing civil, political and
the legal identity agenda, including in collaboration with socio-economic rights.
the World Bank. The LIEG laid the groundwork for future
10SY NTH ESIS R EPOR T
Section 4: Current trends in registration in ESAR
The comprehensive assessments of civil registration countries registration rates spiked dramatically. In
and vital statistics (CRVS) systems6 which preceded Ethiopia the birth registration rate was estimated at 3
and informed CRVS system reforms all recommended per cent in 2016. In the regions of the United Republic
decentralization as a measure towards increasing of Tanzania where the decentralized system has been
registration rates. These assessments found that the rolled out birth registration rates rose from 9.3 per cent
distance to travel to registration centres (generally based in 2012 to 83.3 per cent in 2018.7 The decentralization
in district centres) and the number of visits as well as process further benefited from advocacy and support
costs required to complete registration and obtain birth provided by local communities’ social networks, which
certificate is disproportionally high when compared with strengthen the process by increasing demand for birth
the perceived benefit of obtaining the certificates. and death registration services.
Under a centralized system, all parts of the registration The experience of countries subject to this review so far
process are strictly conducted by the civil registration suggests that higher levels of decentralization generally
authorities. In practice, however, with their limited produce higher registration rates. If certification is
capacities the registration authorities can only cater only enabled down to district level (Mozambique
for a limited network of local offices, usually extending and Zambia), this will also have consequences for
services to provide coverage at district level. Even in registration rates. To overcome lack of certification at all
such cases, registration certificates can only be obtained registration points authorities have introduced additional
at the central office. Decentralization overcomes this facilitation measures. The Mozambique authorities, in
problem by enlarging the scope of public authorities partnership with national telecom provider, arranged
involved in the registration process. Specific aspects of for SMS messages to be sent to applicants informing
the registration process, such as notification of births them that their certificates are available for collection
and deaths, is delegated to the local authorities and/or at the district office. In Zambia, district registration
health facilities, whereas the civil registration authority authorities, in cooperation with local village authorities,
maintains its role of supervising and setting registration arrange for completed birth certificate to be transported
policies for the authorities responsible for delegated to the applicants, who can collect them at village
aspects of the process. administration offices.
With the decentralization of the notification part of the Decentralization is viewed as a key strategy for
registration process the number of registration points mitigating obstacles arising from the large distances
was significantly increased, and it reached the lowest an applicant needs to travel, including multiple visits to
level of public administration and local health facilities, registration offices, in order to complete registration.
in the process bringing registration points closer to the UNICEF United Republic of Tanzania, for instance,
population and the locations where vital events occur. estimates that the annual savings on the side of
While in the past, vital life events registration certificates population resulting only from eliminating travel costs for
could be obtained either at the capital or at a limited the two visits required to the district registrar amounts
number of registration centres, following the reforms, to approximately US$24.8 million.
many countries subject to this review extended the
issuance of registration certificates to district level such Decentralization of the registration process came as
is the case in Mozambique and Zambia. a result of lengthy consultations between a range of
government ministries responsible for civil registration,
In Ethiopia and the United Republic of Tanzania, local self-government and health. Cooperation between
an additional step is made to achieving higher the key ministries for decentralization was facilitated by
decentralization by delegating issuance of birth the findings and recommendation of the comprehensive
certificates to the level of local village authorities or assessments and the determination of the governments
in the case of the United Republic of Tanzania also to implement these recommendations.
to local health facilities. Following the introduction of
decentralized birth and death registration, in both these
Scope of the review
Increased decentralization for both notification in the field and to react when necessary. However,
through village authorities and local health facilities in these countries, information registered through
is an important step forward in ensuring that births mobile phone messages is not yet legally recognized
and deaths are captured and recorded. In legal terms, as proof of notification.
traditionally a valid act of registration of a vital event is
produced in paper format on a designated registration Recent investments in civil identification systems in
form. In the United Republic of Tanzania, Uganda and many countries in the region, followed by en masse
Mozambique, the information is also communicated via issuance of national identity cards, provides some
mobile networks, enabling central registration authorities valuable lessons about the relationship between
to digitally capture the information in central database incentives offered and demonstrated willingness by
to have a detailed overview of the registration process individuals to travel great distances (including more
6 Comprehensive assessments of CRVS systems have been concluded in all the countries subject to this review (Ethiopia, Mozambique Namibia, South Sudan, Uganda, the
United Republic of Tanzania and Zambia)
7 Further details available in United Republic of Tanzania Field Assessment Annex
11SYNTHESIS REPORT
than once) to complete the enrolment. The experience highly decentralized systems. The system in Namibia,
of enrolment in national identity card programmes in for instance, achieved and maintains almost universal
Zambia, and to some extent in Uganda, demonstrates birth and death registration rates, largely as a result
that enrolment can effectively be achieved at district of financial grants which can only be accessed by
level, and having to travel to the district enrolment completing registration of birth and death. This enabled
offices has not been seen by the population as an Namibian registration authorities to achieve high
obstacle to achieving nearly universal enrolment. These registration rates while operating registration centres
high turnout levels, never achieved for civil registration, in only a limited number of district hospitals and district
were made possible because of the population’s registration offices. Even though Namibia has a small
perception that the value and benefits of possessing the population when compared to the rest of the region,
identification document outweighed the costs linked and especially in proportion to its geographical size,
with traveling to the district centres. the attractiveness of the incentives for civil registration
offsets other issues that can be generally perceived as
This demonstrates that increasing incentives for civil obstacles (such as long distances to the registration
registration can be a viable alternative to investing in offices).
The role of local authorities
The review shows that successes gained through the Many coordination challenges are linked with the lack
decentralization of registration services depends on of an efficient means for top-to-bottom communication
the commitment of the local authorities to support as well as group discussion and decision making.
the process, and the effectiveness of coordination The reality for remote districts in many countries
mechanisms that support registration in local is that mobile phones are often the only means of
communities and involve local community, district and communication, either via voice or text messaging.
central registration authorities. The local authorities in UNICEF’s experience shows that the areas where
general have great interest in ensuring that they keep children are more deprived are also the areas with no
track of changes in the population on their territory or little connectivity. The experience from the United
in order to plan for and deliver various services. With Republic of Tanzania shows that internet-enabled
decentralization their commitment is further reinforced mobile phones can provide a highly efficient means of
by their legal obligation to deliver universal registration surrogate business communication. Benefiting from
coverage. the availability of smartphones distributed by UNICEF
at each registration point, district authorities have set
Whereas in Ethiopia, kebele (village) administrative up dedicated coordination groups on WhatsApp as well
services have historically been highly efficient, in the as other mobile messaging platforms that are being
United Republic of Tanzania coordinating the work of used to delegate tasks across all registration points,
local registration points revealed many challenges that providing clarifications on technical questions and
had to be addressed both organizationally and financially resolving other ongoing issues. Smartphones provided
by the government with support from UNICEF. Following by UNICEF are primarily intended for communicating
some failed attempts in the past, efforts by the central registered data to central registration offices. Unlike
registration authorities and UNICEF eventually resulted in some other countries where data transfer relies on
in the successful rollout of decentralized registration USSD messaging, in the United Republic of Tanzania
system across many of the United Republic of the communication is built on the Android platform.
Tanzania’s regions. The decentralized system in the While more expensive, this provides a more user-friendly
United Republic of Tanzania was ready for roll out data entry interface and means for data processing.
already in 2012 when the implementation commenced Additionally, the ability to use messenger apps for
in test regions. After initial successes, the process coordinating registration activates in local communities
stalled. Project evaluation that followed revealed that was perceived to provide further benefits.
the main reason for limited results was the inadequate
coordination among the increased number of CRVS
actors involved in the process.
The role of health facilities
In varying degrees from country to country, many births health programmes also provide birth services in
and deaths take place at health facilities. Between communities, capturing information on mothers as
2013 and 2018, 62 per cent of births in the Eastern they contact health facilities during pregnancy and
and Southern Africa region were assisted by skilled after birth for immunization and other health services.
birth attendants.8 Particularly in these contexts, the This broad range of contacts of health workers in the
benefits of decentralization are further achieved by context of childbirth highlights the role of health facilities
vesting registration authority to the health system. in a decentralized system. Cooperation with health
This in turn allows for information to be captured at facilities is equally important in the case of delayed birth
registration points within health facilities on birth and registration. This allow the registration authorities to
death events as and where they occur. Community take advantage of programmes such as immunization:
8 Joint UNICEF/WHO database 2019 of skilled health personnel, based on population based national household survey data and routine health systems.
12SY NTH ESIS R EPOR T
delayed registration can be completed when children completing birth notifications by capturing key data
receive their vaccinations, during either facility- prior to birth. This approach is already widely in use in
based or outreach activities. This enables registration Namibia.
authorities to clear the back log of unregistered births
at a significantly lower cost, as it eliminates the need Decentralization to the lowest level of local authorities
for dedicated registration campaigns and mobile teams’ alone is not sufficient. The benefits of decentralization
visits. will only be achieved by getting health authorities
on board and authorizing health facilities as birth
Registration at health facilities also provides notification points. This is demonstrated in the
opportunities to collect information on expectant cases of Mozambique and Uganda, where lack of
mothers, supporting accurate collection of statistical birth notification services at health facilities directly
data on foetal deaths and speeding up the process of contributes to lower-than-anticipated registration rates.
Skills and qualifications of registration officials
Except in the case of district registration offices Delegating increased responsibilities to health workers
where registration tasks are completed by dedicated also carries some risks. There is a growing concern that
professionals, at lower administrative levels as well local health workers are increasingly being identified as
as in the health facilities registration is conducted as a potential providers of various local community services
side duty by appointed local administrative workers and and data collection/statistics due to their recognized
health workers. The level of training required to complete skills and frequent contact with large proportions of
registration differs across the region. Except in Namibia the population. These extra tasks add up, resulting in
and South Sudan, where health authorities are required health workers often being swamped with extra duties
to operate registration software and demonstrate that impact their overall ability to perform their core
computer skills, the work is limited to verifying parents’ roles. Additionally, with the growing adoption of digital
documents, completing registration forms and as in case health, yet the continued vertical nature of many of
of the United Republic of Tanzania, Mozambique and these programmes, health workers may be expected
Uganda, communicating registration data digitally via to carry multiple digital devices and be conversant in
mobile network. many different software platforms: this carries many
risks. However, there is an opportunity to embed birth
Practice shows that the initial training of these officials notification modules within these digital health platforms,
requires significant resources. Once the process starts, reducing both duplicate data entry and the need for
their work is often very labour intensive until the backlog extraneous devices or specific knowledge on yet another
of late registrations is cleared. Subsequently, the number software platform.
of registrations routinely handled decreases dramatically
and the work can be completed as a side task.
Decentralization and related registration integrity risks
For countries with low registration rates the priority is to enforcement of documentary support requirements
capture all vital life events, leveraging the introduction is gradually strengthened, but not at the expense of
of highly decentralized registration. Once decentralized lowering registration rates.
systems succeed in sustaining high registration rates,
the priority will likely shift towards tightening the While South Sudan is still developing its legal and
enforcement of legal requirements and preventing administrative framework for CRVS, it provides a
multiple/fraudulent registrations. good example of applying a strongly human rights-
based approach to registration of vital events. In
Concerns about the lack of sufficient safeguards South Sudan there is no legal framework or legal
to maintain legal integrity are counterbalanced requirement to register vital life events. Nevertheless,
by broader facilitation opportunities and a better the national health authorities, supported by UNICEF,
enabling environment for increasing vital life events took the initiative to develop and implement a digitized
coverage rates that result from decentralization. registration system in a limited number of health
From a strictly human rights angle, regardless of facilities. This system is used to collect relevant
certain legal concerns that might arise the better information on newborns and their parents’ identity
protection of children’s rights that becomes possible data, so that it can serve as a basis for completing
as a result of registration should be given priority. registration once the regulatory framework is in place.
With this approach in mind, the highest priority should Another good example can be also found in Uganda,
be given to capturing information on occurrence of which is currently undergoing institutional transition. As
birth. Ensuring legal integrity should also remain a high result of lack of coordination arising from the institutional
priority but it should be seen as a process through which transformation, some health facilities have run out of
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