Health Sector Contribution on Civil Registration and Vital Statistics in Lao PDR

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The Ministry of Health in Lao PDR plays a crucial role in implementing the Civil Registration and Vital Statistics (CRVS) system. This system involves various functions such as improving data accuracy, producing vital statistics reports, and coordinating with other sectors. The health sector's roles include issuing medical certificates, reporting births and deaths, and collaborating with local authorities for effective registration. By enhancing CRVS infrastructure and staff capacity, the health sector aims to ensure universal coverage and timely data collection for policy making and monitoring.

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Birth & Death Notification System and How the Health Sector Contribution on CRVS in Lao PDR Dr. Founkham Rattanavong, Deputy Director General of Planning and Cooperation Department, MOH, Lao PDR, 13-17/17, Hanoi.

MOHs Functions Based on CRVS Strategy 1. With other sectors, clearly define CRVS structure, roles, and responsibilities of each involved institution; 2. Improve coordination with involved institutions both vertically and horizontally from the central to local level; 3. Produce forms, guidelines and train heath staff on the utilization of new forms and procedures, as well as on International Coding of Diseases (ICD); 4. Improve service provision toward universal coverage, especially birth and death notification, and its involvement at onsite registration at the healthcare facility level or during outreach activities; 5. Plan for adequate staffing and capacity building and implement; 6. Improve District Health Information System (DHIS) with accurate, complete, and timely data on births and deaths including causes of deaths; 7. Produce annual report on vital statistics generated from DHIS for comparison with data from other sources, disseminate it, and use it for policy making, planning, and monitoring and evaluation; 8. Plan for needed infrastructure and equipment; 9. Plan and budget for the implementation of all relevant assignments within the Strategy; 10.Cooperate with development partners; 11.Inform the program management secretariat at Ministry of Home Affairs (MOHA) the implementation progresses of the assigned activities.

Roles of the Health Sector in CRVS Main roles ( ) for civil registration CR for vital statistics VS births/ deaths in the health facilities (eg. Place of birth/death, birth weight, cause of death, etc.) -Issue medical and health check-up certificate -Attend any determined death and certify causes of death Possible roles for CR ( ) Late registration during EPI/ MNCH services provision for CR and VS SBA -Advocacy and encouragement of civil registration during stay in the hospital or health education in the community for vital statistics -( ) reporting the number and socio-demographic factors of birth and death in the community through VHV -( ) identification of causes of maternal death by MDSR (Maternal Death Surveillance and Response) -( ) cross-check the number registered with MoHA using DHIS-2 Notification of births/ deaths in the health facilities -Reporting the number and additional information related to -( ) Birth notification for new-borns delivered by SBA in the community and reporting the number and socio-demographic factors of those delivered by

Roles of Health Sectors in CRVS in Lao PDR Birth in health facility Birth outside health facility Death outside health facility Death in health facility Family book covers both births & deaths, NO certification on births/ deaths is necessary for registration notification VHV VHV notification p e r s o n p e r s o n Births assisted by SBA MDSR confirmation EPI registration n u m b e r n u m b e r HC HC certification certification Village chief DHIS-2 DHIS-2 District office of MOHA District office of MOHA notification District Governor District Province District Province Provincial Governor Province office of MOHA Province office of MOHA DPIC DPIC Ministry of Public Security Statistic division MCHC NIP Statistic division MDSR secretariat Ministry of Health Ministry of Health Pilot district site: Ministry of Home Affairs MOHA officers accompany MPS officers in village when registration happen. Registration in family book enables an issue of identification and receiving public services. Family book covers vital events such as birth, death, marriage, moving-in/out.

Targets Defined by 2025: 80% of births and 60 % of deaths in a given year should be registered; 85% of deaths recorded by the health sector have a medically certified cause of death with ICD. Current Status: Birth registration: Figure below Death registration: No data 100 90 80 75 80 70 60 47 50 33 40 30 20 10 0 to MOHA by 5 y.o.(*) to MOPS via village chief by 5.y.o (**) Births at health facilities % in 2016 (***) Target 2025 (in a given year) Data source: * CRVS strategy MOHA latest data ** State of children 2016 by UNICEF, *** DHIS Lao PDR 2016 data (National Health Statistics Report 2016 Draft)

Progress & Challenges Progress Challenges Regulations and guidelines have been published, distributed and staff training in different levels of health facilities. Health Information System can provide number of births with regular report. HC level obtain birth and death information from communities through Village Health Volunteers. Policy on Free Delivery and Under 5 Treatment can be contributed as increased facility births and services Government budget support for guidelines printing and training. ICD-10 is not used in provincial hospitals yet only some central hospitals. Quality of causes of death, is the issue (not standardized in hospitals, causes of death are not diagnosis or analysed, MD not available in health centres for diagnosis, Under 5 deaths not being reviewed). Birth/death notification forms, shortage of the forms and/or different types of formats are still used, forms often not provided to the family (in case of births /deaths) due to various reasons (no request/demand from family, taking time to complete the form), the forms not used in private health facilities yet. Data entry to DHIS in some districts and HC are not correct, not complete and not\delay reporting. Coordination and collaboration between relevant sections appears to be irregular such Provincial Civil Management Committee maybe not functioning. Limitation of technical capacity and budget support.

Requirement & Request To achieve CRVS 2025 targets: 1. Measures to eliminate missed opportunities should be taken by connecting either the births at health facilities with DHIS2 in the public sector (half of births) or those registered to MoPS (75% by 5-years-old) to the birth registration by MoHA (33% by 5-years-old in 2015); 2. Significant investment and effort are seriously necessary to standardize diagnosis and causes of deaths by using ICD; 3. Regular report should be published and assessment could be conducted for improving quality of both health services and CRVS. 4. Issue the ID would be the first basic step toward this CRVS achievement and it will be also useful for others activities and business. 5. Continue our coordination, cooperation, collaboration and commitment by any project support or TA for each sector.