The Health Metrics Network launches a drive today to encourage countries to count all births and deaths through civil registration.

The Health Metrics Network is a global partnership – hosted by World Health Organization (WHO) – established to address the lack of reliable health information in developing countries.

The lack of civil registration systems means that every year, almost 40% (48 million) of 128 million births worldwide go unregistered. The situation is even worse for death registration. Globally, two-thirds (38 million) of 57 million deaths a year are not registered. WHO receives reliable cause-of-death statistics from only 31 of its 193 Member States.

Civil registration is the way by which countries keep track of births, deaths and marital status of their people. These systems are the best way to produce vital statistics – counts of births and deaths and causes of death. Such statistics are needed to show whether health programmes are working. They are also essential to assess whether development aid is well spent.

Other implications

The absence of civil registration has other implications. When children’s births are not registered they are less likely to benefit from basic human rights – social, political, civic or economic.

At the other end of the lifespan, when deaths go uncounted and causes of death are not documented, governments are unable to design effective health policies, measure their impact or know whether health budgets are being spent well.

“No single UN agency is responsible for ensuring that births and deaths are registered, so it has fallen between the cracks. That is why we have failed to establish, support, and sustain civil registration systems over the past 30 years in the developing world,” WHO Director-General Dr Margaret Chan said today at the Global Forum for Health Research in Beijing.

“Without the statistics that these systems produce, we can only have a partial view of the impact of US$ 120 billion spent annually in official development aid.”

Non-existent civil registration systems

The drive to encourage countries to improve civil registration is launched today with a series of papers published in the medical journal The Lancet, entitled “Who counts?” This series shows that most developing countries have rudimentary or non-existent civil registration systems. This means that they cannot count how many people are born and how many die, and they cannot record how long they live or what kills them. The papers also underscore the challenges of establishing civil registration, including new legislation and governance structures.

The drive marks the start of intensive work to help six countries most in need to improve civil registration. The Health Metrics Network has already started working with Cambodia, Sierra Leone and Syria. By the end of the year, three other countries will have been identified for assistance.

“The lack of civil registration systems has been partially compensated by surveys, sample registration and surveillance sites,” says Dr Sally Stansfield, Executive Secretary of the Health Metrics Network. “These provide some useful information, but they give an incomplete picture of population size and needs. And they certainly cannot give individuals the basic human right to a legal identity that comes from civil registration. It’s a major challenge to build civil registration systems: this is the job no one wants.”

As part of this drive, the Health Metrics Network is releasing today a Monitoring vital events resource kit CD-ROM. This kit contains the tools and reference texts that countries can use to guide them in their work towards full civil registration.