Bloomberg Philanthrophies – Data For Health Initiative

Legal and Regulatory Review of Civil Registration and Vital Statistics in the Philippines

By

ImagineLaw, Inc.

San Luis, S.V. and Sto. Domingo, M.R.

September 2017

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Table of Contents List of Abbreviations 4 Executive Summary 5

I. Introduction 6

II. The Philippine Context 7

III. The Philippine CRVS System 7

a. History of the Philippine CRVS System 7 b. Organization and Administration of CRVS 9

i. Civil Registration Authorities 10 ii. Health Authorities 11

iii. Other key actors 12 iv. Inter-Agency Committee on CRVS 12

IV. The Civil Registration System 13

a. Civil Registration in General 13

i. Free and compulsory 13 ii. Amendment of civil registration records 13

iii. Civil registration forms and books 13 iv. Delayed registration of vital events 14 v. Access linked to registration 15

vi. Certified true copies of registry documents 15 vii. Transmittal and encoding of civil registry documents 15

b. Definition of Vital Events 17 c. Registration of births 19

i. Information and proof required to register birth 19 ii. Informants of birth 20

iii. Delayed birth registration 21 iv. Place of registration of birth 21

d. Registration of deaths and cause of death determination 22 i. Information and proof required to register birth 22

ii. The MCCOD 23 iii. ICD Coding 23 iv. Persons required to report the death and

certifiers of cause of death 23 v. Reporting fact of death to the local health officer 24

vi. Procedure for certifying cause of death 24 vii. Delayed birth registration 25

viii. Place of registration of birth 26 ix. Death registration prior to burial 27

V. The Vital Statistics System 28

a. The Philippine Statistical System 28 b. Official Statistics 29 c. Data Sharing 30

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VI. Policy Gaps 30 a. Procedural gaps 30

i. Death reporting and registration 31 ii. Review of cause of death information 31

iii. Recording of paternity and filiation 31 iv. Documentary requirements for registration 31 v. Period for generating vital statistics 31

b. Other policy gaps 32 i. Oversight and discipline 32

ii. Detention of patients 32 iii. Issuance of burial permits 32 iv. Registration of indigenous peoples 32 v. Registration of abortions and miscarriages 33

vi. Electronic filing, automation and information exchange 33 vii. Definition of live birth 33

viii. Local budget limitations in implementing national CRVS policies 33

VII. Recommendations 33

a. Administrative issuances 33 b. Executive Order 37 c. Other recommended actions 37 d. Legislation 38

List of Figures 39 List of Tables 39 Annex A: Certificate of Live Birth 40 Annex B: Certificate of Death 42 Annex C: Certificate of Fetal Death 44

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List of Abbreviations AO Administrative Order BCS Bureau of Census and Statistics BLHSD Bureau of Local Health Systems and Development CD Compact Disk CRVS Civil Registration and Vital Statistics CRVSS Civil Registration and Vital Statistics System DepEd Department of Education DFA Department of Foreign Affairs DILG Department of Interior and Local Government DOH Department of Health DOJ Department of Justice DSWD Department of Social Welfare and Development DTB Doctors to the Barrios EO Executive Order HRH Human Resources for Health I-Stats Interactive Statistical Database IACCRVS Inter-agency Committee on Civil Registration and Vital Statistics ICD International Classification of Diseases IRR Implementing Rules and Regulations LGU Local Government Unit NBI National Bureau of Investigation NCIP National Commission on Indigenous Peoples NDP Nurse Deployment Program NDRRMC National Disaster Risk Reduction Management Council NSO National Statistics Office OHFSRS Online Health Facility Statistical Reporting System OpenSTAT Open Data Portal of the Philippine Statistical Authority PhilCRIS Philippine Civil Registration Information System PNP Philippine National Police PSA Philippine Statistics Authority PSO Provincial Statistics Office RSSO Regional Statistical Service Office TAA Tribal Affairs Assistant TESDA Technical Education and Skills Development Authority USB Universal Serial Bus

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Executive Summary Coverage and completeness of birth and death reporting in the Philippines, according to a 2000 census, is estimated at 87% and 65%, respectively. 1 This report evaluates the legal and regulatory framework of Civil Registration and Vital Statistics (CRVS) in the Philippines based on a review of all laws including legislation and administrative issuances concerning CRVS, with the goal of improving coverage, completeness and quality of birth and death reporting, and mortality statistics. The review showed that the key actors for a functioning CRVS are in place, and the system is sufficiently decentralized as to allow universal access. Existing CRVS laws also specifies the civil registry books required, data and prescribed forms for registration, procedures for timely and delayed registration, informants and certifiers of cause of death, procedures for transmittal to the civil registrar general, amendment and correction of entries, and penalties for violation of the duty to report and for failure of local civil registrars and local health officers to perform their duties. The law also makes registration compulsory, and clearly mandates that timely registration is free. However, the procedures for death reporting and registration are not sufficiently clear, and practices tend to vary from one local government unit to another due to decentralization. Some local health officers are not sufficiently aware of the extent of their responsibilities for death registration. Decentralization also fragmented the authority of the civil registrar general over local civil registrars, such that it now only exercises technical supervision, but not disciplinary authority, over the latter. Generally, key government agencies may address these policy gaps through administrative issuances, training manuals and information dissemination. The following policy changes are recommended: For the Department of Health (DOH):

1. Prohibit the practice of withholding death certificates for non-payment of medical bills of patients treated in private rooms to prevent delays in death registration and the proliferation of fake death certificates;

2. Limit the exceptions to the requirement of death registration before burial under DOH AO 2010-0033 to encourage timely death registration;

3. Regulate cemeteries, funeral parlors and crematoriums to ensure compliance with death registration requirement prior to burial;

4. Include cause of death determination in the curriculum of medical schools and in the coverage of the physician licensure exams to improve cause of death determination by physicians;

5. Issue guidelines on use of verbal autopsy to establish a standard on the conduct of verbal autopsy in the Philippines;

6. Maximize the DOH Online Health Facility Statistical Reporting System by including data on: (a) total number deliveries and deaths which occurred in the health facility; (b) number births and deaths registered by the health facility; and (c) number of births and deaths that were not registered by the health facility, to capture the number of in-facility births and deaths not registered by hospital facilities;

7. Set minimum qualifications for ICD-10 encoders to ensure the quality and accuracy of ICD-10 coding; and

8. Issue guidelines on recording of spontaneous abortions or miscarriages. For the Philippine Statistics Authority (PSA):

1. Allow recording of paternity and filiation after registration to address the practice of late registration by mothers awaiting acknowledgment by the putative father;

1 L. Hufana, Civil Registration and Vital Statistics Assessment: Philippines, Pasig City, p. 7.

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2. Develop mechanisms to strengthen oversight over local ordinances and local policies on civil registration to ensure consistency with national law and rules and regulations issued by the Civil Registrar General;

3. Develop an information exchange platform to allow local government units (LGUs) and health facilities to transmit data directly to the PSA to ensure timely registration and generation of vital statistics;

4. Revise the prescribed forms to include relevant information that would improve the quality of public health data;

5. Separate the Medical Certification of Cause of Death (MCCOD) from the death certificate to protect confidential information;

6. Develop a strict verification process for requests for certified documents to protect confidentiality of information;

7. Issue guidelines for mobile registration to increase rate of registration; and 8. Institutionalize training for local civil registrars on registration of indigenous peoples to

encourage registration and accurate data collection. The DOH and PSA should also jointly issue guidelines clarifying the procedure for death registration, and for determining and reviewing the cause of death in certificates of death. The DOH, PSA, National Bureau of Investigation (NBI), and Philippine National Police (PNP) should also jointly issue guidelines clarifying the procedure for death registration and cause of death determination in medico-legal cases. In line with this, the PSA should immediately convene the Inter-Agency Committee on CRVS (IACCRVS), and create technical working groups to prioritize work on recommended CRVS policies. The PSA may also consider advocating for a new law on civil registration to ensure uniformity of procedures in local government units, improve monitoring and enforcement of the civil registration law, and redefine live birth so that it is completely consistent with the UN recommended definition of live birth. I. Introduction This report was prepared by ImagineLaw, Inc. under the Bloomberg Data for Health Initiative, as part of its legal and regulatory review of the CRVS system of the Philippines. The objective of the review is to map-out the legal and regulatory framework of the Philippine CRVS system and the organization of its key agencies and actors, in order to identify policy gaps and recommend measures to address such gaps. The review covered laws enacted by the Philippine Congress and rules and regulations issued by relevant government agencies related to birth and death registration, and generation of vital statistics. The review also takes into account input from representatives of the PSA, DOH, NBI, National Council of Indigenous Peoples (NCIP), and local health officers from the City of Manila, Quezon City, the municipality of Tanza in Cavite, and the municipality of Kabasalan in Zamboanga Sibugay, during a workshop held on July 24 to 25, 2017. The review did not cover ordinances issued by LGUs and specific practices of LGUs that were not represented in the workshop. This report discusses the major laws on CRVS, and the structure, organization, and functioning of the CRVS system with respect to birth and death registration, and generation of vital statistics. The report also identifies policy gaps and recommendations based on best practices2 and input from private stakeholders. 2 UN, Principles and Recommendations for a Vital Statistics System, Revision 3, New York, 2014; United Nations, Handbook on Civil Registration and Vital Statistics Systems: Preparation of a Legal Framework, New York, 1998; United Nations, Handbook of Vital Statistics Systems and Methods Volume I: Legal, organizational and technical aspects, New York, 1991; World Health Organization, WHO Resource Kit: Strengthening civil registration and vital statistics for births,

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II. The Philippine Context The Philippines is a lower-middle income country3 with a population of over 100 million, according to its 2015 population census.4 With an annual growth rate of 1.7%, the population is expected to rise to 104 million by 2017.5 The Philippine government is a republican democratic government, composed of three co-equal branches—the executive, the legislative and the judiciary. The territorial and political subdivisions of the Philippines are the provinces, cities, municipalities and barangays, and the autonomous regions created by Congress.6 There are, as of this date, 81 provinces, 145 cities and 1,489 municipalities in the Philippines.7 The Constitution granted these LGUs local autonomy8 and mandated Congress to enact a local government code that will provide for a system of decentralization from the national government to the LGUs.9 Republic Act (RA) No. 7160 or the Local Government Code, enacted by Congress in 1991, devolved basic services, including civil registration and health services, to LGUs.10 It also gave LGUs the power to appoint and remove officials that are funded by local funds,11 the power to generate and apply its own resources,12 and the power to enact ordinances to promote the general welfare of their inhabitants13 provided the exercise of these powers does not contravene the Constitution or any law enacted by Congress.14 III. The Philippine CRVS System

a. History of the Philippine CRVS System

The Philippine civil registration system was created in 1930 with the enactment of Act No. 3753 or the Law on Registry of Civil Status. Act No. 3753 established the Civil Register for the recording of civil status of persons15 with the following civil registry books to be maintained by local civil registrars:

1. Birth Register; 2. Death Register; 3. Marriage Register; 4. Legitimation, acknowledgment, adoption, change of name and naturalization

register (register of court decrees or orders).16

deaths and causes of death, Luxembourg, World Health Organization, 2010; Pacific Community, Legislation for Civil Registration and Vital Statistics in the Pacific: Best Practice Guidelines and Examples, Noumea, Secretariat of the Pacific Community, 2016. 3 World Bank, Country Profile - Philippines, as of 17 July 2017, available at: http://data.worldbank.org/country/philippines. 4 2015 Census of Population, Philippine Statistics Authority. 5 2015 Census of Population, Philippine Statistics Authority. 6 Article X, Section 1, 1987 Constitution of the Republic of the Philippines (“Constitution”). 7 Philippine Statistics Authority (PSA), Provincial Summary, Number of Provinces, Cities, Municipalities and Barangays by Region, as of 31 March 2017, available at: http://nap.psa.gov.ph/activestats/psgc/SUMWEBPROV-MAR2017-CODED-HUC-FINAL.pdf. 8 Article X, Section 2, Constitution. 9 Article X, Section 3, Constitution. 10 Section 17, Republic Act (“RA”) No. 7160 or the Local Government Code of 1991 (“RA No. 7160”). 11 Section 3 (c), RA No. 7160. 12 Section 18, RA No. 7160. 13 Section 16, RA No. 7160. 14 City of Manila, et al. vs. Hon. Perfecto A.S. Laguio, Jr., et al., G.R. No. 159110, December 10, 2013. 15 Section 1, Act No. 3753 or the Law on Registry of Civil Status (“Act No. 3753”). 16 Section 4, Act No. 3753.

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In 1993, the National Statistics Office (NSO), the predecessor of PSA, issued Administrative Order (AO) No. 1, s. 1993 or the Implementing Rules and Regulations (IRR) of Act No. 3753. In addition to the above-mentioned civil register books, AO No. 1 s. 1993 also mandated the creation and maintenance of a Register of Foundlings, Register of Legal Instruments, where legitimation and acknowledgment are registered, and Register of Applications for Marriage Licenses.17 The Office of the Civil Registrar General also maintains a Register of Solemnizing Officers issued with Certificates of Registration of Authority to Solemnize Marriage, pursuant to Executive Order No. 209 or the Family Code of the Philippines.18 The Philippine statistical system was created in 1940 with the creation of the Bureau of Census and Statistics (BCS) under Commonwealth Act No. 591. Under Executive Order (EO) No. 314 issued in 1941, the Civil Registry Division of the National Library was transferred to the BCS.19 The BCS was later renamed to the National Census and Statistics Office in 197420 and then to the NSO in 1987.21 In 2013, RA No. 10625 or the Philippine Statistical Act of 2013 was enacted, abolishing the NSO 22 and creating the PSA. 23 The IRR of RA No. 10625 was issued on December 11, 2013, giving effect to the reorganization of the Philippine Statistical System.

17 Rule 7, National Statistics Office (NSO) AO No. 1, s. 1993. The Register of Application for Marriage Licenses is mandated under Article 25 of Executive Order (EO) No. 209 or the Family Code of the Philippines. 18 Rule 7 (4), AO no. 1, s. 1993, in accordance with Article 7 (2) of EO No. 209. 19PSA, NSO History, as of 17 July 2017, available at: https://psa.gov.ph/content/nso-history. 20 Presidential Decree (“PD) No. 418, Reconstituting the Bureau of Census and Statistics, March 20, 1974. 21 EO No. 121 or .Reorganizing and Strengthening the Philippine Statistics System and for Other Purposes. 22 Section 28, RA No. 10625 or the Philippine Statistical Act of 2013 (“RA 10625”). 23 Section 5, RA No. 10625.

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The Philippine CRVS System, headed by the PSA, is composed of several agencies. Its main actors include local government units through their local civil registrars and local health officers, and the DOH, which supervises hospitals and other health facilities. Other agencies such as the NCIP, PNP, and NBI also participate, depending on the circumstances surrounding registration. Given the many agencies involved, coordination for policy-making purposes is achieved through the establishment of an Inter-Agency Committee on CRVS.

i. Civil Registration Authorities The PSA serves as the central statistical authority of the Philippine Government.24 It is also mandated to enforce Act No. 3753.25 As such, the National Statistician, as head of the PSA, also serves as the civil registrar general. The President appoints the National Statistician from nominees selected by a special committee. To be appointed, a candidate must at least have a Master’s Degree in Statistics. The civil registrar general is empowered to issue policies, instructions, and standards on civil registration.26 The civil registrar general also exercises technical supervision over all local civil registrars,27 and may declare acts of local civil registrars as invalid if inconsistent with prescribed standards, criteria, or procedures.28 Act No. 3753 created offices of local civil registrars in all cities and municipalities in the Philippines, under the direction and supervision of the civil registrar general. However, with the enactment of the Local Government Code mandating all cities and municipalities to have local civil registrars,29 local civil registrars were effectively decentralized and devolved to LGUs.30 In effect, local civil registrars became local government officials, funded by local government funds, and falling under the appointing and disciplining authority of the city or municipal mayor. The local civil registrar is responsible for implementing Act No. 3753 and other civil registration laws within his or her territorial jurisdiction. He or she is mandated to register vital events, update, maintain, and preserve the civil register books,31 transmit records of vital events within ten (10) days to the civil registrar general,32 and issue certified copies of registered documents.33 The local civil registrar is also mandated to assist the PSA in the preparation of demographic and other vital statistics of the local government unit concerned.34 The Local Government Code also empowers the local civil registrar to develop plans and strategies on civil registration, subject to the approval of the mayor, and to implement civil registration policies issued by the local council.35 To be appointed as local civil registrar, a candidate must be a citizen of the Philippines, a resident of the LGU concerned, of good moral character, a college graduate, civil service eligible, and must have an acquired experience of 5 years for cities or 3 years for municipalities.36 Local civil registrars are assisted by the barangay secretary who is mandated to: (1) assist in the registration of births, deaths and marriages; (2) keep updated records of all inhabitants of the barangay containing the following items of information: name, address, place and date of birth, sex, civil status, citizenship, occupation, and such other items of information as may be 24 Section 6 (a), RA No. 10625. 25 Section 6 (2), RA No. 10625. 26 Article 18 (a) Implementing Rules and Regulations (“IRR”) of RA No. 10625. 27 Article 18 (b), IRR of RA No. 10625. 28 Rule 4, NSO AO No. 1, s. 1993. 29 Section 443 and 454 of RA No. 7160. 30 Sections 443, 454 and 479 RA No. 7160. 31 Section 4, Act No. 3753. 32 Rule 5 (e), NSO AO No. 1, s. 1993. 33 Section 13, Act No. 3753 and Rule 5 (c) of AO No. 1, s. 1993. 34 Section 479, RA No. 7160. 35 Section 479, RA No. 7160. 36 Section 479, RA No. 7160.

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prescribed by law or ordinance; and (3) submit a report on the actual number of barangay residents as often as may be required by the barangay council.37 Apart from local civil registrars, the field offices of the NCIP are also deputized to register births and deaths of indigenous people. This is meant to facilitate the effective and efficient civil registration of births and deaths of indigenous people and allow the NCIP to develop mechanisms to honor and recognize the naming systems and customs of indigenous people. At present, the NCIP, through its Tribal Affairs Assistants, assists in the registration of births and deaths by helping indigenous people accomplish birth and death certificates and by facilitating transmittal to the local civil registrar. As mentioned, local civil registrars are under the technical supervision of the civil registrar general. 38 This technical supervision is carried-out through the Regional Statistical Service Offices (RSSO) Civil Registration Division and Provincial Statistical Office (PSO), which may exercise delegated inspection and visitorial powers over local civil registrars.39 Note that these powers would have to be delegated by the civil registrar general before it takes effect. Hence, unless a delegation has been made, the RSSO and PSO may not exercise inspection and visitorial powers. Further, although the civil registrar general has technical supervision, inspection and visitorial powers, disciplinary authority still resides in the mayor of the LGU concerned. The civil registrar general can only report the erring local civil registrar to the mayor concerned for disciplinary action.40

ii. Health Authorities Health agencies are also involved in CRVS. The DOH, which serves as vice-chair of the IACCRVS, is the lead government agency for health. The primary mandate of the DOH is the formulation, planning, implementation, and coordination of policies and programs in the field of health. 41 The DOH, through the Health Facilities Development Bureau, also oversees the licensing of hospitals and other health facilities, and is also empowered to collect, analyze, and disseminate statistical data on health.42 As with civil registration, health services were decentralized to LGUs under the Local Government Code. Local health officers are appointed by the mayor and are funded by local government funds. With respect to LGUs, the DOH’s mandate is to provide guidance for the development of local health systems, programs, and services, and is charged with technical oversight and monitoring of the implementation of such programs and services.43 In line with this, the DOH Knowledge Management and Information Technology Service produced a Medical Certification of Death Handbook for Filipino Physicians, in order to provide guidance to medical practitioners on the correct way of certifying causes of death and accomplishing certificates of death. The DOH, through the Bureau of Local Health Systems and Development (BLHSD), also assists in the development of local health systems by providing frameworks, standards, systems, and procedures to LGUs.44 In order to monitor the performance of LGUs, the DOH – BLSHD has an LGU Scorecard designed to track the implementation and achievement of expected outcomes of health sector reforms.45 However, the LGU Scorecard program currently only covers 60 provinces and 17 cities and municipalities.

37 Section 394, RA No. 7160. 38 Article 18 (b), IRR of RA No. 10625. 39 Article 18, IRR of RA no. 10625. 40 Section 455 (b)(1)(x) and Section 444 (b)(1)(x), RA No. 7160. 41 Book IV, Title IX, Chapter 1, section 2, EO No. 292. 42 Section 5, RA No. 4226. 43 Section 2, EO No. 102, Redirecting the Functions and Operations of the Department of Health (“DOH”) s. 1999. 44 DOH, Bureau of Local Health Systems and Development (BLHSD), as of 16 July 2017, available at: http://www.doh.gov.ph/blhd-ogrchart. 45 DOH, To Whom Is the LGU Scorecard Intended For, As of 16 July 2017, available at: http://www.doh.gov.ph/node/1231.

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Local health officers play a crucial role in the CRVS System as they are tasked to determine the cause of death for non-medically attended deaths, and to review and cause the registration of all certificates of death.46 Local health officers are also responsible for administering burial sites, enforcing sanitation laws, and conducting autopsies, when needed.47

iii. Other key actors The Philippine National Police (PNP) and National Bureau of Investigation (NBI) participate in the CRVS System in cases of violent deaths, suicides, and deaths during disasters. The medico-legal officers of the PNP are primarily tasked to determine the cause of death in cases of death due to violence or suicide.48 At the request of the next-of-kin of a decedent, the NBI may also conduct a second or confirmatory autopsy, to determine the cause of death. However, the results of the second or confirmatory autopsy will not affect the findings reflected in the certificate of death. The head of the PNP and NBI are likewise mandated to cause registration of death through the local health officer of the concerned city or municipality, if they find that the death has not been registered.49 The PNP and NBI also assists in victim identification, in cases of human-induced disasters and natural disasters, respectively.50 Their medico-legal officers are required to issue a certificate of identification for all types of disasters. For human-induced disasters, the PNP or NBI are also mandated to issue the certificate of death and determine cause of death.51 In all cases of disasters, it is the National Disaster Risk Reduction Management Council (NDRRMC) that is responsible for issuing rules and regulation for risk reduction, response and management to disaster, including rules on the management of the dead and the missing.52

iv. Inter-Agency Committee on CRVS To coordinate with other government agencies, the PSA is empowered to establish inter-agency committees that may be empowered, in turn, to create sub-committees or technical working groups as needed.53 The PSA, thus, created the IACCRVS to serve as a venue for discussion and resolution of issues on CRVS, to review current techniques and methodologies and recommend policies towards improvement of data generated from CRVS.54 The IACCRVS is composed of representatives from other key actors in the CRVS system—the DOH, Department of Foreign Affairs (DFA), Department of Justice (DOJ) Department of Education (DepEd), Department of Social Welfare and Development (DSWD), Department of Interior and Local Government (DILG), and Commission on Population.55 The IACCRVS is given the power to establish technical working groups and task forces if necessary.56 Presently, the IACCRVS has not yet been convened due to the reorganization of the government following the 2016 presidential elections.

46 Section 6, Act No. 3753 and Rule 33, NSO AO No. 1, s. 1993. 47 Section 478, RA No. 7160; Section 100, PD No. 856; Rule 33, NSO AO No. 1, s. 1993; Paragraphs 3.7 to 3.9, DOH AO No. 114, s. 1991; Section 8, DOH AO No. 2010-0033 s. 2010. 48 Section 16, Department of Justice Manual for Prosecutors; Rule 37 NSO AO No. 1, s. 1993. 49 Rule 37, NSO AO No. 1, s. 1993. 50 6.1, National Disaster Risk Reduction and Management Council (NDRRMC) Memo Circular No. 19. 51 Section 6.1, NDRRMC Memo Circular No. 19. 52 Section 5, RA No. 10121 or the Philippine Disaster Risk Reduction and Management Act of 2010. 53 Section 10, RA No. 10625. 54 PSA Board Resolution No. 12, s. 2014. 55 PSA Board Resolution No. 12, s. 2014. 56 PSA Memorandum Order No. 01, s. 2015.

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IV. The Civil Registration System

a. Civil Registration in General

i. Free and compulsory registration

Under PD No. 651, registration of births and deaths is free and compulsory for all. However, some LGUs charge fees for registration. Act No. 3753, as implemented by AO No. 1, s. 1993, provides uniform procedures for registration of births, deaths, and other vital events. The civil registrar general has the power to supplement these procedures by issuing rules and regulations. As mentioned in the previous section, LGUs may also enact ordinances relating to civil registration. However, these ordinances must not contradict Act No. 3753 and its implementing rules and regulations and other civil registration laws. Otherwise, said ordinances may be declared invalid upon the filing of the appropriate petition in court.

ii. Amendment of civil registration records

AO No. 1, s. 1993 provides specific guidelines for the registration of live birth, foundlings, death, marriage, application for marriage licenses, court decrees, and orders such as adoption, annulment, legal separation, nullity of marriage, correction of entries, change of name, and presumptive death, and registration of legal instruments such as affidavits or reappearance, acknowledgment or admission of paternity, election of citizenship, and repatriation. It also provides the procedures for supplemental reporting for birth, death, and marriage registration, delayed registration, and reconstruction of lost or destroyed civil registry records. The procedures for amending civil registration records are found in other laws, such as:

1. RA No. 9048, as amended by RA No. 10172, with respect to amendment of clerical errors and change of first name or nickname, day and month in the date of birth or sex of a person appearing on the civil register without need of a judicial order.57

2. Rule 108 of the Rules of Court or the Cancellation Or Correction Of Entries In The Civil Registry, with respect to cancellation or correction of entries in the civil registry.58

iii. Civil registration forms and books

The civil registration forms to be used in the registration of vital events and the civil registry books which local civil registrars are required to maintain are also specified in AO No. 1, s. 1993. Notably, the law does not require a register of fetal deaths, though it prescribes a separate form for Certificates of Fetal Death.59 Fetal deaths are thus registered in the same manner as other deaths60 but the data may be disaggregated given that there is a separate form for registering fetal deaths.

57 Section 1 and 4 of RA No. 9048; and Section 1 and 2 of RA No. 10172. 58 Section 1 and 2, Rule 108, Rules of Court. 59 Rule 8 (d), NSO AO No. 1, s. 1993. 60 Rule 38, NSO AO No.1, s. 1993.

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iv. Delayed registration of vital events

The reglementary period for birth and death registration is 30 days. Act No. 3753 requires the registration of births within 30 days after birth. Meanwhile, Presidential Decree (PD) No. 651 requires the reporting of deaths to the local health officer within 48 hours and the registration of deaths within 30 days after death.61 Beyond the period, a report of a vital event is considered delayed, for which additional requirements such as the submission of an affidavit of delayed registration, additional documentary evidence, posting on the city or municipal bulletin board for 10 days, and investigation, are required.62 Additionally, the local civil registrar may charge fees for delayed registration, as opposed to timely registration wherein collection of fees is not permitted.63 Failure to timely report birth and death may also result in the imposition of fines and penalties on informants.64 DELAYED BIRTH REGISTRATION DELAYED DEATH REGISTRATION

Figure 2. Flowchart: Procedure for Delayed Registration

61 Section 5, PD No. 651. 62 Rule 12, 13, 25 and 39, NSO AO No. 1, s. 1993. 63 Rule 17, NSO AO No. 1, s. 1993. 64 Section 17 and 18, Act No. 3753; Rule 69, NSO AO No. 1, 1993; Section 9, PD No. 651. PD No. 651, the most recent law on penalties, prescribes a fine of not less than P500.00 ($10.00) and not more than P1,000.00 ($20.00), or imprisonment of not less than 3 months nor more than 6 months at the discretion of the court, for failure to report vital events as required by law, or for making deliberate false statements, and on any local health officer who fails to perform his duties.

Submit 4 copies of Certificate of live birth with affidavit of delayed registration and additional documentary requirements.

Local civil registrar to post a notice of the application for delayed registration for 10 days.

NO OPPOSITION The local civil registrar to confirm veracity, and whether the event has not been registered, and is within his jurisdiction to register.

Submit 4 copies of Certificate of Death with affidavit of delayed registration and documentary evidence to local health officer.

The local civil registrar shall register the birth or death in the appropriate register.

WITH OPPOSITION The local civil registrar shall investigate, take testimonies of witnesses, etc. and forward his findings and recommendations to the Office of the Civil Registrar General for appropriate action.

For every application for delayed registration, the local civil registrar shall cause the filing of a complaint with the office of the prosecutor for appropriate action under Sec. 17, Act no. 3753.

Local health officer to review and approve Certificate of Death.

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v. Access linked to registration

Certificates of birth and death are required to access basic government services. The submission of the certificate of birth is required for school enrolment, allowance for tax exemptions for dependents,65 passport application,66 availment of social security benefits such as maternity benefits,67 tax registration, registration of primary insured and dependents under the Philippine Health Insurance Corporation,68 and for opening bank accounts.69 Registration of births is also required for indigenous availing of financial assistance under the “Pantawid Pamilyang Pilipino Program” (4Ps), a conditional cash transfer program for indigent Filipino families. Meanwhile, the certificate of death is generally required to obtain a burial permit,70 insurance claims,71 the settlement of estate tax,72 availment of social security benefits,73 and other pensions.74

vi. Certified true copies of registry documents

As mentioned in the previous section, the local civil registrar is authorized to issue certified copies of civil registry documents.75 Requests for certified copies of certificates of birth, death, marriage, and no-marriage76 may also be made online via http://www.e-census.com.ph but the document itself may only be released to:77

1. The person himself or any person authorized by him; 2. The spouse, his parent or parents, direct descendants, or guardian, if a minor; 3. The court or public official where necessary in proceedings; and 4. In case of death, the nearest kin.78

While the law provides restrictions on who may receive certified copies of certificates of birth or death, it does not specify the identity documents that the processor or courier may demand from the requester. Couriers are contracted by PSA partners, that process and facilitate batch requests for certified copies of civil registry documents. The PSA is, thus, unable to monitor if the person receiving the document is authorized to do so.

vii. Transmittal and encoding of civil registry documents The flow of submission of civil registry documents from the local civil registrar to the civil registrar general is provided in the Civil Registration and Vital Statistics Handbook for Health Workers issued by the Philippine Statistics Authority.79 65 Section 3, PD No. 651; DepEd DO No. 41, s. 2012. 66 Section 5, RA No. 8239. 67 Section 14-A, RA No. 8282. 68 PhilHealth Circular No. 50, s. 2012. 69 Manual of Regulations for Banks. 70 Section 91, PD No. 856. 71 Section 391, RA No. 10607. 72 Section 91(c) in relation to Section 94 and 95, RA No. 8424 or the National Internal Revenue Code of 1997. 73 SSS Circular No. 2015-012. 74 The GSIS Citizen’s Charter, as of July 2017; Philippine Veterans Affairs Office, Veteran Benefits and Services, as of 02 June 2017, available at: http://server.pvao.mil.ph/SiteVeteranBenefits.aspx. 75 Section 13, Act No. 3753; Section 479 (c)(2)(v); Rule 5, NSO AO No. 1, s. 1993. 76 A certificate of no-marriage (CENOMAR) is a certificate which indicates that, based on the civil register, a person has not yet contracted marriage and is, thus, free to get married. 77 PSA Office Memorandum No. 2017-050, s. 2017. 78 Rule 24, NSO AO No. 1, s. 1993. 79 Philippine Statistics Authority, Civil Registration and Vital Statistics Handbook for Health Workers 2nd ed., Manila, 2016 (“CRVS Handbook”), p. 10 to 11.

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BIRTH DEATH/FETAL DEATH

Figure 3: Flow of submission of civil registry documents In case of failure by the local civil registrar to perform his or her duties, the mayor of the concerned city or municipality may impose an administrative fine equivalent to his or her salary for not less than 15 days but not more than 3 months for the first offense, and removal from service for the second or repeated offense.80 In order to facilitate encoding, storage, and transmittal of civil registry documents, the PSA uses the Philippine Civil Registration Information System (PhilCRIS). PhilCRIS is a computer software which enables encoding of relevant information from civil registry documents,81 storage of vital data, query and retrieval of encoded records, printing and issuance of certified copies of encoded civil registry documents, generation of transmittal files, and data management and maintenance of the local civil registry database.82 It is available for use by the offices of the civil registrars and other end-users83 but is not mandatory. Some LGUs, like Quezon City and Makati City have their own computerized encoding systems. However, these computerized encoding systems are not integrated with PhilCRIS.

80 Section 18, Act No. 3753. 81 PhilCRIS already allows access by end-users to the following civil registry forms:

1. Certificate of Live Birth (Municipal Form No. 102, Revised January 2007); 2. Certificate of Live Birth – Attachment for IP (IP Form No. 1, Revised January 2007); 3. Certificate of Live Birth – Attachment for Muslim Filipinos; 4. Certificate of Death (Municipal Form No. 103, Revised January 2007); 5. Certificate of Death – Attachment for IP (IP Form No. 2, Revised January 2007); 6. Certificate of Death – Attachment for Muslim Filipinos; 7. Certificate of Marriage (Municipal Form No. 97, Revised January 2007); 8. Certificate of Marriage – Attachment for IP (IP Form No. 3, Revised January 2007); 9. Certificate of Marriage – Attachment for Muslim Filipinos.

82 PhilCris Primer, as of 02 June 2017, available at: https://psa.gov.ph/content/philippines-civil-registry-information-system-philcris-version-30.. 83 PhilCris Primer, as of 02 June 2017, available at: https://psa.gov.ph/content/philippines-civil-registry-information-system-philcris-version-30..

Registrant/ Informant

Informant

Local Health Officer

Local Civil Registrar

PSA Provincial Statistical Office

PSA Central Office

Within 30 days from birth

Within 48 hours from death

Within 30 days from death

Within 10 days after reference month

6th week after reference week

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PhilCRIS facilitates the encoding and generation of mortality statistics using the International Classification of Diseases (ICD)-10 coding feature of the software. PhilCRIS also allows its users to create back-up files and to restore the system using the back-up file, to preserve data.84 Electronic signatures are not yet used in PhilCRIS. The system also does not allow online transmittal of encoded files. In effect, documents are signed manually, brought manually to the local civil registrar for registration, and transmitted manually from local civil registrars to PSOs for consolidation. Note that the laws necessary to enable PSA to leverage technology to facilitate a more efficient registration and recording process are already in place. RA No. 8792 or the E-Commerce Act gives legal effect, validity and enforceability to electronic data messages and electronic documents, subject to authentication, integrity, and reliability.85 Furthermore, the E-Commerce Act mandates government agencies that require or accept the filing, creation, retention, or submission of documents to accept the creation, filing, or retention of documents in the form of electronic data messages or documents and to transact government business and/or perform governmental functions using electronic data messages or electronic documents.86 The E-Commerce Act also recognizes the validity of electronic signatures if it can be proved that the procedure prevents alteration, allows the party to give consent, the method is reliable and the concerned party executed the signature. The law creates a presumption that the e-signature of the party concerned was affixed with the intention of signing or approving the document.87 In terms of data protection, RA No. 10173 or The Data Privacy Act lays down the basic requirements for the digital storage, processing, access, and transmittal of personal data by government.88 When data is stored and shared between government agencies, the law requires the concerned agencies to put in place the necessary clearance procedures and data sharing agreements to ensure the privacy of data subjects, and to install such measures as are necessary to ensure that the data is protected from breach or destruction.89

b. Definition of vital events – live birth, death and fetal death The definition of live birth, death, and fetal death under the law are in some parts consistent with United Nations definitions. Under the UN definition, a fetus is considered born if it shows evidence of life upon complete expulsion or extraction, regardless of the gestation period of the fetus. However, under Act No. 3753 and AO No. 1, s. 1993, a fetus with an intra-uterine life of 7 months that dies within 24 hours is not considered born. This qualification is taken from Article 41 of the Civil Code which provides that a fetus with an intra-uterine life of less than 7 months is not deemed born if it dies within twenty-four hours after its complete delivery from the maternal womb. Nevertheless, a certificate of live birth is prepared for statistical purposes, but the birth is not registered in the registry of births.

84 NSO, PhilCRIS User Guide, Manila, 2011, p. 58. 85 Sections 6 and 7, RA No. 8792 or the Electronic Commerce Act (“RA 8792”). 86 Section 27, RA No. 8792. 87Sections 8 and 9, RA No. 8792. 88 Section 31, 28, IRR of RA No. 10173 or the Data Privacy Act (“RA No. 10173”). 89 Chapter VII, Section 18, 20, 23, RA No. 10173; Section 8, NPC Circular 16-02.

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UN Definition Act No. 3753 AO No. 1, s. 1993 Live Birth Complete expulsion or extraction of a product of conception from its mother, irrespective of the duration of pregnancy which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut off or the placenta has been attached.90

Any fetus having human features, which dies after 24 hours of existence completely disengaged from the maternal womb, shall be entered in the proper registers as having been born and having died.91

(1) Live birth is the complete expulsion or extraction of a product of conception from its mother, irrespective of the duration of pregnancy which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut off or the placenta has been attached, each product of such birth is considered alive. (2) A fetus with an intra-uterine life of 7 months or more and born alive at the time it was completely delivered from the maternal womb but died later shall be considered as live birth and shall be registered in the Register of Births. (3) However, if the fetus had an intra-uterine life of less than 7 months, it is not deemed born if it dies within twenty-four (24) hours after its complete delivery from the maternal womb. For statistical purposes, the certificate of live birth shall be prepared in duplicate, a copy of which shall be forwarded to the office of the civil registrar general and other for the civil registrar’s file.92

Table 1. Comparison of Definitions of Live Birth

Unlike live birth, death and are not defined under Act No. 3753. AO No. 1, s. 1993 adopts the UN definition of death, which is the permanent disappearance of all evidence of life after live birth, but retains the qualification with respect to fetuses with an intra-uterine life of 7 months that die within 24 hours. As these fetuses are not considered born, they are also not considered dead. A certificate of death is prepared for statistical purposes but is not registered in the registry of deaths.

90 UN, Principles and Recommendations for a Vital Statistics System, Revision 3, New York, 2014. Para. 2. 91 Section 5, Act No. 3753. 92 Rule 18, NSO AO No. 1, s. 1993.

UN Definition Act No. 3753 AO No. 1, s. 1993 Death

The permanent disappearance of all evidence of life at any time after live birth has taken place (postnatal cessation of vital functions without capability of resuscitation).1

[none] (1) Death is the permanent disappearance of all evidence of life at any time after live birth has taken place (postnatal cessation of vital functions without capability of resuscitation). (2) A fetus with an intra-uterine life of 7 months or more and born alive at the time it was completely delivered from the maternal womb but died later shall be considered as live birth and shall be registered in the Register of Births. (3) However, if the fetus had an intra-uterine life of less than 7 months, it is not deemed born if it dies within twenty-four (24) hours after its complete delivery from the maternal womb. For statistical purposes, the certificate of death shall be prepared in duplicate, a copy of which shall be forwarded to the office of the civil registrar general and other for the civil registrar’s file.1

Fetal Death Death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy. Fetal death is indicated by the fact that after such separation, the fetus does not breathe nor show any other evidence of life, such as the beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles.

[none] Death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy. Fetal death is indicated by the fact that after such separation, the fetus does not breathe nor show any other evidence of life, such as the beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles.93

Table 2. Comparison of Definitions of Death and Fetal Death

Note also that CRVS laws do not specify a gestation period for recording of fetal deaths. In effect, it would appear that all fetal deaths, regardless of gestation period, are required to be registered. The law also does not specify when abortions and miscarriages are recorded, or if they are to be recorded at all.

c. Registration of births Registration of births is compulsory for all, regardless of race, religion, ethnicity, residency, geography or other characteristics.94

i. Information and proof required to register birth

The following information are required to be recorded in the birth register, as provided in Act No. 3753:

1. Date and hour of birth; 2. Sex and nationality of infant; 3. Names, citizenship, and religion of parents, or if father is unknown, the mother alone; 4. Civil status of parents (legitimacy); 5. Place where the infant was born; and 6. Such other data as may be required in regulation issued by the civil registrar general.

Municipal Form No. 102 or the prescribed Certificate of Birth requires the following additional information:95

1. Age of mother and father, if known; 2. Place of residence of mother and father, if known; 3. Weight at birth; 4. Number of children born alive to mother and order of birth; 5. Place of birth; and 6. Attendant at birth, with signature, name and title.

93 Rule 38, NSO AO No. 1, s. 1993. 94 Section 5, Act No. 3753; Section 1, PD No. 651, Requiring The Registration Of Births And Deaths In The Philippines Which Occurred From January 1, 1974 and Thereafter, as amended by PD No. 766, Extending the Period of Registration up to December 31, 1975 (“PD No. 651”). 95 Appendix A.

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The law does not require a medical certificate of birth or other proof for the registration of births that are medically attended. It suffices that the accomplished Municipal Form No. 102 is submitted to the local civil registrar. For births that are not reported by hospital facilities or medical attendants, there is no mechanism to ascertain the facts contained in the Certificate of Birth as no other authenticating document is required for registration.

ii. Informants of birth

Informants are required to report births to the local civil registrar of the place of birth within 30 days after birth.96 If the birth occurred in a hospital or clinic, the hospital administrator is primarily responsible for causing the registration of birth, and the attendant is only responsible for certifying the facts of birth. If the birth did not occur inside a hospital or clinic, the attendant at birth, which includes the physician, nurse, or midwife are the primary informants. In default thereof, the parents of the child shall cause the registration of birth or, in default thereof, anyone who was knowledge of the birth.97 For births occurring aboard a vehicle, vessel or airplane while in transit, the parents and driver, captain or pilot have joint responsibility to report the birth.98 Though the law seemingly creates a hierarchy between the informants, in truth, all the informants are jointly liable, in case of failure to register a newborn child.99

Figure 4. Flowchart: Registration of Births

96 Section 5, Act No. 3753. 97 Section 2, PD No. 651. 98 Rule 21, NSO AO No. 1, s. 1993. 99 Section 2, PD No. 651.

The attendant at birth shall certify the facts of birth.

The hospital administrator shall prepare and accomplish the Certificate of Live Birth (COLB).

The parents or any responsible person with knowledge of the birth shall confirm the accuracy of the personal information in the COLB.

The hospital administrator shall cause registration of the birth with the local civil registrar.

Is there an attendant at birth?

The local civil registrar shall check the correctness and completeness of the entries and proceed to assign a registry number, register the death in the Register of Births, and issue the Certificate of Live Birth.

Did the birth occur inside the hospital/medical institution?

YES NO

Within 30 days from birth

Within 30 days from birth

YES NO

Physician or midwife shall accomplish the COLB.

Physician or midwife shall cause registration of birth with the local civil registrar.

The parents or any responsible person with knowledge of the birth shall accomplish the COLB and cause registration of birth with the local civil registrar.

Within 30 days from birth

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iii. Delayed birth registration

A common reason for delayed registration of births is the delay or failure of the father to acknowledge an illegitimate child. Under PSA rules, the father’s acknowledgement made after registration will only be recorded as an annotation on the birth certificate. Because of the social stigma attached to not having a father named in the birth certificate, mothers opt to delay registration until after the father is able to sign the birth certificate or acknowledge paternity. Some parents also opt to delay registration to give them time to name the child.

iv. Place of registration of birth

As a rule, births must be registered at the place of birth of the newborn.100 However, AO No. 1, s. 1993 provides for specific rules for registration in cases where the baby is born in a vehicle, vessel or airplane while in transit: Place of birth Destination Place of Registration Within Philippine territory Within Philippine territory but

exact place unknown Civil register of the mother’s destination or place of habitual residence

Outside Philippine territory but exact place unknown

Philippines Civil register where the mother habitually resides (if resident of the Philippines). If the parents or child are foreigners but residents of the Philippines, the place where the mother habitually resides. If parents or child are foreigners but not residents, the birth may be recorded in the civil register of Manila, at their option.

Unknown Another country Philippine Foreign Service Establishment of the country of the mother’s destination or, if none, the nearest country with a Philippine Foreign Service Establishment.

Table 3. Place for Registration of Births

Subject to compliance with specific requirements, out-of-town reporting of birth may also be permitted, not for registration, but for forwarding of the registration documents to the civil registrar where the birth occurred or where the birth should be registered. The requirements for out-of-town reporting of birth includes the submission of an affidavit, attested by 2 witnesses, stating the reasons why the birth cannot be recorded in the appropriate local civil registry.101

100 Rule 19, NSO AO No. 1, s. 1993. 101 Rule 20, NSO AO No. 1, s. 1993.

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d. Registration of deaths and determination of cause of death Registration of deaths is compulsory for all, regardless of race, religion, ethnicity, residency, geography or other characteristics.102

i. Information and proof required to register death

The following information on death are required to be registered according to Act No. 3753:

1. Date and place of death; 2. Full name; 3. Age; 4. Sex; 5. Occupation or profession; 6. Residence; 7. Status as regards marriage; 8. Nationality of the deceased; and 9. Probable cause of death.

In accordance with international best practices,103 Municipal Form No. 103,104 or the prescribed Certificate of Death, requires the following additional information:

1. Age at the time of death; 2. Parents’ names prior to first marriage; 3. Certifier (of death); 4. Immediate cause, antecedent cause, and underlying cause of death, as well as

interval between onset and death, or manner of death; and 5. Source of cause of death information (whether medically attended or not).

As previously mentioned, fetal deaths are registered in the same manner as deaths. As such, Act No. 3753 does not prescribe minimum information required to be registered when it comes to fetal deaths. However, Municipal Form No. 103A105 prescribes the following information to be registered, in accordance with best practices:106

1. Date and place of delivery; 2. Date and place of registration; 3. Attendant at birth; 4. Type of birth (twin, triplet, etc.); 5. Causes of fetal death, specifying main disease or condition of the fetus or the

mother; 6. Certifier; 7. Sex; 8. Weight; 9. Citizenship, religion and occupation of parents; 10. Residence of mother; 11. Method of delivery; and 12. Birth order.

102 Section 6, Act No. 3753 and Section 4, PD No. 651. 103 UN Recommendations, Para. 66, Table III.1. 104 Appendix B. 105 Appendix C. 106 UN Recommendations, Para. 66, Table III.1.

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ii. The MCCOD

The MCCOD is incorporated in the Certificate of Death or Certificate of Fetal Death. As a consequence, a single document containing potentially sensitive cause of death information gets passed-on, from the physician to the family, the health officer, the local civil registrar, and to other agencies that require certificates of death for social services.

The submission of the Certificate of Death or the Certificate of Fetal Death107 with the medical certificate portion completely and correctly filled out is the sole requirement for registration of death within the reglementary period.108 Under the rules, the immediate cause, antecedent cause, and underlying cause of death, as well as interval between onset and death, or manner of death, must all be filled out. As there are no guidelines on how to accomplish the MCCOD for medico-legal cases, the practices of local health officers in reviewing cause of death determination for medico-legal cases vary. According to Dr. Al Anthony M. Chua of the NBI, the NBI standard operating procedure is to indicate the case number in the space provided for cause of death in the MCCOD, leaving the remaining fields blank. The cause of death is then written under the post-mortem analysis at the back portion of the Certificate of Death. In reviewing the Certificate of Death, some local health officers would accept the MCCOD with just the case number and postmortem analysis, while others would return the MCCOD to the PNP or NBI for correction, or fill out the MCCOD themselves using the post-mortem report.

iii. ICD coding

ICD coding happens only at the civil registrar level for statistical purposes, although all categories of hospitals are required to have a full-time or part-time ICD-10 trained coder and ICD-10 books, as a requirement for licensing.109 ICD-10 coding by hospitals is only for the purpose of filing and processing of claims under the Philippine Health Insurance Corporation, and for the reports it generates on the top 10 causes of death which is required by the DOH.110

All hospitals are required to have ICD-10 encoders as part of their licensing requirements. However, the DOH does not prescribe specific qualifications to become a mortality coder, other than training by accredited trainers of the DOH.111

iv. Persons required to report the death and certifiers of cause of death

The persons responsible to report and determine cause of deaths vary depending on the circumstances surrounding the death: Circumstances Person required to report Certifier of Cause of Death Medically-attended Physician who last attended

the deceased or the administrator of the hospital or clinic where the deceased died

Physician who last attended the deceased or the administrator of the hospital or clinic where the deceased died

Death in Emergency Room Physician who last attended the deceased or administrator of the hospital or clinic112

ER officer if he can provide a definite diagnosis, or hospital medico-legal officer, or local health officer113

107 Section 5, Act No. 3753. 108 Rule 11, NSO AO No. 1, s. 1993. 109 DOH AO No. 47, s. 2000. 110 PhilHealth Circular No. 35, s. 2013. 111 L. Hufana, Civil Registration and Vital Statistics Assessment: Philippines, Pasig City, p. 10. 112 DOH, Medical Certification of Death Handbook for Filipino Physicians, Manila, 2015 (“Medical Certification of Death Handbook”), p. 7 to 8. 113 DOH, Medical Certification of Death Handbook, p. 7 to 8.

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Death in Ambulance Physician who last attended the deceased or administrator of the hospital or clinic114

The attending physician during transports115

Death without medical attendance

Nearest relative or person who has knowledge of the death1

Local health officer or, in his absence, the mayor or a member of the local legislative council, or the municipal secretary, but only for burial purposes

Violent or accidental deaths or suicide

Local health officer at the instance of the head of PNP or NBI1

PNP or NBI medico-legal officer

Human-induced disaster PNP to issue Certificate of Identity

PNP or NBI to issue Certificate of Death

Natural disaster NBI to issue Certificate of Identity

Local health officer to issue Certificate of Death

Table 4. Persons Required to Report and Certifiers of Cause of Death

It is unclear if the physician who last attended the deceased and who is required to report the death of the decedent refers only to the decedent at death, or if it refers to any physician who last attended to the decedent before he died, regardless of the relationship of the illness he treated to the death or his presence at the decedent’s death. The law also does not specify the length of the intervening period wherein the physician who last attended the deceased is still required to report the death. As a consequence, it would appear that a physician who attended the deceased long before the latter died is still required to report the death if he has no knowledge of such death. In practice, however, some hospitals have interpreted the law to refer to the physician who attended the deceased at his death.

v. Reporting fact of death to the local health officer

Deaths must be registered with the local civil registrar within 30 days from occurrence, at the city or municipality where the death occurred. 116 Before registration, however, deaths must be reported within 48 hours to the local health officer, who shall review the MCCOD, sign the certificate of death, and order its registration.117 The rules do not mandate the local health officers to transmit the certificate of death to the local civil registrars. As such, in practice, it is the family of the decedent that facilitates the transmittal from the local health officer to the civil registrar’s office. For cases of violent deaths or deaths requiring an autopsy, the medico-legal officer is expected to submit the death certificate to the local health officer within 48 hours. This period, according to Atty. Chua of the NBI, is insufficient to complete the investigation or the autopsy. As a result, the 48-hour reporting deadline is not followed.

vi. Procedure for certifying cause of death

While the law identifies the person responsible for certifying cause of death, it fails to specify procedures for certifying cause of death. For instance, it is unclear how the local health officer is expected to determine cause of death after burial, or in cases where the death occurred without medical attendance. There is no established procedure, standards, or guidelines for local health officers in reviewing the cause of death indicated in the certificate of death prepared by physicians or medico-legal officers. The law does not mandate resort to alternative systems like 114 DOH, Medical Certification of Death Handbook, p. 7 to 8. 115 DOH, Medical Certification of Death Handbook, p. 7 to 8. 116 Rule 32, NSO AO No. 1, s. 1993. 117 Rule 33, NSO AO No. 1, s. 1993.

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verbal autopsy 118 or actual autopsy in such instances. Given that verbal autopsy is not mandatory, it is generally not resorted to. Meanwhile, autopsy cannot be resorted to for all deaths as health officers are generally not trained as medico-legal officers or coroners, and do not have the resources to conduct autopsies for all non-medically attended deaths. While the local health officer reviews all certificates of death before registration, there is no system in place to enable the local health officer to review the accuracy or veracity of cause of death information as the law does not require the attachment of medical records. There is, in fact, no incentive to provide accurate cause of death information, as the law does not provide penalties for inaccurate or false cause of death determination. Some LGUs require additional documents in reviewing the certificate of death, but the practices of LGUs vary. The local health office of Tanza, Cavite requires the submission of a medical abstract or medical records to be attached to the copy of the death certificate for purposes of review. These documents are then filed in their records. They also require an autopsy for all cases of undetermined cause of death. Should the family refuse to conduct an autopsy, the family is required to execute a waiver of their right to the conduct of an autopsy. Meanwhile, in Quezon City, an affidavit from the family certifying to the circumstances attending the death for deaths which are not medically attended, is required. Physicians, hospital administrators and local health officers also generally do not receive in-depth training on cause of death certification as training in certifying cause of death is not mandatory in the Philippines. CHED Memorandum Order No. 18, s. 2016 provides for the minimum curricular content for medical schools 119 which requires Legal Medicine, Medical Jurisprudence and Forensic Medicine, and Family and Community Medicine. However, the memorandum order does not go to the extent of prescribing cause of death certification training, or ICD-10 coding training as components of these subjects.

vii. Delayed death registration

In cases of delayed registration, the applicant for delayed registration must submit an affidavit stating the facts of death, date and place of burial, and circumstances why the death was not registered within the reglementary period. The affidavit must also be accompanied by an authenticated copy of the certificate of burial, cremation, or other means of corpse disposal, and the application for registration must be approved by the local health officer.120 A common cause of delay in registration of deaths is the detention of cadavers for failure to settle the deceased’s medical expenses. Under RA No. 9439 or “An Act Prohibiting The Detention Of Patients In Hospitals And Medical Clinics On Grounds Of Nonpayment Of Hospital Bills Or Medical Expenses” (RA No. 9439), the hospital or medical facility is mandated to release the deceased’s death certificate and other documents required for interment, subject to the execution of a promissory note with security, in case there are unpaid obligations to the hospital at the time of death.121 However, the law provides an exception for patients who stayed in private rooms, defined as accommodating 4 patients at a time under the implementing rules and regulations.122 This exception effectively authorizes medical facilities to hold the death certificates of patients with outstanding obligations forcing the family or relatives to resort to alternative solutions, such as reporting the death as not medically attended or obtaining fake death certificates to be able to proceed with burial. 118 United Nations, Principles and Recommendations for a Vital Statistics System, Revision 3, New York, 2014. Para. 499 – 501. - Verbal autopsy refers to a structured interview of the deceased’s family members who can provide sufficient information to determine the probable cause of death by either using a computer algorithm or what is referred to as, automated verbal autopsy, or by a physician who reviews the interview results and completes an international standard form of death certificate or physician-certified verbal autopsy. 119 Section 6.3, CHED Memorandum Order No. 18, s. 2016. 120 Rule 39, NSO AO No. 1, s. 1993. 121 Section 2, RA No. 9439 or “An Act Prohibiting The Detention Of Patients In Hospitals And Medical Clinics On Grounds Of Nonpayment Of Hospital Bills Or Medical Expenses” (“RA No. 9439”). 122 Section IV (k), IRR of RA No. 9439.

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Figure 5. Flowchart: Registration of Death

viii. Place of registration of death As a rule, deaths must be registered at the place where the death occurred.123 For deaths occurring in a vehicle, airplane, or vessel, the place of registration is as follows:124 Place of death Destination Place of Registration Within Philippine territory Within Philippine territory but

exact place unknown Place of burial or cremation. If abroad, Office of the Civil Registrar of Manila.

Outside Philippine territory but exact place unknown

Philippines Residence of the decedent if Philippine resident. If not, civil registrar of Manila. If decedent is a foreigner and not a resident, Office of the Civil Registrar of Manila.

123 Rule 32, NSO AO No. 1, s. 1993. 124 Rule 32, NSO AO No. 1, s. 1993.

Physician who last attended to the deceased shall certify the cause of death.

The hospital administrator shall forward the accomplished certificate to the local health officer.

The local health officer shall examine the certificate of death and order registration of death by the local civil registrar.

The next of kin, or other authorized person, shall report the death to the local health officer.

The local civil registrar shall check the correctness and completeness of the entries and proceed to assign a registry number, register the death in the Register of Deaths, and issue the Certificate of Death or Certificate of Fetal Death.

Did the death/fetal death occur inside the hospital/medical institution?

The local health officer shall examine the deceased and certify the cause of death.

YES NO

Within 48 hours

Within 48 hours

Within 30 days from death

Is it a violent death or suspected suicide?

YES

PNP or NBI medico-legal officer to examine the deceased, certify cause of death, and report to the local health officer.

No timeline provided

The local health officer shall order the registration of death by the local civil registrar.

Within 30 days from death Within 30 days

from death

Is there a physician who last attended to the deceased?

YES

NO

NO

Unknown Another country Philippine Foreign Service Establishment of the country of destination.

Table 5. Place of Registration of Death

If the person was buried or drowned in the high seas, and the body was not recovered, the death shall be registered in the civil registry of the last known residence of the deceased or, if not a resident, at the civil registry of Manila. The ship doctor, captain, or health officer shall have the discretion to issue the death certificate and cause of registration, subject to the following requirements:

1. Submission of an affidavit of surviving spouse, parent, guardian, or next of kin, stating the circumstances surrounding death; and

2. The death certificate shall contain the annotation, “Body not Recovered.”

ix. Death registration prior to burial

Act No. 3753 and PD No. 856 or the Code on Sanitation of the Philippines prohibits the burial of remains without a death certificate.125 Under PD No. 856, 126 the “local health authority” is mandated to issue burial permits and in so doing, must ascertain that the death has been registered. However, some local health officers are not aware of their duty to issue burial permits as the local health authority. In fact, in some LGUs such as in Tanza, Cavite and Kabasalan, Zamboanga Sibugay, it is the local civil registrar, and not the local health officer that issues burial permits. Moreover, the DOH, in issuing implementing rules and regulations for PD No. 856 or the Sanitation Code, provided the following broad exceptions to the requirement of a death certificate prior to burial: (a) the person died from a dangerous communicable disease and must be buried within 12 hours; (b) religious beliefs or tradition, such as Islam127 or Jewish, call for burial within 12 hours after death; (c) the family members of the deceased have requested immediate cremation without embalming for viewing; or (d) the kin opted for immediate burial.128 In these cases, the death certificate shall be issued within 12 hours after burial, or sanctions may be imposed by the local health officer.129 The local health officer, who is mandated to review certificates of death upon receipt thereof within 48 hours of death,130 is also mandated to ensure that no unembalmed remains may remain unburied longer than 48 hours after death.131 This may encourage the local health officer to cause the immediate burial of unembalmed bodies, under the broad exceptions provided in the implementing rules and regulations of PD No. 856.

125 Section 91, PD 856. 126 Section 100, PD No. 856. 127 Rule 8, NSO AO 1, series of 2005. 128 Chapter XXI, Section 1, par. 1.1, DOH AO No. 2010-0033 (Revised IRR of PD 856); CRVS Handbook for Heath Workers. 129 Chapter XXI, Section 1, par. 1.1, DOH AO No. 2010-0033 (Revised IRR of PD 856); CRVS Handbook for Heath Workers. 130 Note that under Section 91 (a) of PD No. 856 provides that the death certificate must be forwarded to the Local Civil Registrar within 48 hours. However, this has been clarified in the Implementing Rules and Regulations of PD No. 856 to mean that the death shall be reported to the local health officer within 48 hours and forwarded to the local civil registrar within 30 days after death for registration. This is consistent with Act No. 3753, AO No. 1, s. 1993 and PD No. 651 131 Section 91 (g), PD No. 856.

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Note that there are no penalties for funeral parlors, cemeteries, or crematoriums that bury remains prior to registration. In some cases, the families of the deceased are merely required to post a cash bond to be allowed to bury the deceased without a death certificate but no penalty is imposed on the funeral parlor or crematorium in case the family fails to register the death after burial. There is also no system in place for local health officers to monitor compliance by these establishments with this requirement. V. The Vital Statistics System

a. The Philippine Statistical System

In 2013, Congress enacted the Philippine Statistical Act, reorganizing the Philippine Statistical System.

Figure 6. Framework of Coordination of the Philippine Statistical System

The PSA is the central statistical authority in the Philippines.132 Apart from its mandate to carry out and enforce civil registration laws, the PSA also prepares and conduct periodic censuses, surveys and other statistical inquiries. The PSA is comprised of the PSA Board, offices on sectoral statistics, censuses and technical coordination, civil registration and central support, and field statistical services. Data produced by PSA is the official and controlling statistics of government.133 The PSA Board is the highest policy-making body on statistical matters. 134 It is the body responsible for formulating policies on government statistical operations, standards and classification, approves the Philippine Statistical Development Program, and has the power to create inter-agency committees on statistics.135

132 Section 6 (a), RA No. 10625. 133 Section 5, RA No. 10625. 134 Section 5, RA No. 10625. 135 Section 9 and 10, RA No. 10625.

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Figure 7. Organizational Chart of Philippine Statistical Authority

b. Official Statistics

Official Statistics are produced by the Philippine Statistical System and disseminated by the Philippine Statistics Authority.136 However, the law does not prescribe the frequency of generating vital statistics. It also does not prescribe a format for reporting vital statistics. This may be prescribed by the PSA Board through a policy issuance or by including it in the Philippine Statistical Development Program. The Office of Sectoral Statistics is responsible for the generation of vital statistics.137 The law gives the Office of Sectoral Statistics broad authority to develop methodologies on producing health statistics. It does not prescribe a hierarchy between civil registration data and other forms of statistical inquiries. However, it defines Civil Registration and Vital Statistics System (CRVSS) as comprising the total process of collecting information on the occurrence and characteristics of vital events (e.g., birth, death, cause of death, marriage, adoption, etc.) and generating vital statistics through the compilation, analysis, evaluation, presentation and dissemination of data.138 This suggests that the generation of vital statistics derive primarily from data collected through civil registration. 136 Section 5, RA No. 10625; Rule 3, Article 4 (e), IRR of RA No. 10625. 137 Section 12 (3), RA No. 10625. 138 Article 4(c), IRR of RA No. 10625.

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The Philippine Statistical Act does not prescribe the frequency of generating vital statistics. However, the PSA Board has the authority to specify frequency.

c. Data sharing

Data sharing between government agencies is neither mandated nor automated but government agencies have various options to access statistics from the PSA:

1. Request of Data – Data may be requested online139 or directly at PSA offices. 2. Publication – Data may be accessed through publications of official statistics that are

also accessible online140 or may be requested directly from PSA offices. 3. OpenStat – A soon-to-be-launched open data portal, OpenStat allows direct access

by the public to statistical data. OpenStat will contain datasets on various statistical subject matters with metadata.141

4. I-Stats – I-stats or Interactive Statistical Database is a subscription service for viewing and downloading datasets on economic and social indicators, including vital statistics.142

VI. Policy Gaps The basic framework for a functioning civil registration system can be found in Act No. 3753 and AO No. 1, s. 1993. These laws specify the key actors in the CRVS system, the civil registry books required to be kept, the data and prescribed form of certificates required for registration, procedures for timely and delayed registration, informants and certifiers of cause of death, procedures for transmittal to the civil registrar general, procedures for amendment and correction of entries, and penalties for violation of duty to report and for failure of local civil registrars and local health officers to perform duties. The law also makes registration compulsory, and clearly mandates that timely registration is free. However, some procedural gaps would have to be addressed with respect to death reporting and registration, cause of death determination, and other areas of concern. Additionally, other specific gaps were identified, with respect to the roles of key actors in CRVS, supervision of the PSA over local civil registrars and the definition of vital events.

a. Procedural gaps

i. Death reporting and registration

For death reporting, the procedures, statutory deadline, and certifiers of death have to be clarified. Municipal Form 103, though containing most of the UN prescribed information, includes cause of death information, which may discourage registration in cases involving sensitive causes of death.143

139 PSA, Data Request Form, as of 16 July 2017, available at: https://psa.gov.ph/content/data-request-form. 140PSA, Catalog of Publications, as of 16 July 2017, available at: https://psa.gov.ph/products-and-services/publications. 141 PSA, About OpenSTAT, as of 16 July 2017, available at: http://openstat.psa.gov.ph/about-open. 142 PSA, General Description of I-Stats, as of 16 July 2017, available at: http://nap.psa.gov.ph/i-stats/describe.asp?xu=&yp=&lang=. 143 United Nations, Handbook on Civil Registration and Vital Statistics Systems: Preparation of a Legal Framework, New York, 1998. pp 52-53.

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It is also unclear how the health officer is expected to certify the cause of death for deaths that are not medically attended. The law does not specify the extent or manner of examination to be conducted by the local health officer, and whether verbal autopsy or actual autopsy is required. For causes of deaths certified by the last attending physician, it is not clear if the provision refers to the physician who attended the decedent at death, or if it refers to the physician who last attended the decedent, regardless of the intervening period between the treatment and death and the relationship of the death to the illness. The same is true for reporting violent deaths and suicides. The head of PNP or NBI is only required to report death if it had not been reported to the local health officer for registration. This suggests that the responsibility for reporting lies with the local health officer. Additionally, it should be clarified if the investigation into the circumstances surrounding death or a full autopsy must be completed before the death can be registered, given the 48-hour deadline for reporting and considering that death cannot be registered if the medical certificate containing cause of death information is not completely filled-out. Further, specific guidelines for filling-out the MCCOD in medico-legal cases must be clarified as the NBI, in practice, only indicates the case number on the MCCOD and indicates cause of death in the post mortem analysis portion.

ii. Review of cause of death information

There is no system in place to ensure the accuracy of cause of death information in the certificate of death as there are no monitoring systems in place for this purpose. While some local health officers require medical abstracts or affidavits to review cause of death information, others do not, because this is not required in the law. Hence, the practices of LGUs in reviewing cause of death information vary.

iii. Recording of paternity and filiation

Some socio-cultural issues also cause delays in the registration of births. In the Philippines where there is a high population of Overseas Filipino Workers, it has become a practice for mothers to delay registration of birth, to await the return of the father and give the father the opportunity to sign the birth certificate. This is done to avoid the stigma of not having the father’s name recorded in the birth certificate as the law does not allow amendments in the name of the father, despite acknowledgment by way of an affidavit. In cases where the mother opts for immediate registration, the name of the father who acknowledges paternity belatedly will only be annotated using an acknowledgment form, but will not be indicated in the death certificate itself.

iv. Documentary requirements for registration

The law does not prescribe the presentation of any other document such as a medical notification of birth, apart from the certificate of birth, for registration. This may encourage registration, but it does not guarantee the veracity of information to be registered, particularly for community or home births.144

v. Period for generating vital statistics

The period for generating vital statistics must be specified, in order to ensure that it is completed in a timely manner. Currently, vital statistics are not published annually, inconsistent with the best practice.145 144 United Nations, Principles and Recommendations for a Vital Statistics System, Revision 3, New York, 2014. Para 365 – 366, 368. 145 United Nations, Handbook of Vital Statistics Systems and Methods Volume I: Legal, organizational and technical aspects, New York, 1991. p. 46, Para 333.

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b. Other policy gaps

i. Oversight and discipline

With the enactment of the Local Government Code, disciplinary authority over local civil registrars is now vested in the city or municipal mayor. The civil registrar general can only recommend disciplinary action to the mayor, for appropriate action. Likewise, LGUs, acting through their local legislative councils, are theoretically empowered to enact policies on civil registration for which the PSA has no oversight. Indeed, as a result of decentralization, there is no uniformity in the practices of local civil registrars and local health officers from different LGUs. For instance, in some LGUs, it is the local civil registrar instead of the local health officer who issues burial permits, despite the directive under PD No. 856 that it should be the local health authority. The procedure followed by the local health officer in reviewing the cause of death also varies from one LGU to another. In some LGUs, the local health officer requires additional documents such as medical records. In other LGUs, local health officers review the certificate of death based solely on the information provided in the death certificate.

While ordinances enacted by LGUs are required to be consistent with national laws and the Constitution, ensuring this is difficult given that PSA neither has the mandate to oversee all ordinances enacted by LGUs nor the resources to cause their invalidation. Notably, plans and strategies on civil registration developed by the local civil registrar are subject to the approval of the mayor and not the civil registrar general. Hence, it is legally possible for the mayor to disallow civil registration projects initiated nationally.

ii. Detention of patients

Some hospitals detain death certificates and other medical records due to unpaid medical bills. As a consequence, death registration is delayed. Some families also resort to falsely reporting the death as not medically attended or submitting a false death certificate.

iii. Issuance of burial permits

PD No. 856 mandates the local health authority to issue burial permits. However, it is unclear if the local health authority referred to in PD No. 856 is the local health officer, given that the term is not used under the Local Government Code. As a consequence, there is confusion on who is mandated to issue burial permits. In some local government units, it is the local health officer who issues burial permits, while in others, it is the local civil registrar.

Exceptions to the requirement of death registration prior to burial are also overly broad, as it follows families to opt for immediate burial or cremation, provided that they will cause registration within 12 hours. However, there are no enforcement mechanisms in place to ensure that the families will comply with the requirement after burial.

iv. Registration of indigenous peoples

There is no procedure for determining whether a registrant identifies as indigenous. Hence, when a member of an indigenous group requests for a form from the local civil registrar, they are not given the additional forms required for indigenous people such as IP Form No.1 (birth) and IP Form No. 2 (death).

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v. Registration of abortions and miscarriages

The law does not specify how abortions and miscarriages are to be recorded, resulting in an inconsistency in the recording of these events. Some local health officers reportedly register miscarriages of fetuses with a gestational period of more than 7 months as fetal deaths, while others do not. It is also unclear whether abortions or miscarriages are to be treated as fetal deaths, or “still births” that are recorded for statistical purposes only.

vi. Electronic filing, automation and information exchange

PSA’s PhilCRIS, which facilitates encoding, query and retrieval, ICD-10 coding, printing, storage and management of civil registry documents is a step in the right direction. However, the program is not yet designed for mobile registration, online registration, and online transmission of documents with electronic signatures.146 Further, local civil registrars, hospitals, local health officers and medico-legal officers of the PNP and NBI are not yet mandatory end-users of the system. Additionally, there is no mechanism to integrate the encoding systems of some LGUs with PhilCRIS, or to allow information exchange between other encoding systems and PhilCRIS.

vii. Definition of live birth

For birth reporting, the procedures, statutory deadline, and prescribed forms for registration generally allow efficient and timely registration. However, the definition of live birth is not consistent with the UN definition as it treats children that had an intra-uterine life of 7 months but dies within 24 hours as not born.

viii. Local budget limitations in implementing national CRVS policies

The ability of local civil registrars to implement national CRVS initiatives may be hampered by inadequate local funding as all expenses in connection with the operation and maintenance of the local civil registry office are paid out of the city or municipal funds.147 Given that local civil registrars are funded using local funds, and their budget is subject to the approval of the local legislative council, it is likely that the budget of local civil registrars are not aligned with the demands of national initiatives. VII. Recommendations The legal framework of the Philippine CRVS system is structurally complete. The key actors are defined, the system for coordination is in place, and the basic procedures for civil registration and generation of vital statistics are laid out. Nevertheless, there is still a need to improve the system by issuing additional guidelines in order to increase coverage and improve the quality of data collected.

a. Administrative issuances Most of the policy gaps with respect to the details of implementation, may be addressed through the issuance of administrative polices. 146 United Nations, Principles and Recommendations for a Vital Statistics System, Revision 3, New York, 2014. Para. 378, 381 – 382. 147 Rule 17(3), NSO AO No. 1, s. 1993.

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For the DOH, the following administrative policies are recommended:

1. Disallow the practice of detaining corpses or death certificates for non-payment of medical bills of patients treated in private rooms to facilitate death registration and prevent the proliferation of fake death certificates – The DOH should amend the implementing rules and regulations of RA No. 9439 to remove the exception created against rooms that accommodate at least four (4) persons. The law should further be amended to remove the practice altogether.

2. Limit exceptions to requirement of death registration prior to burial to encourage timely death registration – The DOH should revise DOH AO 2010-0033 which creates broad exceptions to PD No. 856. The exception to the death registration requirement for burial permits in cases where the next of kin requested for immediate cremation, or opts for immediate burial should be removed. Further, the procedures for certifying cause of death after burial should be specified.

3. Include cause of death determination in the curriculum of medical schools and

hospital facilities to improve data on causes of death – Training on cause of death determination should be mandatory for all physicians. Additionally, DOH may provide trainings to local health officers through regional offices.

4. Issue guidelines on use of Verbal Autopsy to establish a standard on the conduct of

verbal autopsy in the Philippines – the DOH may issue guidelines on when and how to conduct verbal autopsy and who shall be authorized to conduct the same. For this purpose, Human Resources for Health (HRH), such as the Nurse Deployment Program (NDP) and Doctors to the Barrios (DTB), may be utilized in conducting verbal autopsy. Verbal autopsy may also be included in training curricula of barangay health workers under Technical Education and Skills Development Authority (TESDA).

5. Improve the DOH Online Health Facility Statistical Reporting System to include data

on: (a) total number deliveries and deaths which occurred in the health facility; (b) number births and deaths registered by the health facility; and (c) number of births and deaths that were not registered by the health facility, to capture births and deaths not registered– The DOH, through the BHFD, may include the reporting of all deliveries and deaths which occurred in health facilities, and all births and deaths registered by said health facilities to capture births and deaths which are left unregistered for any reason. The DOH may submit this data to the PSA or require health facilities to directly report such information to the PSA.

6. Regulate cemeteries, funeral parlors, and crematoriums to monitor deaths registered

or facilitated – Compliance with civil registration laws should be part of the licensing requirements of cemeteries, funeral parlors and crematoriums. Rules should be issued mandating these establishments to report all burials that preceded death registration, all burials facilitated, and deaths registrations processed.

7. Set minimum qualifications on ICD-10 encoders to ensure the quality and accuracy of

data – DOH may specify minimum qualifications for ICD-10 coders such as educational attainment level, experience, and training hours.

8. Establish uniform procedures on recording spontaneous abortions or miscarriages –

The DOH should provide a uniform procedure for recording abortions or miscarriages. The guidelines should clarify whether all fetal deaths, including abortions and miscarriages with less than 7 months gestation period, or fetuses that are not yet developed are required to be registered. The DOH should study whether to include medical abortions, with utmost consideration for the rights of women.

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For the PSA, the following administrative policies are recommended:

1. Allow supplemental reporting of paternity after timely registration to encourage early registration of births despite the father’s unavailability to acknowledge the child – The civil registrar general may consider developing a system to allow the recording of the name of the father on the death certificate after registration, when paternity is acknowledged, or to allow the recording of paternity using a special power of attorney or a similar document where the father is overseas.

2. Develop an information exchange platform to allow LGUs and health facilities to transmit data directly to the PSA, to allow for ease of transmittal and accessibility of data – The PSA should establish an information exchange platform to allow LGUs, hospitals and other health facilities to transmit data directly to the PSA and allow integration with PhilCRIS.

3. Revise the prescribed forms to include other relevant information – The prescribed forms for certificates of birth, death and fetal death can be revised to include the following recommended information:148

Live Birth Death Fetal Death Parents’ date of birth Parents’ educational attainment Parents’ marital status Mother’s duration of residence in usual place of residence Country of birth Nationality of the child Ethnicity Date of previous live birth Literacy status Date of last menstrual period Number of prenatal visits Month when prenatal care began Children born alive to mother Fetal deaths to mother

Educational attainment Literacy status Whether birth was registered Whether born in wedlock Place of usual residence of mother (death under 1 year) Duration of residence in usual place of residence Previous place of residence Country of birth

Place of occurrence Literacy status of parents Parents’ marital status Duration of residence in usual place of residence Previous residence Date of last menstrual period of mother Number of prenatal visits Month when prenatal care began Children born alive to mother Fetal deaths to mother

Table 6. Recommended Revisions on Forms

However, PSA should consider if these additional information should be made mandatory, as it may pose an additional burden on informants and even discourage registration.

148 UN Recommendations, Para. 66, Table III.1

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4. Separate the Medical Certification of Cause of Death (MCCOD) from the death certificate, to protect confidential information and encourage physicians to indicate the proper cause of death in sensitive cases – PSA may consider making the MCCOD a separate or bifurcated form so that families have the option to exclude cause of death information on the death certificate that is submitted to other government agencies for social service benefits, settlement of estate, etc.

5. Develop strict verification process for requests for certified documents to protect

confidentiality of information – The PSA should specify the identity documents required for the release of certified copies of civil registry documents. It should ensure that the contracts between the couriers and the PSA partners require compliance with this requirement, particularly for online requests for birth and death certificates.

6. Develop mechanisms to strengthen oversight over local ordinances and local policies

on civil registration, to ensure compliance with national law and rules and regulations issued by the Civil Registrar General –The civil registrar general may require all local civil registrars to submit all local ordinances affecting civil registration, including, if any, fees being charged for registration. The civil registrar general may also consider requiring local civil registrars to submit records of barangay secretaries of its Barangay’s inhabitants to monitor completeness and coverage of local civil registrars.

7. Issue guidelines for mobile registration to increase rate of registration – The Civil

Registrar General may issue guidelines on mobile registration for local civil registry offices with wide geographical coverage and with sufficient resources for mobile registration. This would help increase coverage of indigenous peoples. In line with this, the Civil Registrar may consider providing financial support to local civil registries with low registration, conditioned on the improvement of coverage.

8. Institutionalize training for local civil registrars on registration by indigenous peoples

to encourage registration and accurate data collection – The PSA should issue specific guidelines for the registration of IPs. The guidelines must specify the role of the TAA and tribal leaders in registration of both birth and death and if the TAA is responsible for the timely recording thereof. The PSA should also institutionalize training for local civil registrars on assisting and facilitating civil registration by indigenous peoples. Local civil registrars must be trained on how to determine the ethnicity of the registrant and to ensure that all required attachments are complete upon filing. An IP Register may also be established.

It is also recommended that the PSA and DOH jointly issue guidelines in order to:

1. Clarify the role of local health officers, whether they are considered informants with a duty to report, or just reviewers of the Certificate of Death;

2. Clarify whether the last attending physician refers to the physician who attended to the deceased at death, or the physician who last attended to the deceased. If it is the physician who last attended to the deceased, limit the intervening period between the treatment and the death, and qualify the relationship of the death to the illness;

3. Provide a system for reporting to local health officers when the local health officer is unavailable or when the deadline for reporting falls on a weekend or holiday;

4. Provide standard procedure for certifying or reviewing cause of deaths by local health officers;

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5. Identify a certifier of cause of death for deaths where the decedent is dead on arrival, and the ambulance is not attended by a physician;

6. Manner of determining cause of death for deaths without medical attendance, whether verbal autopsy or actual autopsy;

7. Procedures for incorporating physician-conducted verbal autopsy findings in the certificate of death; and

8. Procedures for ICD-10 coding, whether at the hospital, local health officer or local civil registrar level.

It is also recommended that the PSA, DOH, PNP and NBI jointly issue a memorandum circular on the procedure to be followed for medico-legal cases, specifying the following:

1. Procedure for cause of death determination, reporting, and registration of medico-legal cases and deaths during emergencies and disasters;

2. Timeline for reporting and registration of medico-legal cases and deaths during emergencies and disasters;

3. Whether or not an autopsy or investigation is required before death can be registered;

4. Manner of filling-out COD information, whether or not the postmortem analysis

indicating cause of death is sufficient; and

5. Training requirement for medico-legal officers on COD determination, filling out the fields of cause of death in death certificates and ICD-10 coding.

b. Executive Order

It is also recommended that an Executive Order be issued providing for the following items:

1. Augmenting the budget of LGUs on CRVS in order to modernize CRVS.

2. Providing direct technical assistance by national agencies to LGUs on CRVS.

c. Other recommended actions The legal review has shown that there are no legal obstacles to pursuing the following actions in order to improve the completeness and coverage of civil registration in the Philippines:

1. Coordination with the Commission on Higher Education, Association of Philippine Medical Colleges and the Professional Regulation Commission on inclusion of cause of death determination in the medical curriculum, medical internship program and board exams for physicians.

2. Improvement of PhilCRIS to include: (1) online registration; (2) online transmittal from institutional informants to the local civil registrar; (3) online transmittal from the local civil registrar to the civil registrar general; and (4) use of electronic signature. In line with this, PSA should conduct a resource assessment to determine the resource requirements and availability to be able to participate in PhilCRIS.

3. Coordination with other government agencies in order to link registration to access to other government services.

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Further study is recommended on the following:

1. Registration practices of indigenous people to determine particular issues affecting

registration of indigenous peoples.

2. Feasibility of the use of bifurcated forms separating Certificates of Death and MCCOD.

3. Training requirement on ICD-10 coding, cause of death determination, medical

autopsy and verbal autopsy.

d. Legislation A new civil registration law may also be considered to: (1) consolidate disciplinary and technical control over local civil registrar in the civil registrar general; (2) ensure uniformity of procedures, funding, fees, strategies and plans; and (3) improve monitoring and enforcement of the civil registration law. A new civil registration law will also provide an opportunity to redefine live birth so that it is completely consistent with the UN recommended definition of live birth, which does not consider the gestational period of the fetus. However, consideration should be given to the timeliness of this option. Aside from the issuance of the above-discussed administrative issuances, a new civil registration law is also the proper medium to:

1. Allow a grace period for late registration with no administrative fine or criminal penalty attached;

2. Introduce new administrative fines and / or criminal penalties for failure to report, for providing false information, and for failure to correctly fill out cause of death information;

3. Clarify the procedure for certifying the cause of death performed by the mayor, members of sanggunian or local city/municipal council and city or municipal secretary for burial purposes, or provide a system for reviewing the cause of death for these cases; and

4. Make funeral parlors, cemeteries and crematoriums responsible for reporting and registration in cases where burial preceded registration and impose penalties for violation thereof.

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List of Figures Figure 1. Organization of CRVS System in the Philippines 9 Figure 2. Flowchart: Procedure for Delayed Registration 14 Figure 3. Flow of submission of civil registry documents 16 Figure 4. Flowchart: Registration of Births 20 Figure 5. Flowchart: Registration of Death 26 Figure 6. Framework of Coordination of the Philippine Statistical System 28 Figure 7. Organizational Chart of Philippine Statistical Authority 29 List of Tables Table 1. Comparison of Definitions of Live Birth 18 Table 2. Comparison of Definitions of Death and Fetal Death 18 Table 2. Place for Registration of Births 21 Table 3. Persons Required to Report and Certifiers of Cause of Death 23 Table 4. Place of Registration of Death 26 Table 5. Recommended Revisions on Forms 35

Annex A : Certificate of Live Birth

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Annex B : Certificate of Death

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Annex C : Certificate of Fetal Death

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