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Development of Civil Registration & Vital Statistics Systems in the Asia-Pacific region:

results from the application of the HISHub/WHO Rapid Assessment

Prof. Alan Lopez

Health Information Systems Knowledge HubSchool of Population HealthUniversity of Queensland

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Health Information Systems Knowledge Hub (HISHub)

• One of 4 knowledge centres established in Australian Universities in 2008 to strengthen the evidence base for Australia’s health development/poverty reduction investments in the region.

• Funded by AusAID, initially 2008-2013• Broad focus on Health Systems strengthening

(HSS)– Within HSS, UQ focus is on HIS– Within HIS, UQ focus is on CRVS strengthening

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Health Information Systems Knowledge Hub (HISHub) (cont.)

• 3 broad activities• Knowledge creation, synthesis and dissemination of learnings

(Working Paper series)• Tools/Guidelines (helping countries help themselves)• Capacity building (short courses in CRVS/HIS)

• Dissemination strategy for Hub closely linked to activities/mandates of international multilateral organizations, especially UNESCAP, WHO (regional offices), SPC, UNICEF, etc. Strong regional collaboration built around principle of comparative advantage

• HISHub website: www.uq.edu.au/hishub

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HISHub CRVS Tools

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HISHub/WHO Rapid Assessment• Short (25 question) tool to support stakeholder appraisal &

discussions about functioning of CRVS system• NOT a questionnaire. Designed to elicit responses, discussion

and consensus agreement (i.e. assessment) of ALL key elements of a CRVS (e.g. birth & death registration, legislation, cause of death certification, etc.)

• Intended to be FIRST step in a more comprehensive assessment, strategic planning and implementation process. Provides rapid information to identify primary areas of CRVS weakness AND to support advocacy for CRVS action

• NOT a questionnaire. Designed to be completed BY stakeholders, FOR stakeholders, WITH stakeholders.

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Where has the RA been applied in Asia-Pacific

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Key components and Scores (%) for RA in Asia-Pacific

Components assessed Total Asia Pacific 1. Legal framework for CRVS 2. Registration infrastructure and resources 3. Organization and function of the vital Statistics system 4. Completeness of birth and death registration 5. Data storage and transmission 6. ICD – Compliant practices and certification within and outside hospitals

7. Practices affectin g the quality of cause-of- death data 8. ICD coding practices 9. Coder qualification and training and quality of coding 10. Data quality and plausibility checks 11. Data Access, Dissemination and use

Average percentage scores for the regions

74 75 65 74 62 60 56 66 40 51 74

63

80 83 67 80 67 57 67 77 47 60 80

69

66 62 60 63 57 64 38 47 29 34 63

53

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Regional variation in RA scores: all countries

Sub-regional variation in RA scores: Asia & Pacific

Pacific

Asia

CRVS strengths (green) and weaknesses (orange/red)Legal framework Registration Infrastructure & Resources Organization & Function Completeness Data Storage & Transmission ICD COD Quality Coding Coder Training Data Quality & Check Data Access, Dissemination & Use

Assessment Score Average score Average score Average score Average score Average score Average score Average score Average score Average score Average score Average score

79 3.0 2.7 2.5 3.0 1.5 2.5 2.5 3.0 1.0 1.5 2.5

92 3.0 3.0 2.5 3.0 3.0 3.0 2.0 3.0 1.5 3.0 3.0

95 3.0 3.0 3.0 3.0 3.0 3.0 2.5 3.0 2.5 2.0 3.0

52 2.0 2.3 1.5 0.0 0.0 0.0 2.0 2.0 0.5 2.5 2.8

99 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 2.5 3.0

60 2.0 2.7 0.0 3.0 2.0 2.0 1.5 3.0 0.5 1.5 1.8

12 0.3 2.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.5

67 3.0 2.0 2.5 3.0 3.0 3.0 1.5 0.0 3.0 0.0 0.8

57 2.0 2.3 2.5 3.0 2.5 1.5 0.0 0.0 0.0 1.5 2.0

73 3.0 1.7 2.0 3.0 2.0 3.0 2.0 2.0 0.5 1.0 3.0

85 3.0 2.3 2.5 3.0 2.0 2.0 3.0 3.0 1.0 3.0 3.0

52 0.7 2.0 1.0 2.0 1.5 1.5 1.0 3.0 1.5 0.0 2.8

61 1.7 2.0 2.5 0.0 2.0 1.5 0.5 3.0 2.0 2.0 2.8

51 2.0 1.0 2.0 2.0 1.5 2.0 2.0 1.0 0.0 0.0 2.3

32 1.7 1.0 1.5 3.0 0.0 2.0 0.0 0.0 0.0 1.0 0.3

35 0.7 0.7 1.5 2.0 3.0 1.5 0.0 1.0 0.0 0.0 1.3

47 0.3 2.0 2.5 2.0 0.5 2.0 2.0 1.0 0.0 0.0 2.3

80 3.0 3.0 2.5 3.0 3.0 1.5 1.0 3.0 1.5 1.5 2.8

76 3.0 2.3 2.5 3.0 1.5 1.5 1.5 3.0 1.5 2.0 2.8

92 3.0 3.0 3.0 3.0 3.0 1.5 3.0 3.0 1.5 3.0 3.0

59 1.7 2.3 2.5 1.5 1.5 1.0 1.0 1.0 1.0 1.0 3.0

43 2.0 2.3 1.0 1.0 1.5 1.0 2.5 1.0 1.0 0.0 0.5

67 2.7 2.3 2.5 3.0 3.0 1.5 0.5 1.0 1.5 0.5 2.3

96 3.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 2.0 2.5 3.0

93 3.0 3.0 3.0 3.0 3.0 3.0 2.5 3.0 1.0 3.0 3.0

43 2.7 1.7 1.5 1.0 1.0 1.5 0.0 2.0 1.0 1.0 0.8

89 2.7 3.0 2.5 3.0 3.0 1.5 2.0 3.0 2.5 3.0 3.0

87 3.0 2.0 2.5 2.5 2.5 2.0 3.0 3.0 2.0 3.0 3.0

11 0.7 0.3 0.0 2.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0

76 3.0 3.0 2.5 0.0 2.0 2.0 2.5 3.0 2.0 1.0 3.0

71 1.3 3.0 1.5 3.0 3.0 0.0 1.5 2.0 1.5 3.0 2.8

63 3.0 2.3 1.5 2.5 1.0 1.5 0.5 3.0 1.0 0.0 3.0

25 1.3 0.3 2.0 0.0 0.0 1.5 0.0 0.0 0.0 0.0 1.8

91 3.0 3.0 2.5 3.0 2.0 3.0 3.0 3.0 1.5 3.0 2.8

77 2.0 1.7 1.5 3.0 2.5 2.0 3.0 3.0 2.0 2.0 3.0

75 3.0 2.7 2.5 1.5 3.0 3.0 1.0 1.0 1.0 2.0 2.5

92 3.0 3.0 2.5 3.0 2.0 3.0 2.5 3.0 2.0 3.0 3.0

83 3.0 3.0 3.0 3.0 3.0 2.5 2.0 0.0 1.0 2.0 2.8

12 1.0 1.3 0.0 0.0 0.5 0.0 0.0 0.0 0.0 0.0 0.3

81 1.7 3.0 2.5 3.0 3.0 3.0 2.0 3.0 1.5 1.0 3.0

83 2.7 2.7 3.0 1.5 2.5 2.0 2.0 3.0 2.5 2.0 3.0

89 2.0 3.0 2.0 3.0 1.5 3.0 3.0 3.0 3.0 3.0 3.0

69 2.7 2.3 2.0 3.0 1.0 1.5 2.0 2.0 1.5 2.0 2.3

75 3.0 2.0 2.5 2.5 1.5 1.5 2.0 3.0 1.5 2.5 2.5

69 1.7 1.7 2.0 2.5 1.0 2.5 2.5 1.0 1.5 3.0 2.8

16 1.3 1.7 0.0 0.5 0.5 0.5 0.0 0.0 0.0 0.0 0.0

20 1.3 1.7 0.0 0.0 0.5 0.0 2.5 0.0 0.0 0.0 0.0

83 1.7 3.0 2.5 3.0 3.0 1.5 2.5 3.0 1.0 3.0 3.0

91 3.0 3.0 2.5 3.0 2.5 1.5 3.0 3.0 2.0 3.0 3.0

59 2.7 2.3 1.5 3.0 2.0 0.5 0.5 0.0 0.0 2.5 2.3

89 3.0 3.0 2.5 3.0 2.5 3.0 3.0 3.0 1.5 2.0 2.8

93 3.0 3.0 3.0 3.0 2.5 2.5 2.5 3.0 3.0 2.0 3.0

25 1.0 0.0 0.0 0.0 1.0 2.0 1.5 2.0 1.0 0.0 0.8

35 0.7 2.7 0.0 2.0 1.5 0.5 2.0 3.0 0.5 0.0 0.0

Percentage score 73.9 75.5 64.8 73.8 63.0 59.6 57.1 66.0 40.7 51.9 73.9

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Using the RA results: Pathway to improvement

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Regional application of the RA: key lessons

• The RA has acted as a catalyst to initiate a dialogue about CRVS among concerned agencies and stakeholders in countries where it has been applied

• Correctly implementing the RA has led to a greater understanding of strengths and weaknesses of CRVS systems

• Threshold (>85%) score useful indicator of whether a country should go on to do a comprehensive assessment (80% have in the AP region)

• High “face validity” given knowledge about socio-economic and statistical infrastructure development in the region

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Regional application of the RA: key lessons (cont.)

• Strategic coordination of partners is essential to achieve good national and regional outcomes, as best evidenced by the rapid results obtained in the Pacific

• Leadership is crucial (ESCAP/ the Regional Plan). So is multipartner commitment (technical, development agencies, donors and most of all, countries)

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