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

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

Roles of the Health Sector in CRVS Main roles (①) for civil registration CR Notification of births/ deaths in the health facilities for vital statistics VS -Reporting the number and additional information related to births/ deaths in the health facilities (eg. Place of birth/death, birth weight, cause of death, etc.) -Issue medical and health check-up certificate -Attend any determined death and certify causes of death Possible roles for CR (②) Late registration during EPI/ MNCH services provision for CR and VS (③) Birth notification for new-borns delivered by SBA in the community and reporting the number and socio-demographic factors of those delivered by SBA Advocacy and encouragement of civil registration during stay in the hospital or health education in the community for vital statistics (④) reporting the number and socio-demographic factors of birth and death in the community through VHV (⑤) identification of causes of maternal death by MDSR (Maternal Death Surveillance and Response) (⑥) cross-check the number registered with MoHA using DHIS-2 *LuangPrabang province has been conducing a household survey every year to record name, age, and sex of the household members.

Roles of Health Sectors in CRVS in Lao PDR ① ① Birth in health facility Birth outside health facility Death outside health facility Death in health facility Family book covers both births & deaths, NO certification on births/ deaths is necessary for registration notification ④ VHV ④ VHV notification number person person person number ③ Births assisted by SBA person MDSR ⑤ confirmation ② EPI registration HC certification certification HC Village chief DHIS-2 DHIS-2 ⑥ ⑥ District office of MOHA District Governor District office of MOHA notification District District Province Province office of MOHA Provincial Governor Province office of MOHA Province DPIC DPIC Ministry of Public Security Statistic division MCHC NIP MDSR secretariat Statistic division Ministry of Health Ministry of Health Pilot district site: MOHA officers accompany MPS officers in village when registration happen. Ministry of Home Affairs Registration in family book enables an issue of identification and receiving public services. Family book covers vital events such as birth, death, marriage, moving-in/out.

Targets Defined by 2025: Current Status: 80% of births and 60 % of deaths in a given year should be registered; 85% of deaths recorded by the health sector have a medically certified cause of death with ICD. Current Status: Birth registration: Figure below Death registration: No data Birth registration to MOHA　－ 30% by 5 years old* Birth registration to MoPS (though village leaders) – 70% by 5 years old** Facility delivery % in Lao PDR - about 50% of delivery*** Death registration - no % data in many countries

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

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

Thank you for your attention  “Sustainability needs a long life and it could not be done without being healthy” Thank you for your attention 