1. BIRTHS AND DEATHS REGISTRATION IN THE GAMBIA I

2. INTRODUCTION Registration is legal and mandatory Decentralised and integrated into the RCH services There are 48 basic health facilities and 232 out-reach stations RCH attracts 90% of pregnant women and children for immunisation services

3. Purpose for Decentralisation and Integration To register 90% of children receiving immunisation To get registration closer to the communities To cut on other costs

4. INSTITUTIONAL BIRTHS Births take place at the maternity wards Mother and child are discharged if conditions of both are satisfactory After one week, the baby is given a name in a traditional ceremony Mother and child attend RCH clinics for immunisation on monthly basis On the first visit for immunisation, the child is issued an Infant Welfare Card (IWC0)

5. INSTITUTIONAL BIRTHS (CONTD.) The IWC contains the topics for registration The child is registered at the clinic Data on birth registration is sent to the Regional Health Directorate on monthly basis Regional Health Directorates compiles all the data from all health facilities in the region and send to Health Management Information System (HMIS) office at central level on monthly basis and Birth Registry Office on quarterly basis

6. BOTTLENECKS ON THE CURRENT BUSINESS PROCESS Lack of adequate human resources at clinic level Waiting time both by mothers and service providers Untimely delivery/collection of birth certificates

7. DESIRED BUSINESS PROCESS To register all births within the first month of birth Issue certificates on the spot

8. FIVE STRATEGIES 1.To increase human resources at the clinic level 2.To device a mechanism to distribute certificates on time 3.To develop a single register to accommodate both immunisation and birth registration topics 4.Create circuit birth registers to feed into the basic health facility register on monthly basis

9. FIVE STRATEGIES (CONTD.) 5. HMIS to send birth registration data to the Bureau of Statistics on quarterly basis