Abstract
For almost a decade, countries and development partners in Asia and the Pacific have worked together to improve civil registration and vital statistics across the region. The regional initiative to ‘Get Every One in the Picture’ has had widespread support from countries and an increasing number of development partners who are also providing assistance and guidance to countries. This article looks at how this initiative has fostered coordination at the national, sub-regional and regional level and highlights some of the impact and improvements seen in civil registration and vital statistics in Asia and the Pacific. Collaboration at the national, regional and global level has been key to the improvements made to CRVS and this paper outlines the structures supporting collaboration and the challenges and successes of this collaboration.
Why are development partners in Asia and the Pacific collaborating to ‘Get Every One in the Picture’?
Civil registration is the starting point for a person’s legal identity. The birth registration process and associated documentation provide an official and permanent recognition of a child’s existence. A birth certificate enables individuals to exercise their rights and access services by providing them with proof of their legal identity. When individuals die, the death certificate represents a final and permanent record of their death, which can be useful for families to manage the legal or financial details of the individual. Registration records are a key administrative data source to provide timely vital statistics on births, deaths, including on causes of deaths, and marriages. These statistics are critical to design, implement and monitor public policies, and to monitor the 2030 Agenda for Sustainable Development.
A well-functioning CRVS system by its very nature involves many different institutions and, thus, effective coordination is a prerequisite for these systems to be universal and responsive. Coordination must take place among all relevant stakeholders in countries, at all levels of government, among development partners and between Governments and development partners with agreed and assigned responsibilities. As collaboration and coordination is a key challenge to improving systems, this has been a continued focus area for the regional initiative to ‘Get Every One in the Picture’. It is broadly recognized that ministries of health, civil registrars and national statistical offices are all key stakeholders in CRVS systems. Their involvement is necessary to reduce duplication of efforts, ensuring universal registration of vital events and for ensuring consistency of vital statistics published by different government agencies.
However, despite the clear importance of CRVS for sustainable development, the lack of a clear lead institution and fragmented plethora of stakeholders is observed, but even more acutely among development partners. In particular, as pointed out by AbouZahr et al. [1] and Mahapatra et al. [2] more than 15 years ago and then again in AbouZahr et al. [3], among UN and international agencies, there is not a single entity which has a clear mandate for CRVS systems. Each agency has its own focus and expertise such as the UN DESA, WHO, UNICEF, UNFPA, UNDP and World Bank, often working with different line ministries in a particular country. To quote: “Yet when it comes to providing the support that countries need to develop their civil-registration systems, no agency takes the lead. The UN Department of Economic and Social Affairs – instrumental in producing normative guidance – has provided only limited support for implementation. The UN Population Fund, although mandated to help countries generate data on population, pays scant attention to civil registration. UNICEF supports birth registration but ignores death registration. The UN Development Programme addresses development and governance, but has not made the link with civil registration. WHO produces cause-of-death classifications but does not tackle the practical realities of death certification and coding in countries. Funding by the World Bank for statistical capacity-building has not been directed to civil registration.” Clearly this situation needed to change to improve CRVS systems in Asia-Pacific and beyond.
Given the many disparate stakeholders from across many different areas of expertise, it is essential to allocate roles and responsibilities, and identify the appropriate mechanisms for coordination between different government offices at the national level and between different agencies at the regional and international level. Coordination is essential between the bodies involved in civil registration, statistics, health services, and research. In particular, significant attention is devoted to ensure better linkages and coordination between the health sector (which reports vital events through health facilities) and the civil registration system which relies on individual reporting and their associated international agencies. Poor communication between civil registration and national or provincial statistical offices can result in data not being used even though registration is occurring, which constitutes a disappointing case of data wastage. Coordination and collaboration are essential to ensure standard concepts, definitions, and classifications are used and duplication of responsibility is avoided [4].
Regional coordination is needed to ensure that there is no duplication of efforts as mentioned above. But, even more, coordination is needed to ensure synergy between the common interests of the multiple development partners. At the regional level it is essential to ensure a systemic approach is taken to improving the collective effort to strengthen civil registration and vital statistics systems. A clear and coordinated regional approach also helps improve coordination within countries, especially given the plethora of counterparts of the various development partners. Some of the main challenges in developing and maintaining a well-functioning CRVS system, include robust infrastructure, efficient logistics, the capacity of local and national-level stakeholders and information and communications technology (ICT), financial resources and political will. Coordination is a key enabler in addressing all of these challenges.
The impact of COVID-19 has further highlighted the need for coordination. It is paradoxical that attempts to meet the increased demand for timely statistics on deaths and causes of death in countries with deficient civil registration systems, such as through rapid mortality surveillance, may have led to the perception that these can replace universal and inclusive civil registration in the long-run. Well-coordinated action can ensure that the long-term systemic approach is not lost in the rush to meet the intense and immediate needs from the pandemic with short-term solutions. Furthermore, coordination across agencies ensures that while, for example, some statistical needs may be met through alternative methods, these alternative methods may not provide the wide range of benefits offered by a well-functioning civil registration system. This includes benefits both to the individual, as well as more broadly, providing a wider range of data.
Key milestones in the collaborative efforts
The adoption of the Millennium Development Goals in 2000, with goals on child mortality, maternal health, deaths from HIV and malaria and adolescent childbearing, led to an increasing realization that achieving these goals, and monitoring them, required strong CRVS systems. While action was taken, this action was disjointed and often donor-led. Indeed, it was the Lancet series [5] “scandal of invisibility” where the failings of civil registrations systems were first highlighted. The series included the stark judgement that this was “The single most critical failure of development over the past 30 years” [5]. Momentum built as the demands for data increased, further intensified by the 2030 Development Agenda which brought even more to the fore, the need for inclusive and comprehensive CRVS systems. This highlighted CRVS as a good in its own right but also as the best source of data for many SDG indicators and potentially underpinning all the indicators which are population-based, especially for more granular, disaggregated data.
Accordingly, within the Asia-Pacific region, the need to improve CRVS systems began to attract more attention. Following a call from Statisticians in Asia and Pacific, though the Committee on Statistics convened by ESCAP, in May 2011, ESCAP adopted resolution 67/123 acknowledging the need to improve national CRVS systems in the region. The resolution recognized the important role CRVS systems play in generating reliable and timely statistical information that not only bolsters “evidence-based planning and development outcomes” but increases “efficiency in resource allocation” [6]. In December 2012, a high-level meeting was convened to address recommendations for moving forward. The meeting was attended by 43 Members and Associate Members of ESCAP as well as 22 development partners – a testimony to the multitude of partners active in this area.
As a result of the meeting, the participants reached consensus on a Regional Strategic Plan.
The following year, in May 2013, Members and Associate Members of ESCAP adopted resolution 69/15 to implement the outcome of the high-level meeting and move the Regional Strategic Plan forward. This resolution was sponsored by the Philippines, Australia, Bangladesh, Cambodia, Japan and Turkey, highlighting the broad support for the issue across the region. The resolution called for a Ministerial Conference dedicated to the issue of CRVS as well as the establishment of a Regional Steering Group. The resolution also approved the recommendation of the Committee on Statistics made at its third session that a regional meeting of relevant ministers and development partners be held in order to attain the high-level political commitment required to support the successful improvement of Civil Registration and Vital Statistics in Asia and the Pacific.
In 2014, the Ministerial Conference on CRVS in Asia and the Pacific was organized by ESCAP, the Office of the United Nations High Commissioner for Refugees (UNHCR), the United Nations Children’s Fund (UNICEF), United Nations Development Programme (UNDP), United Nations Population Fund (UNFPA), WHO, ADB and Plan International in collaboration with the Partnership for Maternal, Newborn and Child Health, the World Bank Group, the Asia Pacific Observatory on Health Systems and Policies, the Partnership for Statistics Development in the 21st Century (PARIS21), the Secretariat of the Pacific Community and World Vision. The conference brought together Ministers and Senior Officials from relevant ministries and development partners across Asia and the Pacific.
With the theme “Get Every One in The Picture”, delegations agreed on priorities for improving civil registration and vital statistics in Asia and the Pacific and committed to accelerate and focus the efforts of governments and development partners to achieve universal and responsive CRVS systems in all Asian and Pacific countries by 2024. The 2014 Ministerial Conference became a key milestone for CRVS improvement activities in Asia and the Pacific. The outcomes of the conference provided a very clear framework and timeline for action and was instrumental in guiding country and development partners’ activities in the following years.
Ministers at the conference declared the years 2015–2024, the Asia and Pacific CRVS Decade and agreed on a vision and a set of three high level goals for the region as well as the Regional Action Framework for CRVS in Asia and the Pacific.
The shared vision is that, by 2024, everyone in the region will benefit from universal and responsive civil registration and vital statistics systems that facilitate the realization of rights and support good governance, health and development. The vision is underpinned by three goals for the region: universal registration of vital events, documentation of legal identity for all and the production of vital statistics from civil registration records. To support the realization of the goals, countries were to set 15 national targets for the extent of improvements intended during the Asia Pacific CRVS decade. The national target setting served the purpose of galvanizing political commitment and coordination in a formal document within countries.
What have countries and partners committed to?
To support the achievement of the vision and goals of the Decade, the Regional Action Framework for CRVS in Asia and the Pacific, recognizes the centrality of coordination and alignment, highlighting it as one of the six key principles for achieving the shared vision to ‘Get Every One in The Picture’ by 2024. This framework provides a platform to facilitate harmonization and avoid duplication of activities of local, provincial, national, regional and international stakeholders, including subregional initiatives, for augmented impact in countries.
In countries, the Regional Action Framework requires the establishment of national CRVS coordination mechanisms as well as identification of a national CRVS focal point, which should be the link for coordination with development partners. The national coordination mechanism should be effective and sustainable and comprise all relevant stakeholders who represent the cross-cutting nature of CRVS. In some countries, specific coordination bodies have been established, such as the technical support unit for CRVS under the Ministry of Planning, Development and Special Initiatives in Pakistan and CRVS secretariat in the Cabinet Division in Bangladesh.
The partners operating within national contexts are encouraged to establish working groups to coordinate activities among themselves and with the Government as part of the governance structure of the Regional Action Framework. This has happened more or less formally in several countries, including Pakistan, Viet Nam and Turkmenistan.
Furthermore, at the regional and subregional level, development partners have committed to a set of key principles contained in the Regional Action Framework. These include committing to activities being country led, providing assistance through a comprehensive and integrated approach to improving CRVS, delivered in a coordinated and harmonized manner. All involved stakeholders have a mutual obligation to ensure coordination.
More recently in 2022, members and associate members of the Economic and Social Commission for Asia and the Pacific reaffirmed their commitment to this regional initiative by adopting the resolution entitled “Implementation of the Ministerial Declaration on Building a More Resilient Future with Inclusive Civil Registration and Vital Statistics”. The resolution recalled earlier commitments to CRVS and endorsed the Ministerial declaration on Building a more resilient future with inclusive civil registration and vital statistics. The resolution also requested for the review of the Asia and Pacific CRVS Decade to be held during a Third Ministerial Conference on CRVS in Asia and the Pacific in 2025.
The formal setup for collaboration: Regional Steering Group for CRVS in Asia and the Pacific
The Regional Steering Group for Civil Registration and Vital Statistics in Asia and the Pacific is responsible for providing regional oversight and guidance for the implementation of the Regional Action Framework, including acting as custodian for the decade 2015 to 2024. The Regional Steering Group (RSG) is also responsible for facilitating synergies between the Regional Action Framework and other ongoing initiatives to improve CRVS systems in Asia and the Pacific.
The RSG is composed of a geographically balanced combination of representatives from both member states and regional development partners. It has 30 members with ESCAP servicing its meetings and activities. The RSG membership is designed to “reflect the multifaceted nature and diverse development perspectives and beneficiaries of civil registration and vital statistics”, and should include “representation from civil registration, health, statistics and other relevant sectors”. This includes ministries of Planning or equivalent.
The RSG has three central functions. The first is to provide regional oversight, advice and strategic guidance for the implementation of the RAF, including support for carrying out regional reviews. The group’s meetings have always included in-depth discussions on issues relevant to CRVS and have been essential in guiding development partners in which kind of support is needed in countries. The meetings also facilitate peer-to-peer learning among the members.
As a second function, the group fosters coordination with various global, subregional or country initiatives. These initiatives include regional or global mandates corresponding to CRVS improvement activities, such as the UN Legal Identify Agenda, or initiatives from development partners at the national, regional or global level actively supporting CRVS activities in Asia-Pacific.
Finally, the Regional Steering Group plays a role in ensuring the principles of the Regional Action Framework are followed. This includes countries taking the lead in improving CRVS systems by adopting flexible and responsive, stepwise approaches, building on local expertise and coincide with international legal and human rights instruments.
The Regional Steering Group has played a pivotal role in the baseline and midterm review of the CRVS Decade as their insights guided the focus of the reviews. They also supported the development of the questionnaire used to collect information from countries and helped with drafting the report. This has helped in created greater country ownership of the process. It has also supported ESCAP’s efforts in collecting results for the midterm review, as development partners actively followed up with countries and supported their submissions of the questionnaires. Partners working on CRVS systems in the region were also consulted regarding countries on which they had in-depth knowledge, to make sure that the information provided in the questionnaire was coherent with the existing knowledge and literature. In addition, they played a key part in following-up with countries on the completion of the questionnaire and in particular UNICEF provided technical support on birth registration completeness estimates. In addition, multiple workshops organized by ESCAP and development partners included sessions on the midterm review process, highlighting the important role of the midterm review for all stakeholders active in CRVS in Asia and the Pacific.
CRVS Partnership and subregional groupings
The Regional Action Framework highlights the role of a regional partnership in the following terms: The regional partnership of organizations supporting the implementation of the regional action framework will provide their support in accordance with the key principles. In particular, assistance shall be conducive to a comprehensive and integrated approach to improving CRVS, and delivered in a coordinated and harmonized manner that is aligned with the priorities set by members and associate members through their comprehensive multisectoral national CRVS strategies. Where subregional or other related CRVS initiatives exist, all involved stakeholders have a mutual obligation to ensure coordination [7].
The Asia-Pacific Civil Registration and Vital Statistics Partnership, established in 2013, provides support to Governments to improve their CRVS systems. The partnership brings together United Nations entities and development partners with mandates to help to strengthen national civil registration and vital statistics systems and achieve the goals of the Regional Action Framework. Development partners include the following founding partners: ESCAP; International Organization for Migration (IOM); United Nations Children’s Fund (UNICEF); United Nations Development Programme (UNDP); Office of the United Nations High Commissioner for Refugees (UNHCR); United Nations Population Fund (UNFPA); World Bank Group; World Health Organization (WHO); Asian Development Bank (ADB); Pacific Community; Partnership in Statistics for Development in the 21st Century; Plan International; and World Vision International.
Since the initial establishment of the partnership, several additional partners have joined, including the following: Brisbane Accord Group; Data for Health Initiative of Bloomberg Philanthropies; Centre of Excellence for Civil Registration and Vital Statistics Systems; Statistics Norway; Regional Support Office of the Bali Process on People Smuggling, Trafficking in Persons and Related Transnational Crime; Centers for Disease Control and Prevention; and Global Financing Facility for Women, Children and Adolescents. ESCAP services the partnership and coordinates its regular meetings as well as communication to members between meetings. The partnership is collectively sharing their efforts in CRVS strengthening on the www.getinthepicture.org platform as well as through a monthly ‘CRVS Insight’ newsletter to CRVS stakeholders within and beyond the region.
The members of the partnership are also involved, collectively and individually, in various global efforts including the Global Civil Registration and Vital Statistics Group and the United Nations Legal Identity Agenda Task Force. In addition, multiple partners are working with other regional initiatives, including the Africa Programme on Accelerated Improvement of Civil Registration and Vital Statistics.
Considering the large diversity within Asia and the Pacific, several subregional initiatives are also in place to cater to specific sub regions. The Pacific Vital Statistics Action Plan (2011–2014) was developed by the Pacific Community to support one of the four priority areas of the Ten-Year Pacific Statistics Strategy 2011–2020, and the Brisbane Accord Group is supporting its implementation. The Brisbane Accord Group was established in 2010 and supports work in 15 Pacific Islands with the aim of pooling technical expertise amongst agencies. As with the Regional Action Framework, the BAG predominantly focuses on births, deaths and causes of deaths. Most of the partners active in the BAG are also involved in the regional CRVS Partnership and some, including the BAG secretariat, are members of the Regional Steering Group for CRVS in Asia and the Pacific.
The different key government stakeholders in CRVS have global and regional professional forums, where CRVS frequently is discussed, including the global Commission and regional Committee on Statistics, the International Association for Official Statistics Conferences and the regional Committee Meetings of the World Health Organization and the Pacific Heads of Health and Pacific Heads of Planning meetings. Development partners are frequently supporting these forums.
One professional group, that until recently, did not engage in an international professional network, were the civil registrars. While Asia-Pacific civil registrars face unique national challenges in achieving universal registration, they must also address practical registration issues, as well as cross-border issues such as migration caused by conflict, natural hazards and climate change. As such, strengthening information and communications technology, and adopting innovative approaches to meet these challenges requires Registrars to network in a space suitable for sharing ideas, learning from each other, and finding common solutions through South-South cooperation.
Recognizing universal civil registration as critical for sustainable and inclusive development and the important role of civil registrars for the achievement of universal registration, ESCAP and its development partners hosted an initial meeting of Asia-Pacific Civil Registration Authorities in 2014. The Authorities agreed to create subregional mechanisms for national registrars to meet, share ideas and practices and collaborate on cross-border issues.
Since then, two subregional mechanisms were established with assistance from ESCAP, UNICEF, SPC and other development partners; namely, the Pacific Civil Registrars Network (PCRN) for Pacific Island States and the Civil Registration Professionals of South Asia (CR8) for South Asian countries. Additional networks for the Commonwealth of Independent States (CIS) countries and countries in South East Asia are currently under discussion.
The subregional mechanisms promote South-South cooperation through disseminating knowledge of methods for improving CRVS systems, developing data-sharing approaches and sharing good practices for improving systems to ensure no one is left behind. Shared visions to improve civil registration systems alongside platforms for sharing information allow stakeholders to communicate with one another and have generated collective approaches to CRVS data storage and retrieval in the Pacific.
The subregional mechanisms are the first of their kind in Asia-Pacific, which specifically prioritize the needs of civil registration authorities while still accounting for cross-border interests. Each mechanism is based on the shared regional vision for addressing common issues while maintaining flexibility to local needs. Development partners have been providing significant support to initiate and run these sub regional networks for civil registrars. Globally, the Consejo Latinamericano y del Caribe de Registro Civil, Identidad y Estadisticas Vitales (CLARCIEV) established in 2005, is providing a successful example of an organization that brings together civil registrars with the aim of providing a space for knowledge sharing and good practices in the registration and identification of people in Latin America and the Caribbean.
Successes so far: findings from the midterm review of the Asia Pacific CRVS Decade
As agreed in the Regional Action Framework, the midpoint of the Decade marked the point at which the region took stock of the progress made since the beginning of the Decade and identified remaining challenges for achieving the shared vision of universal and responsive CRVS systems by 2024. The midpoint of the Asian and Pacific CRVS Decade was celebrated with the Second Ministerial Conference on CRVS in Asia and the Pacific in 2021. Over 400 participants including ministers, senior officials and stakeholders from 48 countries and 15 international and civil society organizations convened. The conference celebrated the successes of the first half of the CRVS Decade and served as an interactive platform for identifying the remaining challenges as the region looks towards the second half. The Conference was co-organised by most members of the regional CRVS partnership, with thirteen co-organizers in total.
In the lead up to the Conference, a survey was conducted by the Regional Steering Group on progress made towards the targets of the Regional Action Framework in 2019–2020. A total of 45 countries responded to the midterm questionnaire and the responses were reviewed by the secretariat and other development partners and cross-validated with other sources of information. These responses were used to develop the midterm report of progress.
Findings from the midterm report [8], showed a mixed picture of progress. Although significant progress has been made in several of the key target areas of the Regional Action Framework (see Fig. 1), differences in achievements were observed across the Asia-Pacific subregions (see Fig. 2).
Status of action for key targets of the Regional Action Framework at the midterm of the Civil Registration and Vital Statistics Decade. Source: “A snapshot of progress midway through the Asian and Pacific Civil Registration and Vital Statistics Decade”, UNESCAP, 2021.
Proportion of reporting countries having achieved key targets of the Regional Action Framework, by Asia-Pacific subregions. Source: “A snapshot of progress midway through the Asian and Pacific Civil Registration and Vital Statistics Decade”, UNESCAP, 2021.
The CRVS systems of most countries in East and North-East Asia are well-functioning, where almost all births and deaths are registered and registration records are used for the production of vital statistics. However, the situation in the Pacific, South-East Asia and South and South West-Asia1 is vastly different, where many countries have weaker systems and progress needs to be accelerated, in order to achieve the vision of universal and responsive CRVS systems by the end of the Decade. Although the differences in the level of development of CRVS systems between subregions has been longstanding, the gap between them is gradually narrowing as improvements are observed in most countries.
The region overall has made significant progress towards the universal registration of births, and as a result, the number of children aged under five years, whose birth was never registered, has decreased from 135 million in 2012 to 64 million in 2019 [9]. While regional differences remain, the gap in birth registration completeness between countries has also narrowed as countries which previously had low birth registration completeness at the beginning of the Decade have made impressive gains in this action area. For example, birth registration completeness increased from 50 to 66 percent in Cambodia between 2014 and 2018 and from 32 to 46 percent in Afghanistan over the same period (See Appendix A). Nevertheless, some countries require renewed momentum to achieve the target on birth registration completeness by the end of the Decade. Among countries who submitted reports for the midterm review, most also reported issuing birth certificates for all registered births, which in many countries grants individuals access to rights and services.
The progress made by countries to improve the completeness of birth registration has in part been a result of comprehensive assessments of the civil registration system, to identify the bottlenecks and streamline processes to ensure equal access to civil registration. Vital Strategies, WHO and ESCAP have collaborated to introduce business process mapping [10] and improvement techniques into the analysis of national civil registration and vital statistics systems. In several countries, including Myanmar, Papua New Guinea, Niue, Maldives, Samoa, Bhutan and Vanuatu, business process improvement approaches have been introduced to identify gaps and bottlenecks in the system, allowing stakeholders to work collaboratively to identify solutions and targeted interventions.
Additional cooperation between civil registration and health authorities will also play a significant role in improving registration completeness, and gradually removing the silos as outlined in the paper by AbouZahr et al. in the Lancet, 2007 [4]. As an example, in 2021 WHO and UNICEF issued joint guidance on the Health sector contributions towards improving the civil registration of births and deaths in low-income countries: guidance for health sector managers, civil registrars and development partners [11]. The importance of a paradigm shift from placing the burden of registration on families to an increased role of the health sector was also one of the key discussions during the Second Ministerial Conference on CRVS in Asia and the Pacific. Pakistan, Vanuatu, Cambodia and Viet Nam are currently some of the countries pursuing this strategy to improve registration rates with the support of multiple development partners.
However, despite these impressive achievements, an estimated 64 million children under five years old remain unregistered in Asia and the Pacific, most of whom reside in South and South-West Asia. In terms of percentage, the Pacific subregion has the highest percentage of children under five years not registered (30 percent).
Improvements in death registration, but there is still a long way to go, especially on medical certification of causes of death
Although completeness of death registration follows a similar encouraging trend to birth registration, death registration completeness remains lower than birth registration in Asia and the Pacific. Since the beginning of the Decade, countries in the Pacific, South-East Asia and South and South-West Asia which had lower rates of death registration, have been catching up with countries that had higher levels (See Appendix B). Notably, Lao People’s Democratic Republic reported an increase in death registration rates from 33 percent in 2014 to 42 percent in 2018 and Fiji, from 73 to 88 percent over the same time period.
The lower levels of death registration in the region when compared with birth registration, is partly attributable to the fact that many deaths in the region still occur outside of health facilities or without the attendance of a medical practitioner which means that these deaths are often not recorded by the health sector and furthermore, are unlikely to have a medically certified cause of death. Fewer incentives to register deaths also contribute to lower levels of registration compared to birth registration.
When it comes to cause of death, only one third of all deaths taking place in 33 countries in the region (those that submitted data in their midterm reports), have a medically certified cause of death. Verbal autopsy, which is an alternative approach to determine the likely cause of death, is currently being used by 13 countries, with more planning to implement this by the end of the Decade. To build national capacities on ascertaining cause of death, the Brisbane Accord Group and partners, including the Australian Bureau of Statistics, the Fiji National University, the Pacific Community, the Queensland University of Technology, UNFPA and WHO, organized subregional training sessions for doctors on medical certification of cause of death in Pacific countries [11].
Although most countries in Asia and the Pacific progressed towards their target for death registration, the current rate of progress would need to be accelerated for countries to achieve their target by the end of the Decade.
In the past, there was very limited attention to death registration by development partners, but this has slowly changed over the decade, and in particular the COVID-19 crisis has cemented this and a holistic life cycle approach to civil registration has become more common.
Use of civil registration records for vital statistics
As civil registration completeness improves in the region, an increasing number of countries are using registration records for the production of vital statistics. Thirty-two countries with high civil registration completeness reported using birth and death registration records for vital statistics during the midterm review. Nearly all of these countries are disseminating their tabulations in the public domain in electronic format within one calendar year. To support the production of statistics form civil registration records at the national level, ECA, ESCAP, Statistics Norway and Vital Strategies developed guidelines and a template for the production of national vital statistics reports. [132] The guidelines served as a basis for support provided to 14 countries on the use of civil registration data for vital statistics and as a result, the Governments of Georgia, Timor-Leste and Bhutan published their national reports, while other Governments are working on publication.
Increasing use of civil registration records for the production of vital statistics in the region has also been facilitated through subregional activities, such as joint activities of the Brisbane Accord Group, the Pacific Community, ESCAP and the Australian Bureau of Statistics who have been providing capacity-building to countries in the Pacific subregion on the analysis and interpretation of civil registration data for the production of vital statistics reports.
However, 18 countries (mainly located in South and South-West Asia, South-East Asia and the Pacific) have yet to achieve their target of using registration records for producing vital statistics and dissemination of these statistics in the public domain. Fifteen of them are aiming to do so by the end of the CRVS Decade.
Inclusion of marginalized population groups in civil registration and vital statistics systems
Although registration of births and deaths in the region are increasing every year, most countries are yet to reach universal civil registration. One of the main obstacles impeding countries in reaching this goal is the lack of information about the experience of marginalized and hard-to-reach population groups in accessing civil registration services. In response to this challenge, partners in the region developed the Bali Process Civil Registration Assessment Toolkit [14], which helps member States to assess and improve their national civil registration systems in order to scale-up the inclusion of births, deaths and marriages among refugees, asylum seekers, stateless persons and persons of undetermined nationality.
Several countries are targeting specific subgroups of populations either as part of their comprehensive strategies or with a specific strategy. For example, Kiribati is conducting a mobile birth registration campaign targeting outer islands as well as improving the infrastructure and training civil servants responsible for civil registration. Indonesia has established a specific target for birth certificate ownership of children from the poorest 40 per cent of households and has also approved a regulation that stipulates special procedures to assist subgroups of the population experiencing difficulties in accessing identity cards and civil registration documents.
Nonetheless, there is still a lack of information on inequalities experienced by some populations in the region. Although work has started in some countries to conduct inequality assessments, the majority of countries are yet to address this issue. Development partners have increased support to this area of CRVS since 2020, partially in response to the shortcomings highlighted by the midterm review.
Strengthening coordination
Since the beginning of the Decade, an increasing number of countries are addressing CRVS issues in a coordinated and multisectoral manner, rather than through ad-hoc activities, as demonstrated by the 38 countries who reported having a CRVS coordination mechanism. In terms of commitment to the regional initiative, most countries (
A comprehensive multisectoral national CRVS strategy with a transparent plan of work with clear delineation of responsibilities and backed by necessary resources is key to improve CRVS systems. At least 20 countries have developed such a strategy, and around 12 countries are working on developing one. The strategies give a clear framework for collaboration at the national level. The improvement of national coordination is therefore one of the main successes of the regional initiative and is testimony to increased national leadership and political commitment, facilitating action at local, provincial and regional levels by enabling multiple stakeholders to align and prioritize their efforts, as well as monitor progress towards achieving shared results at both the national and regional level. In the spirit of the Regional Action Framework, 16 countries have strategies that include specific and measurable targets for the CRVS systems. 12 of these countries, including Cambodia, Indonesia and Papua New Guinea, use targets of the Regional Action Framework in their national strategies.
While coordination of activities of partners and within countries have improved significantly, funding for CRVS system improvement is still often fragmented and many countries do not have estimates of the expected costs needed for improving their systems. There is no current estimate of the funds needed or the funds available at the regional level to support this work across so many institutions and sectors. Since the inception of the CRVS decade, there has, however been an increase in development partners specifically mentioning support to CRVS in their strategic plans and country level workplans.
As highlighted in the outset of this paper in the statement by AbouZahr et al. [3] – as a result of the multi-sectoral nature of CRVS which engages a range of institutions and stakeholders – until recently, development partners have focused their attention on siloed areas of CRVS according to their technical areas of expertise. This regional initiative to “Get Every One in the Picture” in Asia and the Pacific has provided a valuable mechanism to break down these siloes through the coordination of various efforts of development partners working to strengthen national CRVS systems, ensuring alignment of activities which effectively support every aspect of CRVS systems.
Conclusion and recommendations for the way forward
As demonstrated in this paper, coordination is vital for achieving the shared regional vision of ensuring all people in Asia and the Pacific benefit from universal and responsive CRVS. Due to the cross-cutting nature of CRVS and the diversity of institutions and stakeholders involved, a clear division of responsibilities and effective coordination is essential to ensure a cohesive system. This paper has outlined the ways in which coordination and alignment of activities is needed across local, national, subregional and regional levels, as well as among development partners. The Regional Action Framework helps meet this need as it serves as a platform to facilitate harmonization and avoid duplication at all levels.
Although Asia and the Pacific has made significant progress towards meeting the three goals of the Regional Action Framework, efforts will need to be maintained or even accelerated so countries reach their targets by 2024, especially for death registration. Improved coordination is required to ensure these efforts are successful.
Coordination with the health sector
When the health sector takes a more active role in reporting live births and deaths occurring in health facilities, completeness of birth and death registration is likely to improve, as well as the accuracy and timeliness of data on vital events, including on causes of death. A lack of coordination and interoperability between the health sector and civil registration system remains a challenge for some member States. Moreover, registration of vital events occurring outside of health facilities poses a significant challenge, especially death registration which highlights the importance of integrating verbal autopsies into national CRVS strategies. For this to happen, agencies and line ministries must use standardized and harmonized definitions, groupings, data processing and data synthesis. Further, there should be common data elements, with appropriate data sharing mechanisms in place.
Coordination with identity management systems
Increased focus on identity management systems is a challenge for coordination but also an opportunity when implemented appropriately. It makes the need for digitization of systems even more acute. In many countries the need to digitize civil registration and vital statistics systems has come from a desire to establish identity management systems, to provide a legal identity for everyone. As a response to this, and to ensure coherence between civil registration and legal identity initiatives within the UN system, the UN Legal Identity Agenda Task Force was established. At the request of the Secretary-General, the Deputy Secretary-General’s office in 2018 convened relevant UN entities to develop a ‘common approach to the broader issue of registration and legal identity, taking into account the importance of preventing statelessness’ [15]. So far, the task force has mainly supported countries in Africa as well as the development of global guidance on a variety of issues related to legal identity.
Coordinated funding
Efforts to strengthen CRVS systems requires political commitment and sustainable funding that not only supports initial strengthening activities or system redesigns, but also supports the longer-term ongoing operation of these systems and their maintenance. Although sustained and coordinated resource allocation and commitment from development partners is critical for initial system-strengthening activities, it is anticipated that future workplans may include more focus on budget advocacy and supporting governments to take informed decisions around budget priorities and commitment of domestic funds for CRVS, to ensure its financial sustainability. The development of national costed strategic plans for CRVS is a future area of work that the regional initiative plans to support as countries start to look towards harnessing domestic resources for system reform, and coordination is key in this regard.
Coordinated approach to data governance
Given the data generated by CRVS systems, should be confidential by its very nature, clearly there is a need for strong data governance with clear authority, control and decision-making over the management of the data. Data integration with other databases, such as those described above from the health sector and from the identity management sector, can greatly increase the utility of the data for decision-making but in order for integration to happen, there needs to be coordination to ensure compatibility of datasets. While coordination of data governance goes beyond the scope of this paper, it is clear that the appropriate mechanisms do need to be in place and applied to all administrative data generated by Government, including civil registries and related databases.
Regional and international development partners and agencies need to take a normative role for setting international data collection, processing, synthesis and sharing standards. These standards should reflect good current practice, and partnerships with national stakeholders in government and with academia are needed. Innovative methods for data processing, data synthesis and data sharing, could prove useful but they should only be used when accompanied by clearly defined principles by which they can be evaluated and adopted [16].
Lessons from COVID-19 and building back better
The COVID-19 pandemic presented significant challenges to the delivery of civil registration and vital statistics services, impacting multiple areas of the 2030 Agenda and expanding existing inequality gaps. Further to this, the pandemic has impacted the mode of support provided by development partners to member States and whilst a large proportion of work has been adapted to a virtual modality, there remain activities that would still benefit from in-country support. The virtual modality has created additional challenges related to coordination, with development partners and country stakeholders still adapting to the new mixed modalities for support.
At the same time, the deficiencies of CRVS systems to provide real-time, accurate surveillance of COVID-19 deaths or, indeed, excess mortality, has provided an opportunity for national, regional and international stakeholders to assess those failures and leverage this interest to ensure necessary improvements, including on coordination, are implemented.
Continued support from international development partners is more important than ever to meet the nationally set goals and targets of the Regional Action Framework.
Closing the circle – linking back up with the Sustainable Development Agenda
Ensuring alignment with the Sustainable Development Goals is a key coordination priority going forward. While CRVS is key for both measuring and achieving the Sustainable Development Goals, there are gaps in the Regional Action Framework which should be addressed. For example, the principle of “Leave No One Behind” means that explicitly measuring the extent to which all are included in CRVS systems is an important way to understand the barriers to inclusion of marginalized and vulnerable groups. Further, marriage and divorce registration is not an explicit part of the Regional Action Framework despite its clear importance for achieving Goal 5 on gender equality and female empowerment. Coordination with and between development partners and national focal points is key to ensuring the alignment of interventions to improve CRVS systems with the momentum towards achieving the SDGs, ensuring synergistic and catalytic action for both.
Footnotes
SUBREGION: EAST AND NORTH-EAST ASIA (ENEA): Chinamathrm; Democratic People’s Republic of Korea; Hong Kong, China; Japan; Macao, China; Mongolia; Republic of Korea. SUBREGION: NORTH AND CENTRAL ASIA (NCA) Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, Tajikistan, Turkmenistan, Uzbekistan. SUBREGION: THE PACIFIC (PACIFIC): American Samoa, Australia, Cook Islands, Fiji, French Polynesia, Guam, Kiribati, Marshall Islands, Micronesia (Federated States of), Nauru, New Caledonia, New Zealand, Niue, Northern. Mariana Islands, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu. SUBREGION: SOUTH-EAST ASIA (SEA): Brunei Darussalam, Cambodia, Indonesia, Lao People’s Democratic Republic, Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste, Viet Nam. SUBREGION: SOUTH AND SOUTH-WEST ASIA (SSWA): Afghanistan, Bangladesh, Bhutan, India, Iran (Islamic Republic of), Maldives, Nepal, Pakistan, Sri Lanka, Turkey.