Quality of data after decentralisation of civil registration and vital statistics in Iringa region 2016 -2022

Abstract

ABSTRACT Background: Globally, the Civil Registration and Vital Statistics (CRVS) Systems are insufficient to meet the needs of various governments, as approximately one-third of births go unrecorded and approximately half of deaths go unreported. More than one billion individuals worldwide lack a legal identification, which implies that they could be denied their rights, access to services like health and education, and involvement in political and economic progress. In the majority of Sub-Saharan African (SSA) nations, the CRVS is not complete. Tanzania is now undergoing several reforms on CRVS systems including legal review reforms which have accelerated the decentralization of CRVS services in many regions in the country since 2013. It’s therefore important to strengthen the CRVS systems to make sure that all vital events that happen in our territories can adequately be accounted for. Aim of the study: This study aimed at assessing the quality of data after decentralization of Civil Registration and Vital Statistics in Iringa Region 2016-2022. Materials and methods: The goal of this study was to conduct a mixed-methods analysis of CRVS data obtained from all healthcare facilities via the District Health Information System (DHIS2) and Civil Registration Centers (wards) under Local Government Authorities (LGAs) via CRVS databases. This data was from all Councils of the Iringa region (Rural and Urban Councils) which was the first region to decentralize death registration and deploy various interventions to improve the quality of causes of death data as completed by the clinicians through the Medical Certificate of Cause of Death forms. In addition, qualitative data was collected and analyzed to determine factors that led to the change in trends of CRVS data in Iringa, whereby the structured questions through a questionnaire were completed by officials at ward level who collect data and those who are decision-makers from the key CRVS implementing institutions (MoH, RITA, and PoRALG). Data on death registration completeness was analysed by using STATA and quality of causes of death was analysed by using ANACoD3. Findings: This study included a total of 295 health facilities (privately and government owned) and wards responsible for collecting and registering vital events in the Iringa region. The findings revealed an enhancement in the CRVS system following the vi implementation of interventions in Iringa, specifically in the quality of medical certification of causes of death. The percentages increased from 86% in 2016 to 93% in 2019, 91% in 2020, 92% in 2021, and returned to 86% in 2022, aligning with the baseline level. Notably, seven ill-defined causes (Infectious and parasitic diseases, Neoplasms, Diseases of blood, Diseases of the circulatory system, Symptoms and signs, and External causes of morbidity and mortality) consistently appeared throughout the five-year study period. Meanwhile, the overall completeness of death registration in the entire region was initially low for both males (12.4%) and females (6.7%) before the necessary interventions. However, after the application of interventions, completeness increased to 15.2% for males and 14.9% for females in the year 2022. Over the five-year period, the trend in completeness for males was slightly higher compared to females. Scaling up interventions through institutionalization was observed to be a critical step towards CRVS improvement. Conclusion: There has been a positive improvement in the quality of Civil Registration and Vital Statistics (CRVS) in the Iringa region during the study period. However, this improvement has been incremental, with some fluctuations in the quality of CRVS observed. These variations can be attributed to the challenges on negligence in using CRVS guidelines that persisted throughout the region over the years covered by the study. It is crucial for the government and other stakeholders to take into consideration the proposed interventions highlighted in this study. Addressing these interventions is essential to bridging the existing gaps before extending the interventions to additional regions.