Table 3 Summary of key weaknesses and challenges identified across UoM D4H countries through process mapping [5]

1. Notification

The capture and onward transmission of minimum essential information on the fact of birth or death by a designated agent or official of the CRVS system, using a CRVS authorised notification form (paper or electronic) with that transmission of information being sufficient to support eventual registration and certification of the vital event

The notification of vital events was one of the least consistent sub-processes across countries; the stakeholders involved varied from country to country (even among different regions within a country) and some countries did not have a SOP for how to notify a vital event

It was difficult to find regulations or SOPs describing how the notification of vital events should be done or which institution or individuals were entitled/responsible to notify vital events; globally, there is a paucity of guidance for countries on the international standards for notification of vital events

2. Validation

The act by which a relevant authority confirms that all necessary documentation to prove the vital event is correct and that the registration process can continue

The validation of the vital event, although present in all countries as a sub-process, was not consistent across countries or even among different regions within a country; least-developed CRVS systems did not have written procedures to support their local civil registration offices in the validation process; it was also difficult to find global recommendations on what the minimum requirements should be to validate a vital event

3. Registration

The act of formally registering an event at a civil registration office; at this point, the details of the event are entered into the official civil register by the registrar

Registration of the vital event by civil registrars was quite consistent across countries and aligned with global recommendations

4. Certification

The issuance by the civil registrar of a legal document certifying a birth or death

Certification of the vital event by civil registrars was quite consistent across countries and aligned with global recommendations

5. Sharing of information

All activities in which some information about the individual event is shared with other systems (i.e. ID)

Several initiatives were identified among the countries to share civil registration information with other institutions such as the national ID system or the health sector

6. Storage and archiving

Activities where all or part of the information captured about the vital event is stored either digitally or in paper

The storage of vital records was fragmented and there were no consistency checks among the different databases in multiple countries; although the global recommendations are clear about the ideal storage system and minimum requirements for archiving vital event records, this was not consistently applied in many countries

7–10. Compilation to dissemination of vital statistics

The process of condensing and summarising information on vital events by classifying and tabulating data within categories or groups to produce vital statistics according to a predetermined tabulation programme

Timely publication of an annual national vital statistics report on births and deaths disaggregated by age, sex and sub-national region, including numbers and completeness (coverage) rates, with trends and patterns of leading CODs, in a public repository

Although all countries mapped a step where the quality of the data compiled is assessed and improved, it was difficult to get accurate information about the type of checks performed or if these were done in a systematic way; this activity is either done by the health sector/civil registration authority directly on the main database or by the NSO in an anonymised database

Once the database is clean, the NSO generates the vital statistics report and publishes it in different formats; a few countries conduct some form of matching among different databases containing information about vital events (usually health sector notification database and civil registration records) aiming to obtain a more complete set of vital statistics