There is no single blueprint for establishing and maintaining systems for gathering sound statistics on births, deaths, and causes of death, as each country has its own unique set of challenges. But whatever the individual country’s situation, there are steps that can be taken, conclude Carla AbouZahr, Health Metrics Network, World Health Organization, Switzerland, and colleagues from the Monitoring of Vital Events (MoVE) group.
The authors say: “All high income-countries, without exception, have national civil registration systems that record these events and generate regular, frequent and timely vital statistics. By contrast, these statistics are not available in many low-income and middle-income countries, even though it is in such settings that premature mortality is most severe and need for robust evidence to back decisionmaking most critical.”
In an impassioned plea, they add: “This series has asked: ‘Who counts?’. Sadly, the answer seems to be that too many people, especially the poor, are never counted, they are born, and live and die uncounted and ignored. It is a fundamental principle of human rights that every life counts, that every individual matters. If we are to give life to such principles, it is time to start counting everyone. Individual proof of birth and death is possibly the clearest indicator of that much-hyped concept ‘good governance’. Its absence surely ranks as the single most critical failure of development over the past 30 years.”
The authors propose three options, which are not mutually exclusive, to tackle the challenge of establishing civil registration systems and obtaining and maintaining vital statistics.
First, development agencies and donors must advocate for and provide technical and financial support to governments to enable them to do more to strengthen civil registration and enhance the availability and quality of vital statistics. Second, the possibility of establishing an international body with the specific mandate of improving civil registration systems should be considered. Such a body would bring all the relevant parties together more effectively and help overcome the current fragmentation and neglect.
Finally, the authors say: “We also need ways of harnessing the significant new funding flows in global health including through the private sector and foundations, such as the Bill and Melinda Gates Foundation, the Global Alliance for Vaccines and Immunization and the Global Fund to fight Aids, TB and Malaria. All these agencies pay particular attention to the importance of monitoring and evaluation, and could represent new opportunities to strengthen country capacities in vital statistics.”
They conclude: “The global development community should assist countries in taking the measures needed to improve civil registration, including support for policy development, institutional strengthening, increased funding and capacity building.”
Carla AbouZahr, Health Metrics Network, World Health Organization, Switzerland T) +41 22 791 33 67 / +41 79 217 34 49 E) abouzahrc@who.int
Journal
The Lancet