Dr Sabeen Afzal Deputy Director Mo NHSRampC Tunis Tunisia 2630 March 2018 Introduction Pakistan do not have well functioning CRVS systems Birth registration and death registration levels are very low ID: 1038761
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1. Digitizing Civil Registration and vital Statistics Dr. Sabeen AfzalDeputy DirectorM/o NHSR&CTunis, Tunisia, 26-30 March 2018
2. IntroductionPakistan do not have well functioning CRVS systemsBirth registration and death registration levels are very low.There is little vital statistics generated from the civil registration systems.Cause of death information is not available, or of poor quality (from hospitals but not using ICD-10).Aim is to automate all the local governments in a country and provide centralized computerized registration and certificate issuance of the mentioned vital events to the grass root level
3. Impediment to Registration
4. National Statistics34% children get Birth RegistrationMaternal and neonatal Mortality is very high Data usually comes from survey held after 2-4yrs.Causes are not recorded Birth (school admission,) & Death are register only if there is a requirement (inheritance)
5. InitiativesTwo initiative were takenDigital Birth registration pilot -local government in selected districts of Punjab, Sindh and FATANeonatal and Maternal Mortality surveillance and response system- IRMNCH & Nutrition Program, Punjab,
6. Digital Birth registration pilotPiloted in four districtsTwo in Punjab & two in SindhLocal government with support of UNICEF and Plan international in collaboration with NADRAUse Digital version of the paper-base form authorized by provincial govt.
7. Digital Birth registration pilotuse of mobile phones to register births directly at home by a visiting health worker or a Nikah Registrar, who inputs the data into the DBR app on his/her phone. The data is then transferred to the local union council validation for registration for after which a unique identification number is sent directly to the applicant’s phone. The applicant then presents this number, together with the required documents, to collect his/her birth certificate at the union council.
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9. Neonatal and Maternal mortality surveillance and response system9Lead by Health Department Punjab with support of UNFPA in collaboration with PITBAim at getting real time data, improve accountability and decrease Neonatal and maternal deathsSMS-based mortality reportingDistrict-focused action plan (DRM meeting)Case tracking on central dashboard
10. Short overview10Pilot launchedRefine systemMaster training Step-down training in districtsJuly 2015Aug-OctNov 20151st week of DecPilot PhaseUpscale
11. Neo-natal and Maternal Death e-surveillance SOP11LHS reports caseLHS completes verbal autopsyDistrict collects reportsData inputDistrict review board meetingTimelineDuring the monthDuring the month1st week of every monthBy 20th of every monthBy 25th of every monthDescriptionLHW/CMWs to inform LHS LHS sends SMS within 3 days to initiate a case no.LHSs complete verbal autopsy in the fieldLHSs submit verbal autopsy reports to district office in the monthly meetingEDO calls the district review board (DRB) meeting to review verbal autopsy forms, and prepare action planGynaecologist/Pediatrician reviewBy 15th of every monthAutopsy forms are submitted to Gynaecologist/Pediatrician to determine cause of death123456Upload verbal autopsy data on dashboardPrepare summary for district review board meeting
12. NEO *______*_______*______*_____ParametersNEO: System identification for neonatal mortality case1 - Name of neonate: If name not available, write gender as M or F2 - Father’s Name: Father Name 3 - Date of Death: (DDMMYY) 4 - Village: Village NameExample 1: NEO * F * M. Anees* 010715 * MariExample 2: NEO * Aalia * M. Anees * 010715 * 174/GB-MariSMS format to report neonatal mortality 121234
13. SMS format to report maternal mortality 13MAT *______*______*______*______ParametersMAT: System identification for maternal mortality case1 - Name of Women: Women Name2 - Husband’s Name: Husband Name 3 - Date of Death: (DDMMYY) 4 - Village: Village Name Example 1: MAT * Zoya* Arslan* 210615 * AttokiExample 2: MAT * Aalia * Asif Ali * 010715 * Attoki1234
14. System will send two confirmation SMS to confirm case has been recorded 14SMS sent by LHS MAT* Raheela * Mohsin Raza * 040715 * Attoki System Reply You have reported Maternal Death Maternal Name: Raheela Husband Name: Mohsin Raza Date of Death: Jul 04 2015Village: AttokiCase Number: 54LHS should maintain a register noting mortality data and the cases number assigned by the system
15. To update data for a previous reported case, a corrections SMS can be sent15NEO *______*_______*______*_____* ____ParametersNEO: System identification for neonatal mortality case1 - Name of Mother: Mother Name2 - Husband’s Name: Husband Name 3 - Date of Death: (DDMMYY) 4 - Village: Village Name5- Case Number: Case number generated by the system when case was first reported Example 1: NEO * F * Asif Ali * 010715 * MariCorrection: NEO * Aalia * Asif Ali * 071115 * Mari *5412345
16. 16Correction SMS exampleSuppose following case was reported by LHS via SMS MAT* Raheela * Mohsin Raza * 040715 * AttokiThe system sent the following reply assigning the case numberYou have reported Maternal Death Maternal Name: Raheela Husband Name: Mohsin Raza Date of Death: Jul 04 2015Village: AttokiCase Number: 54LHS finds that the date of death was actually Jul 05 2015. She can correct that by sending this SMS MAT* Raheela * Mohsin Raza * 050715 * Attoki * 54Note that system will only update the record if the case number and LHS’s phone number match
17. 17System will send following SMS to confirm if the record has been updated or not:Correction SMS example (cont’d)If case updatedIf case not updatedRecord successfully updated for Case Number 54Record could not be updated. Please check your case number.
18. LHS needs to send an attendance SMS in case no mortality was reported in her catchment area in the month18LHS should send the following SMS to mark her attendance ATT*NOSystem will send the following reply You have reported that no Neonatal or Maternal death occurred in your area during this month.Attendance SMS by LHS should be sent by the end of the month (30th/31st)
19. LHS should do a verbal autopsy of each mortality case 19Neonatal mortality verbal autopsy toolMaternal mortality verbal autopsy tool
20. Neonatal and maternal summary sheets20
21. Action plan template21
22. Summary
23. Summary
24. Way ForwardMeasures to develop political commitment and sensitization for enhancement and continuous function of CVRS system.Developing clarity on roles of involved departments/ agencies without duplicity of mandate on registration of vital events.Improvement of infrastructure and resources for vital events registration, and measures to facilitate vital events registration in remote areas.Human Resource Development Plan for the respective stakeholders including staff of LG&CD departments.Measures to create demand generation/ advocacy and awareness.Inclusion of medically certified cause of death recorded using the standardized form of death certificate (ICD Coding).
25. Thank you