A functional Civil Registration and Vital Statistics system ensures that every person in the country is legally identified, to inform national policy, promote efficient government planning, effective use of resources and provide accurate monitoring of interventions and progress towards achieving the Sustainable Development Goals.
The government of Uganda, guided by the 1995 constitution and the Registration of Persons Act 2015 requires the registration of all births and Deaths in this country. The ROPA mandates the MoH to notify all births and deaths that occur at all health facilities and within the community to the National Identification and Registration Authority(NIRA) for registration. Currently, birth registration stands at 34% while death registration is at 17% (NIRA-2022). Uganda is estimated to have about 280,000 deaths per year with 33% expected at health facilities while 67% are expected from the community.
Since 2019, the partnership of CDC foundation, through the Data for Health Initiative (D4H) project, with the Ministry of Health (MOH), National Identification and Registration Authority (NIRA) and the Uganda National Institute of Public Health (UNIPH) has supported the development of the country CRVS system to ensure the notification and registration of all births and deaths with issuance of the relevant certificates. The D4H Focus areas include NIRA and MoH Governance (process mapping, legal review, technical working group establishment); death notification (health facilities and communities); medical certification of cause of death and the UNIPH data Impact program.
A team from CDCF had a 2 weeks (10th-11th April 2023) in-country technical support visit to get a deeper understanding of the mortality processes, gaps, bottle necks and challenges that impact on death notification and registration. Following the team’s (CDCF) week long field visits to 4 health facilities (Kawempe and Naguru and NRH, Mukono Hospital and Entebbe RRH and 2 community settings (Iganga/Mayuge HDSS and Mukono distrit VHT team) a half day CRVS partner’s meeting/workshop was held supported by CDCF, to review the country’s mortality processes and priorities to address identified gaps/challenges and bottlenecks.
In collaboration with MoH, NIRA, UNIPH and UBOS, the team made some recommendations for improvements in the current mortality processes at both health facility and community level and priority actions to address the identified gaps, bottlenecks and challenges. Below are the major recommendations.
- Delineate death notification process (Frame 1a, 1b and manner of death in frame C) from medical certification of cause of death processes in Frame A, B and C (with reference to HMIS for 100/Medical certificate of cause of death-attached) to support real time death notification from MoH/DHIS2 to NIRA (MoH/DHI)
- Harmonize the death notification tools at community level – Use NIRA form 12 (See attached).
A team from MoH, UNIPH, CDC-Uganda and NIRA was also privileged to meet with one of the leaders of the global health programs at Bloomberg Philanthropies (the funder for all of Data for Health), Miss Kelly Henning on Tuesday 25 April. During the meeting, the team discussed with Kelly the status, progress and needs for further support for the data Impact and the CRVS work in the country.
A summary report from the meeting discussions including the revised process maps (Health facility and community) and priority key actions to improve death notification will be availed to the MoH, NIRA and UNIPH for reference.