Elsevier

The Lancet

Volume 370, Issue 9599, 10–16 November 2007, Pages 1653-1663
The Lancet

Series
Civil registration systems and vital statistics: successes and missed opportunities

https://doi.org/10.1016/S0140-6736(07)61308-7Get rights and content

Summary

Vital statistics generated through civil registration systems are the major source of continuous monitoring of births and deaths over time. The usefulness of vital statistics depends on their quality. In the second paper in this Series we propose a comprehensive and practical framework for assessment of the quality of vital statistics. With use of routine reports to the UN and cause-of-death data reported to WHO, we review the present situation and past trends of vital statistics in the world and note little improvement in worldwide availability of general vital statistics or cause-of-death statistics. Only a few developing countries have been able to improve their civil registration and vital statistics systems in the past 50 years. International efforts to improve comparability of vital statistics seem to be effective, and there is reasonable progress in collection and publication of data. However, worldwide efforts to improve data have been limited to sporadic and short-term measures. We conclude that countries and developmental partners have not recognised that civil registration systems are a priority.

Section snippets

Vital statistics for making and testing public-health policy

The first paper in this Series described the importance of civil registration systems, which are the cornerstone of any health information system1 because they generate comprehensive vital statistics. These systems have many social, political, and economic benefits apart from their public-health importance. The primary function of civil registration systems is to create and maintain legal documents proving the identity of individuals. Since these systems also provide official records of births

Assessment framework for vital statistics

Most countries have introduced civil registration systems which generate some vital statistics, but their usefulness has been restricted because of many systemic difficulties. Good statistical systems should meet the information needs of their users in an efficient, credible, and objective manner.19 Previous assessments of the quality of general vital statistics have been done with few criteria, such as the completeness of registration.20, 21 Moreover, comprehensive assessment criteria to

General vital statistics from civil registration systems

Countries which need most to improve their civil registration systems are also those from which obtaining accurate information on the criteria listed in table 1 is difficult. Every year, the UN seeks information from countries about, among other things, their vital statistics. Results are published yearly in the UN Demographic Yearbook and provide a partial picture of the quality of every country's general vital statistics.31 However, the Demographic Yearbook should be interpreted with caution

Cause-of-death statistics from civil registration systems

Country reports to the WHO (WHO Statistical Information Systems [WHOSIS]) are the major source of international cause-of-death statistics from civil registration systems. WHO published two volumes containing the annual epidemiological and vital statistics for 1939–46 and 1947–49.37 These reports were a continuation of the annual epidemiological reports formerly published by the League of Nations Health Organization. The WHO Mortality Database38 in the WHOSIS, however, contains data from 1950.

International efforts to improve vital statistics and strengthen civil registration systems

Over the past 60 years, many efforts by international agencies and others have been made to improve the availability of usable vital statistics for public health. These fall into three categories: (1) setting standards to improve comparability of vital statistics, (2) international collection and publication of data, and (3) strengthening national statistical systems.41

Conclusions

Worldwide civil registration systems have largely stagnated during the past five decades, which has severely restricted their potential as a source of vital statistics on the health of populations. Yet at a time when accountability and rational allocation of resources for health development have become an increasing concern, the need for reliable national statistics for births, deaths, and causes of death has never been greater.

UN initiatives have largely succeeded in making vital statistics

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