Reliable vital statistics based on births and deaths are necessary for population health assessment, epidemiological research, health planning and programme evaluation. Civil registration is considered the optimal source of statistics on vital events (i.e. births and deaths). The national authority for civil registration in India is the Office of the Registrar-General and Census Commissioner, under the Ministry of Home Affairs. Registration is, however, decentralized to India's 29 states and 6 union territories. In theory, India's registration system provides a good basis for overall coordination, direction, technical guidance and standards for birth and death statistics, but the reality is vastly different. For the period 2000-2006, birth registration in India was 41% and death registration was < 25%, (1) with large regional differences. In Andhra Pradesh state, birth registration was 50% and death registration was 25%. (2,3) Numerous factors including political, administrative, economic and legislative barriers, and neglect of cultural and community realities act as constraints to the complete, accurate and timely registration of births and deaths in India. (3,4) This paper describes an initiative called Strengthening of Local Vital Event Registration (SOLVER) by a nongovernmental organization that worked with the government and the public at a subdistrict level in southern India.
The programme was held in five mandals (subdistricts)--Palamanet, Gangavaram, Baireddypalle, V Kota and Ramakuppam--with a total population of 281 500 (in the year 2007) in Chit-toot district of Andhra Pradesh state. The first three proximal rnandals were located at a mean distance of 15 km and the last two distal mandals were at a mean distance of 50 km away from Palamaner, the main town. Estimated annual number of births and deaths were 5320 and 2055 respectively, based on crude birth and death rates of 18.9 and 7.3 per 1000 respectively. (5)
The duration of the programme was 12 months (September 2007-August 2008). Fig. 1 summarizes the existing process of vital event registration, the various interventions (3,4) and the consequent learning points for improving civil registration in India. (6,7) These interventions targeted both the "supply-side" (civil registration and vital statistics by the government) and the "demand-side" (service utilization by the community) with the objective of achieving target rates of 75% for birth registration and 50% for death registration.
The nongovernmental organization (St John's Research Institute, Bangalore, India) fostered partnerships with local government departments including revenue, social welfare, health and education. (8)
Awareness workshops on registration procedures were held at each mandal, chaired by the mandal revenue officer/assistant statistical officer.
Data management mechanisms were set up between the government and project staff to share information on vital events
in the project area. Discussions were held with public and private hospitals for transmission of data on births and deaths to the government. Procedures were also established to evaluate project outcomes using evidence of birth and death registration.
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Publicity campaigns were conducted to improve awareness in the community using various media such as pamphlets, audio announcements via village drummer and recorded messages, and brief jingles on local cable television.
The project staff visited households to inform them of the juridical and statistical benefits of vital event registration. (9) Juridical benefits include establishing nationality, legal rights, ration card/identity card/passport, access to education, welfare schemes and utility services. Registration also has the statistical purpose of enabling measurement and monitoring of the health status of the population. …