Birth and Death Notification for improving Civil Registration and Vital Statistics (CRVS): an innovation from Rural Bangladesh (Preprint)

BACKGROUND Effective health policy formulation requires sound information of numbers and causes of deaths in the population. Currently, in Bangladesh, neither births nor deaths are fully and promptly registered. Birth registration in Bangladesh is around 54% nationally. While the legal requirements are to register within 45 days of an event, only 4.5% of births and 35.9% of death were reported within the timeframe in 2020. This study adopted an innovative digital notification approach to improving coverage of registration of these events at the community level. OBJECTIVE Our primary objective was to assess-i) the proportion of events identified by the new notification systems (success rate), and contribution of different notifiers individually and in combination (completeness), and ii) the proportion of events notified within specific time limits (timeliness of notifications), after introducing the innovative approach METHODS We conducted a pilot study in 2016 in two sub-districts of Bangladesh to understand whether accurate, timely and complete information on births and deaths can be collected and notified by facility-based service providers, community health workers, including those who routinely visit households, local government authorities and key informants from the community. We designed a mobile phone technology-based platform; an application and a call centre through which the notification was provided. All notifications were verified through the confirmation of events by family members during a visit to the concerned household. We undertook a household survey-based assessment at the end of the notification period. RESULTS Our innovative system gathered a total of 13,377 notifications for births and deaths from all channels including duplicate reports from multiple sources. Project workers were able to verify 92% of births and 93% of deaths through household visits. The household survey conducted among a sub-sample of the project population identified 1,204 births and 341 deaths. After matching notification with the household survey we found that the system was able to capture over 87% of births in the survey areas. Health Assistants (HAs) and Family Welfare Assistants were the primary sources of information. Notification from facilities was very low for both events. CONCLUSIONS The global investment plan for CRVS scaling up 2015 to 2024 and the World Health Organization (WHO) reiterated the importance of building an evidence base for improving CRVS. Our pilot innovation revealed that it is possible to coordinate with the routine health information system to notify births and deaths as a first step to ensure registration. HAs could capture more than half of the notifications as a standalone source. CLINICALTRIAL