IMPROVING VITAL STATISTICS Sri Lanka Health Sector ...siteresources.worldbank.org/.../060909SriLankaPresentation.pdf · WORLD BANK SRI LANKA OFFICE Improving Vital statistics through

KUMARI VINODHANI NAVARATNE

PUBLIC HEALTH SPECIALIST

WORLD BANK SRI LANKA OFFICE

Improving Vital statistics through the Civil Registration System in

Sri Lanka

Health Sector Development Project

Out line

Introduction to Sri Lanka

Background to vital statistics system

Back ground to the SL HSDP

Process of engaging to develop VS

Results

What can we learn from this experience

Sri Lanka

•Multi ethnic and multi religious country

•Population: 20 million

•Pop density: 300/km2

•Per capita : US $ 1600, high debt ratio

•Effects of Civil war

Sri Lanka

Life Expectancy : 75 yearsCrude Birth Rate: 19 per 1000 popCrude Death rate: 5.9 per 1000 popHigh literacy rate > 90%

Health Sector Sri Lanka

Free health care to all, no referral system2.5% of GDP is spent on healthHas 60000 public sector beds in 9 levels of hospitals, 47% in specialist hospitals8000 private sector beds Curative care services and Preventive care services provided through 2 networks

1000 health institutions (415 CDs provides only OPD)324 preventive health areas

Sri Lanka Health Status

Major achievements: Maternal and Child Health (skilled ANC 95%)

Communicable diseases (Immunization coverage > 95%)

Challenges include:Increasing NCD burden (> 60% of deaths)

Re-emerging and emerging Diseases (Dengue, Leptospirosis, Tuberculosis)

Un resolved – Malnutrition (17% LBW, 22% underweight)

Civil Registration system generated Vital Statistics

Has been in existence from 1867

Fully GOSL owned, under Ministry of Public Administration and not devolved

Paper based

No modernization efforts until 2005

Annual Mortality report 8 years behind

Death and Birth coverage 94%

Quality of Cause of Death data: 42%

Why did the Health team from the Bank want to improve CR/VS system?

The NCD burden is increasing

NCD cause specific death data was poor

Under reporting of maternal deaths

Under reporting of still births, neo natal deaths

So, birth and death registration and Cause of Death reporting needed changes

Approach

Bank team approached the Vital Statistics Unit of the RG Department

The Head of the unit was very interested to use the Banks resources to improve the system

Over about 3 months detailed discussions were conducted to better understand the changes needed to improve the system.

Implementation plan was developed by the VS unit in close collaboration with us.

Approach

During this time, the Bank team also discussed with the MOH data unit on the advantages of reliable Vital Statistics data for an important data user of the country.

It was agreed that VS should be included in the HSDP.

Project design and fund flowCentral Bank

Special Dollar A/C 1

MOH sub components

Treasury / MOF

Project Office

Central Bank Special Dollar A/C 2

Central BankSpecial Dollar A/C 3

Finance Commissio

n

Vital Statistics

sub component

Provincial Component

Census Dept DHS

Vital Statistics Subcomponent

Objective of this sub component was to:

Provide birth and mortality statistics of good quality and in time, to data users

Vital Statistics sub component

Specific objectives were to improve:

Coverage and completeness of birth and death registration

Accuracy and quality of cause of death data

Timeliness of death registration and reporting

Efficiency and operations of the VS unit

Results

Completeness and coverage improvements

Issue: Death and Birth registration had a coverage of only around 94%

The Birth and Death registration act amended to address gaps in the original Act of 1867

Results

Improvements to accuracy and quality of data

Issue: only 55% of all deaths are medically certifiedMore reliable and higher quality reporting formats developed, tested and rolled out across country

Simple Verbal autopsy forms introduced for home deaths

Large scale training provided to all 1000 registrars to use new forms

Follow up quality improvement training to poorly performing Registrars

Results

Timeliness of mortality data reporting

Issue: the VS unit had more than 8 years of backlog in publishing the annual mortality report and during tsunami 2004/5 data was lost.

Backlog up to end of 2005 cleared. Mortality data available.

Mortality data for 2006 completed. COD in progress

Mortality data for 2007 and 2008 are progressing

Results

Improve efficiency and operations of VS unit

Issue: Major GOSL budget restrictions, complicated old design formats, centralized coding, poor infrastructure for staff, lack of transport facilities

Basic infrastructure support completed; exposure to USA and Australia country systems

Decentralized 33 scanning centres coring the entire country created and functioning

Facilities for coding and relevant software for digitalizing data and simplified reporting through pre-formatted reports

Automatic coding possibility studied

What can we learn from working with the VS unit?

Health projects can incorporate VS improvement under evidence base improvements; even if initiated by the Bank side

Small allocations can do a lot of changes on the ground (in HSDP US $ 0.75 million out of a 60 million project)

Good understanding of the local VS situation and building on the current situation is better than ideal changes.

Lessons learnt….

As these VS units are outside of health ministries, careful understanding of the existing institutional arrangements are required for smooth implementation

Proactive interventions and redesigning may be required to cross implementation hurdles from both sides.

It is always great to have a committed champion from the government side

Future engagement

This component has opened out continuing and new areas and a solid relationship for engagement in the future

Cause of death quality improvement measures through introduction of a more comprehensive Verbal autopsy form

Making data more user friendly through the use of technology

Summary

SL and its health status

VS unit and the current status

Summary of the project design

Results achieved through the VS sub component

Lessons learnt

Thank you