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Impact of policy initiatives on civil registration system in haryana.
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MedLine Citation:
PMID:  22654286     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite the existence of Registration of Birth and Death Act (1969), Civil Registration System (CRS) in India registered only 68.3% of the births and 63.2% of the deaths. Hence, National Population Policy (2000) emphasized the need to improve registration of vital events. In 2005, Haryana initiated policy changes to enhance registration of vital events. We evaluated the impact of these policy changes on CRS in 2009.
MATERIALS AND METHODS: Records and reports of CRS were reviewed. On the basis of the birth and deaths reported by the Sample Registration System, the proportion of births and deaths registered by CRS were estimated using the projected population from 2001 Census.
RESULTS: Before 2005, Police Stations were the registration centers in rural Haryana. On 1(st) January 2005, the birth and death registration was made the responsibility of Primary Health Centers (PHCs). Medical Officers at PHCs were designated as Registrar and Pharmacists as Sub-Registrar of Births and Deaths. Auxiliary Nurse Midwife and Anganwadi Workers facilitated the registration. Till 2004, the registration of births was stagnant at the level of 70% for several years, which increased to 95% by 2009. Similarly registration of death events increased from 73.5% to 92.1%.
CONCLUSION: Haryana state is still to achieve complete registration of births and deaths, but certainly shift of registration from police to health department has strengthened the CRS.
Authors:
Pravin Kumar Singh; Manmeet Kaur; Nidhi Jaswal; Rajesh Kumar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine     Volume:  37     ISSN:  1998-3581     ISO Abbreviation:  Indian J Community Med     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-06-01     Completed Date:  2012-10-02     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  9315574     Medline TA:  Indian J Community Med     Country:  India    
Other Details:
Languages:  eng     Pagination:  122-5     Citation Subset:  -    
Affiliation:
Directorate of Health, Haryana, Panchkula, India.
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Full Text
Journal Information
Journal ID (nlm-ta): Indian J Community Med
Journal ID (iso-abbrev): Indian J Community Med
Journal ID (publisher-id): IJCM
ISSN: 0970-0218
ISSN: 1998-3581
Publisher: Medknow Publications & Media Pvt Ltd, India
Article Information
Copyright: © Indian Journal of Community Medicine
open-access:
Received Day: 28 Month: 4 Year: 2010
Accepted Day: 03 Month: 12 Year: 2011
Print publication date: Season: Apr-Jun Year: 2012
Volume: 37 Issue: 2
First Page: 122 Last Page: 125
ID: 3361795
PubMed Id: 22654286
Publisher Id: IJCM-37-122
DOI: 10.4103/0970-0218.96100

Impact of Policy Initiatives on Civil Registration System in Haryana
Pravin Kumar Singhaff1
Manmeet Kaur1
Nidhi Jaswal1
Rajesh Kumar1
Directorate of Health, Haryana, Panchkula, India
1School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Correspondence: Address for correspondence:Rajesh Kumar, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India dr.rajeshkumar@gmail.com

Introduction

Civil registration was started in India way back in 19th century; however, it remained voluntary for considerable period of time. States developed their own legislations having different conceptual understanding, definitions, and classifications. The enactment of Registration of Births and Deaths (RBD) Act in 1969 replaced diverse laws with a uniform piece of legislation. National Authority for Civil Registration is the Office of the Registrar-General and Census Commissioner under the Ministry of Home Affairs, Government of India. This office provides overall coordination, direction, technical guidance, and standards for civil registration throughout the country. Registration of vital events is decentralized to the states and union territories.

Civil Registration System (CRS) provides permanent legal records of births and deaths. Mandatory provision of the first copy of the birth certificate free of charge to the child is accepted as his/her first right. However, only 27% of the under-5 children had a birth certificate.(1) According to the Office of Registrar General of India, only 68.3% of the births and 63.2% of deaths are registered in India.(2) National Rural Health Mission is focusing on reduction of total fertility rate, infant mortality rate, and maternal mortality ratio.(3) Estimation of these indicators demands valid information on the events like births and deaths. Moreover, the state where sex ratio is a public health issue, measurement of sex ratio at birth is also required.

Considering the weaknesses of CRS, a Sample Registration System (SRS) was adopted as a way of ensuring reliability of vital data in 1969–1970. SRS holds regular surveys of usual resident population, continuous enumeration of vital events, twice-yearly surveys of births and deaths and updated household schedules, matched records between continuous and twice-yearly counts, and field verification of unmatched and partially matched events.(4) Sample registration system has successfully provided fertility and mortality rates at national and state levels. However, due to its small sample size, SRS does not provide vital statistics at district and sub-district levels.

In India, CRS has undergone manifold changes in the last decade under the banner of sector reforms. States are at different stages of reforming this system. Hence, it is important to understand how reforms brought through policy initiative may make the system more effective and efficient. Haryana state had shifted the responsibility for implementation of RBD Act in rural areas from police to health in 2005. Hence, a review of CRS system was conducted to study the process of policy change and the impact it had on the registration of vital events in Haryana.


Materials and Methods

Until 2005, 175 Police Stations were functioning as registration centres in the rural areas of Haryana. Village watchmen (Chowkidars) were responsible for reporting vital events for registration to the Station House Officers of Police Stations who were the Registrar of births and deaths in rural areas. There were 78 registration centres in the urban area, where municipal authorities were the Registrar of births and deaths. Besides municipalities, Post Graduate Institute of Medical Sciences, Rohtak, Cantonment Board, Ambala, and Urban Estate, Panchkula, were also the notified registration centres in the urban area. Registration of hospital events was done in the Municipal Committees, which usually took a week or more time, and by the time birth events were registered, the mother would usually be discharged and families generally did not obtain birth certificate from the Municipal Authorities.

Haryana government revamped the registration system on 1st January, 2005. To ensure better implementation of various provisions of RBD Act, it was decided to get the work of registration done through Primary Health Centres (PHC) instead of Police Stations. This policy change was also meant to increase the number of registration centres so as to make registration more accessible to people. Expected outcomes of the new policy were to make the registration of births and deaths available at the door step, i.e., delivery of the free copy of registration extract to the head of the household (through the health workers) as Section 12 of the RBD Act mandates provision of one copy of the extract to the family free of cost as soon as registration is completed, and PHCs can issue birth or death certificates, under Section 17 of RBD Act.

Medical Officer-in-Charge of the PHCs were designated as Registrar (Births and Deaths) vide Government Notification (3/49/97-3 HB-III dated 10 December 2004). Pharmacist of PHCs were declared as Sub-Registrar (Births and Deaths) under Section 7(5) of the RBD Act to assist the Registrar in performing day to day activities related to birth and death registration. Sub-registration centers were also started in five Government Hospitals so that free extract of birth or death registration could be handed over to the family/relatives at the time of discharge. Certificate under Section 12 of RBD Act has been made a part of the reporting form. With this innovation, cent percent delivery of free extract under Section 12 can be ensured. Medical Certification of cause of death has also been made compulsory. Medical Officer-in-Charge in urban as well as in rural area and Medical Practitioners in urban area have been made responsible for reporting the cause of death to the concerned Registrar.

Evaluation of the process of policy change was done by review of the records and interviews with key staff. Completeness of birth and death registration was calculated by comparing with the estimated births and deaths in Haryana using SRS vital rates and estimated population from the census. Percent of births and deaths recorded before and after 2005 were compared.


Results

In the rural areas of Haryana, the numbers of registration centers have increased from 175 to 413. The level of births and deaths registration has also increased after 2005 [Figure 1]. Birth registration was stagnant at around 70% till 2004, which has gone up to 95% during 2009. Similarly, registration of death events has also increased from 73.5% to 92.1%. An added advantage of the improved birth registration was that monitoring of sex ratio became possible [Figure 2]. The districts and blocks that needed special attention especially in a state like Haryana could be identified for priority action.

Process evaluation indicated that in the initial period health system was not geared up for initiating the changes in the registration system. The officials and health workers at various levels were initially hesitant to take up the registration task, though it was part of their routine duties to record births and deaths. PHC officials considered registration work as “difficult” since they did not have experience or training in handling legal matters related to registration of vital events. They did not perceive it as “their” work. Legal sensitivities involved were not appreciated in the beginning, i.e., Medical Officers who were designated as “Registrar” did not pay required attention to the tasks related to registration of vital events. Health workers too initially resented the work related to birth and death registration as it was considered as an “additional burden.” They felt that already they were overburdened with record keeping. Poor record keeping was seen in some registration centers such as cutting/overwriting in the records. Potential for misuse of loose blank forms that were easily available with the Anganwadi workers and Auxiliary nurse midwives was also observed initially. However, with periodic training and reorientation new system stabilized within a year. Periodic review at the state level and a word of caution by state Registrar kept the district authorities alert.


Discussion

CRSs are generally weak in most developing countries.(5) Substantial administrative reforms/policy changes are required to improve these systems. Haryana state took bold step and shifted the registration of birth and death from police to health with encouraging trends [Figure 1]. Though the state has not yet achieved 100% registration of births and deaths but substantial improvements have been made. Various provisions of the RBD Act which favor the public, e.g., easy access to the Registrar and provision of free copy of the birth and death certificate at the time of registration, have been implemented successfully. The policy reform made it possible to provide birth registration as first right of the child as declared by United Nations.(6) However, it was not easy to implement policy changes to reform CRS in Haryana.

There are many theories that explain the process of policy change. The economic, sociological, and cultural approaches have emphasized the importance of “neglect” and “environment” for policy change. “The core of a fundamental policy change is always concerned with a change of attention toward those (aspects of) problems that were the most chronically neglected in the previous policy.”(7) The CRS has been “neglected” for a long time. Sector reforms initiated the policy change “environment” in Haryana. However, Kingdon's Agenda-Setting Theory states that there are always three important elements required for policy formulation or change, namely (a) agenda setting or problem identification, (b) thinking about the solutions or preparing proposals, and (c) advocating or seeking political commitment.(8) The chain of events for switching over to the new registration system in Haryana started with the submission of a proposal by the Health Department to the State Government. However, State Government directed the Health Department to constitute a Departmental Committee to review the proposal. A Departmental Committee was formed under Chairpersonship of Additional Director General Health Services with two Civil Surgeons, two PHC doctors, and concerned Deputy Director and Assistant Director (Vital Statistics) as members. Later, Secretary Health convened a meeting on the proposal with Police, Social Welfare, Health and Census Officers and its recommendations were sent to the Chief Minister. Additional Principal Secretary to Chief Minister held a meeting with Officers of Health and Police Departments. Then, the proposal was approved by the Chief Minister, and a Gazette Notification was issued.

It illustrates that consensus building and approval may take time, but it is possible to change policies that lead to improvement in the Public Systems; however, it is important to understand the process of policy change. It is equally important to identify people who can lobby and advocate for the policy change within the medical fraternity, health workers and ministerial or support staff. Regular sample checks are very important initially when policy changes are implemented, otherwise policies may remain unimplemented or face sloppy implementation. Regular training of Registrars and Sub-Registrars is the key to success. They must be sensitized on the issue of legal importance and the issues of human rights.


Notes

Source of Support: Nil

Conflict of Interest: None declared.

References
1. National Family Health Survey-3, 2005-06Year: 20071MumbaiInternational Institute for Population Sciences (IIPS) and Macro International
2. Registrar General of India. Civil Registration System Newsletter No.8Year: 2004Month: 12
3. Mission Document (2005-2012), National Rural Health Mission, Ministry of Health and Family Welfare, Government of India, New DelhiLast accessed on 2010 Apr 14 Available from: http://www.mohfw.nic.in/NRHM/Documents/NRHM%20Mission%20Document.pdf.
4. Sample Registration System. Annual Report, Office of the Registrar General, India, Ministry of Home AffairsYear: 1971New DelhiGovernment of India
5. Mahapatra P,Shibuya K,Lopez AD,Coullare F,Notzon FC,Rao C,et al. Civil registration systems and vital statistics: successes and missed opportunitiesLancetYear: 200737016536318029006
6. The United Nations and Human Rights, 1945-1995Year: 1995New YorkDepartment of Public Information, United Nations
7. de Vries MS. The importance of neglect in policy-makingYear: 2010HampshireMcMillan Publishers Ltd
8. Kingdon JW. Agendas, alternatives, and public policiesYear: 19952nd edNew YorkLongman

Figures

[Figure ID: F1]
Figure 1 

Trends of births and deaths registration in Haryana, 1996–2009



[Figure ID: F2]
Figure 2 

Sex ratio at birth in sample registration system (SRS) and civil registration system (CRS) in Haryana



Article Categories:
  • Original Article

Keywords: Birth, death, legislation, policy, vital registration system.

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