Civil Registration and Vital Statistics Investment Plan 2015–2019

Civil Registration and Vital Statistics Investment Plan 2015–2019 Republic of the Philippines

Reaching the Hard To Reach to Get Every One In the Picture

A joint project of the Philippine Department of Health, Philippine Statistics Authority, Canadian Department of Foreign Affairs, Trade and Development, the World Health Organization and the United Nations Economic and Social Commission for Asia and the Pacific.

Republic of the Philippines

Philippine Statistics Authority National Statistics Office

Republic of the Philippines

Department of Health Kagawaran ng Kalusugan

Civil Registration and Vital Statistics Investment Plan 2015–2019 Republic of the Philippines

Reaching the Hard To Reach to Get Every One In the Picture

A joint project of the Philippine Department of Health, Philippine Statistics Authority, Canadian Department of Foreign Affairs, Trade and Development, the World Health Organization and the United Nations Economic and Social Commission for Asia and the Pacific.

Republic of the Philippines

Philippine Statistics Authority National Statistics Office

Republic of the Philippines

Department of Health Kagawaran ng Kalusugan

Contents

Acronyms................................................................................................................ iv Executive Summary ............................................................................................... v PART 1: Strategic Need for Investment..................................................................1

1.1 The Case for CRVS.........................................................................................1

1.2 Objectives for CRVS....................................................................................... 2

1.3 Past Performance and Current State of CRVS................................................ 4

A Quick Look at CRVS Initiatives in the Recent Past....................................... 7

1.4 Summary Investment Plan and Budget........................................................... 9

Part 2: Detailed Investment Plan......................................................................... 10

2.1 Objectives for CRVS Strengthening.............................................................. 10

2.2 Program Logic for CRVS.............................................................................. 12

2.3 Project Management................................................................................... 14

2.4 Investment Framework................................................................................ 16

CRVS Forum................................................................................................ 18

2.5 Analysing the Investment Strategy............................................................... 18

Annexes................................................................................................................. 22

ANNEX 1. Draft DPO of CRVS Management Structure......................................... 22

Reaching the Hard To Reach to Get Every One In the Picture

Acronyms

iv

CRVS

Civil Registration and Vital Statistics

LCRO

Local Civil Registrar Office

LCR

Local Civil Registrar

CCR

City Civil Registrar

MHO

Municipal Health Office

MHO

Municipal Health Officer

PHN

Public Health Nurse

RHM

Rural Health Midwife

DOHRep

Department of Health Representative

LCE

Local Chief Executive

BCRS

Barangay Civil Registration System

HOMIS

Hospital Operation Management Information System

ClinicSys

Clinic Information System

Civil Registration and Vital Statistics Investment Plan 2015–2019

Executive Summary As a state policy, the Civil Registration and Vital Statistics system mandates the basic and compulsory registration of all vital events and the accompanying changes in the civil status of every Filipino citizen. This simple validation of one’s identity and mortality provides the foundation for the country’s health policy and programme development, as well as its implementation.

Civil registration, in the Philippines as in most countries, is a collaborative endeavor.

The Philippine Statistics Authority (PSA) has the technical oversight and the National Statistician also wears the hat of Civil Registrar General. The one who undertake the actual registration are the local civil registrars in the employ of the local governments in the different municipalities and cities of the country, all 1650 of them. The local health workers are very involved in the registration process: attendants at births which are usually midwives, nurses and doctors have to certify that they attended the birth and all death certificates, whether death occurred in a facility or in the community, have to be reviewed by the municipal or city health officer. The Department of Health (DOH) which has technical oversight on the country’s health system has been working with the PSA on improving the civil registration and vital statistics (CRVS).

In an effort towards the improvement in civil registration, the PSA and the DOH with the World Health Organization (WHO) has developed the Civil Registration and Vital Statistics Investment plan for the year 2015–2019. This will serve as guidance for the attainment of the global goal in universal civil registration of births, deaths and other vital events. Most recent support for improving CRVS has been an integral component of implementation of high-level recommendations of the United Nations Commission on Information and Accountability for Women’s and Children’s Health in the Philippines.

The key challenge to CRVS is reaching the hard-to-reach, the last mile. Amongst these are the Muslims, indigenous people, the poor and marginalized population. A key feature of the investment plan details how to reach these targeted population.

The investment plan has identified the following goals: Goal 1 – Improve coverage and quality of registration QQ

QQ

Increase death registration from 66% to 80% and birth registration from 93.5% to 99.0% by 2019.

Increase medical certification of deaths from 35% to 70% and decrease the proportion of ill-defined causes of death from 15% to 7% by 2019.

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Reaching the Hard To Reach to Get Every One In the Picture

Goal 2 – Increase awareness and utilization of Vital statistics QQ

By 2019, quality VS is readily available and accessible for use on policy development, health development, health planning, and program management across all levels

Goal 3 – Enhanced support for strengthening CRVS QQ

QQ

By 2019, governance and policy support mechanisms for civil registration are established for both local and national level.

By 2019, the CRVS Development Plans are crafted and implemented.

The CRVS Investment Plan details the logical framework for each goal, the priorities as well as the strategic actions required to achieve the goals. The key issues are: QQ

QQ QQ

QQ

QQ

Strengthening capacity, business processes and routine monitoring and governance of the CRVS system Ensuring standards across a decentralized system Ensuring the capture of all civil events and accurate cause of death for mortality statistics Harnessing information and communications technology (ICT) more effectively to reach the hard to reach Increasing awareness, demand and use of a reliable CRVS system with comprehensive and timely data, analysis, and generated vital statistics

Over a 5-year period from 2015 through 2019, it is expected to require approximately USD $26 million to achieve a fully functioning and sustainable CRVS system. When adjusted by 15% to account for risks and uncertainty in the estimation and unexpected changes in the future, the overall investment totals USD $30 million. The priority actions include the following: Immediate Priorities QQ

QQ QQ

Improve birth registration among marginalized populations / death registration throughout Improve proportion/quality of death registration (underlying cause of death) Connect relevant MNCH monitoring systems with CRVS systems to address losses to follow up and accuracy (birth/death certifications)

Medium-term Priorities QQ QQ

vi

Increase awareness and utilization of vital statistics Improve timeliness of VS to shorten release of vital statistics from 3 to 1.5 years— by decreasing the time lag

Civil Registration and Vital Statistics Investment Plan 2015–2019

QQ QQ

Analysis of business processes for improvements Improve CRVS governance structure and mechanisms

Development partners can assist the Philippines with targeted technical assistance by engaging with government in sustainable “quick win” opportunities while more comprehensive plans and actions emerge. The piloted Barangay CRVS system has demonstrated success in reaching the hard to reach and is ready to be scaled across 43 000 Barangays with convergence with health sector notification and registration of events. Some additional technical assistance opportunities identified include the following: QQ

QQ QQ QQ

Specialized training, capacity building (Cause of Death, ICD-10 coding, verbal autopsy) Learning about best practices / alternatives for registration from other countries Expert review of SOPs, regulations, policies Optimizing ICT investments—interoperability, scaling, architecture, infrastructure

Partners can benefit from reuse of good practices in Philippines across the region. The Philippines has much yet to achieve to reach the last mile in CRVS strengthening and this investment plan outlines the roadmap to reach the hard to reach.

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Civil Registration and Vital Statistics Investment Plan 2015–2019

PART 1: Strategic Need for Investment 1.1

The Case for CRVS

The social contract of President Benigno Aquino with the Filipino people emphasizes on human development in improving the overall quality of life of the Filipino people. Social protection is the cornerstone of the present administration’s campaign for inclusive growth and sustainable development. The Social Protection Framework is very explicit that no one should be left behind in national social and economic development. And a very essential component is that every individual to be a beneficiary should have an identity through birth registration. Another important consideration of the framework is the strengthening of social protection statistics component of which vital statistics is a critical part. There is urgency in achieving the last mile in Civil Registration and Vital Statistics (CRVS) strengthening to ultimately reach the hard to reach, marginalized populations and the poor.

The 2014 Case Study on Strengthening CRVS in the Philippines provides a detailed overview of the history, status, and future challenges being addressed currently through the recent development of a comprehensive national CRVS strategy. Civil registration in the Philippines was legally instituted in 1930, when the basic registration of births, deaths and marriages was made compulsory for identity and enumeration purposes.

Since then, CRVS system has grown to play a prominent role in providing a crucial source of reliable data, from the demographic and health information that presents the current picture of the nation’s health status to statistical indicators that is vital for various agencies in ensuring that the basis for their policy development, program planning, decision making and fund allocation is grounded on an accurate population data.

The Government of the Philippines has recognized the critical importance of developing the CRVS system as a key national resource, particularly for protecting the rights of Filipinos, facilitating public service delivery and for monitoring national health situations and trends. Adding impetus to this recognition is the need to address the fact that with 221 maternal deaths per 100 000 live births in 2011, the Philippines is not on track to meet the Millennium Development Goal 5 (MDG) target of 52 maternal deaths per 100 000 live births, although it is on track for MDG 4 on infant and child mortality.

Understanding the details of maternal and neonatal deaths – including the causes, characteristics of the mother and newborn, and location – is a key to improving the quality of maternal and neonatal health services and making targeted interventions and strategies for prevention.

To date, the country has relatively high coverage for birth at 93.5% but only 66% for death registration. A closer look at the data will however reveal approximately 10 million citizens working or living overseas (2010), very wide geographical and sectoral variations in registration especially for those living in the geographically isolated mountainous, and disadvantage areas, and recognizing that Muslim communities which have to bury

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Reaching the Hard To Reach to Get Every One In the Picture

their dead within 24 hours and the indigenous people who may not see the need for registering births and deaths.

Other challenges including a highly devolved government structure and varying degrees of local support for strengthening CRVS. Even when the birth and death registration data is available there are issues with data quality. Even more pervasive is the questionable quality of the cause of death information produced given 15% of registered deaths have an ill-defined causes. Coding of deaths using the WHO International Classifications of Diseases (ICD) version 10 is instituted nationally, however, there is inadequate training of physicians and health worker for ascertaining cause of death or using verbal autopsy (VA) and a major shortage of trained ICD coders at the local government unit (LGU) level.

The last mile in any undertaking is always difficult and the same is true in the case of the Philippines CRVS strengthening. Trying to reach the segment of the population who are hard to reach geographically, whose cultural beliefs may not be facilitative of registration, who may not have the money to pay for registration and who may be resistant or just do not see the need to register vital events require a lot of effort and resources on the part of the government to value the importance of CRVS. The Philippine civil registration system needs the Filipino people to register vital events.

Thus, CRVS should be sensitive to their culture and beliefs. And that Philippine CRVS strengthening program should be ready for an uphill struggle because reaching the last mile would be very challenging and would require innovative approaches.

Further assistance to the Philippines can be mobilized through multisectoral engagement and local partnerships, coordination and technical support from development partners, and engaging in the AsiaPacific Regional Action Framework for Strengthening CRVS to “Get Every One In The Picture” to achieve the highest possible performance of CRVS systems across the region and within the Philippines.

The regional CRVS initiative is valuable for advocacy, generating high-level political leadership, identifying strategic areas for further implementation support, knowledge learning and sharing across countries, and applying better and new techniques and solutions in order to reach the hard-to-reach, marginalized, and vulnerable populations.

1.2

Objectives for CRVS

A fully functioning CRVS should ensure continuous, timely, accurate, consistent and complete registration and reporting of all human beings’ life vital events highlighting the

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Civil Registration and Vital Statistics Investment Plan 2015–2019

facts of birth and the causes of death. Specifically, the following are the goals of the Philippine CRVS system: QQ

Improved coverage and quality of registration

QQ

Increased awareness and utilization of Vital Statistics

QQ

Enhanced support for strengthening CRVS

Objectives for the improvement program are to increase registration coverage for both births and deaths, improve the quality and use of mortality statistics, and improve awareness of the value of CRVS for policy development. Finally, the objectives for CRVS focus on building a sustainable system for CRVS over the long term. Each goal contains immediate, short-term and longer-term priorities for attention, and a range of activities designed to support key strategies against each priority.

STRENGTHENING THE POLITICAL COMMITMENT ON CRVS The 16th Congress of the Philippines has demonstrated positive prospects in terms of enacting a more responsive CRVS law that would institutionalize an effective, comprehensive and rights-based CRVS system.

The House Committee on Population and Demography, chaired by Rep. Rogelio Espina, convened a TWG last 4 June 2014 to consolidate four House Bills seeking to establish a more responsive national civil registration system, effectively repealing the outdated 1930 Civil Registration Law (Act No. 3753). During the TWG, bill authors and representatives from government agencies discussed what should be included in the proposed law in order to increase people’s access to civil registration services, address bottlenecks in the present system, and establish a modern CRVS system that is efficient, disaster-resilient, and that upholds human rights. A working draft of the law will be taken up by the TWG later this year.

At the Senate, Senate Bill 436 (“Civil Registration Act”) filed by Senator Francis Escudero is pending with the Committee on Justice and Human Rights, while Senate Resolution 417 urging the conduct of an inquiry, in aid of legislation, on the total number of unregistered births in the Philippines was filed by Senator Grace Poe in December 2013.

In both Houses, advocacy efforts of the Civil Society Coalition on CRVS have been crucial in ensuring CRVS is prioritized by relevant committees. The Coalition is led by Plan International, Good Neighbors International and the Philippine Legislators Committee on Population and Development.

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Reaching the Hard To Reach to Get Every One In the Picture

“

The Civil Registration and Vital Statistics System is now considered as the gold standard of health information in the country.

”

-Enrique Ona, Secretary of Health

GOALS

OBJECTIVES

Goal 1 – Improve coverage and quality of registration

Increase death registration from 66% to 80% and birth registration from 93.5% to 99.0% by 2019 Increase medical certification of deaths from 35% to 70% and decrease the proportion of ill-defined causes of death from 15% to 7% by 2019

Goal 2 – Increase awareness and utilization of Vital statistics

By 2019, quality VS is readily available and accessible for use on policy development, health development, health planning, and program management across all levels

Goal 3 – Enhanced support for strengthening CRVS

By 2019, governance and policy support mechanisms for civil registration are established for both local and national level.

By 2019, the CRVS Development Plans are crafted and implemented

1.3

Past Performance and Current State of CRVS

The Philippine CRVS has gone through various significant developments from the time it was legally instituted as a system. Moves towards the improvement in registration have transformed to address the varying situation and needs of the nation. Monitoring the completeness and coverage, and a steady and considered process of CRVS assessment, accompanied by technical and technology development, have been important in strengthening the CRVS system of the country with a large population and a dispersed geography.

The key features in the production of vital statistics based on civil registration records in the Philippines are: QQ At present, it takes three years for national vital statistics based on civil registration records to be produced and publicly available. The delays are largely caused by the time needed to clean and consolidate data from a variety of sources and conduct quality checks, particularly for consistency and preventing duplication of records.

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Civil Registration and Vital Statistics Investment Plan 2015–2019

QQ

QQ

QQ

QQ

QQ

Between full releases of vital Even a mighty statistics data, some demographic indicators based on typhoon cannot stop civil registration records are the CRVS work from periodically released, such as progressing fertility rates and life tables.

Although there are 80 provinTyphoon rains and forceful winds cial and 17 regional PSA officcould not stop the 3 057 participants es, the PSA does have limited composed of City/Municipal human resources and equipCivil Registrars, Mayors, Judges, ment to meet the demands of Solemnizing Officers, Barangay around 51 000 civil registraSecretaries and other stakeholders tion certificates issued to Filipito attend the 6th national workshop nos each day. on civil registration (NWCR) held The quality of the data obon August 7–9, 2012 held at SMX tained from civil registration Convention Center, Mall of Asia, is influenced by how it is enPasay City with the theme “Tamang tered by the Local Civil RegisRehistro, Pananagutan ng Bawat trars (LCRs). Some LCRs do not Pilipino”. have a full appreciation of the statistical implications for their The National Convention on Civil work and thus some of the Registration started in 1991 until it data received by the PSA are was renamed as National Workshop unreliable. on Civil Registration in 2002. The As of 2010, 66% of deaths NWCR is conducted every two years. were registered and 35% The objectives of the workshop is a) of registered deaths in the to have a continuing education for Philippines have a medically civil registration stakeholders and certified cause, representing an avenue to share experiences and about a quarter of all deaths ideas; b) to inform the participants that occurred in that year (see updates and new developments in Table 1). As of 2011, an escivil registration; c) discuss issues timated 45% of births took and concerns about civil registration; place at home. In the Autonand d) to recognize the efforts and omous Region of Muslim Minexemplary accomplishments of the danao (ARMM) the figure is Local Civil Registry Offices (LCROs). over 80%.

PhilHealth, the social health insurance programme, mandates all accredited health care providers, regional managers, claim processing departments and all concerned to use the ICD-10 for health claims and reimbursements, thus contributing to the improvement of cause of death coding.

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Reaching the Hard To Reach to Get Every One In the Picture

Table 1. Percent Completeness of Death Registration by Region Philippines: 1995, 2000 & 2010 Region

1995

2000

2010

PHILIPPINES National Capital Region

67.1

63.7

66.0

99.4

116.7

*

Cordillera Administrative Region

43.2

54.2

*

Region I

87.9

101.2

*

Region II

63.1

75.2

*

Region III

81.3

96.0

*

Region IV-A

76.7

102.0

*

Region IV-B

-

64.4

*

Region V

70.9

81.2

*

Region VI

72.9

83.7

*

Region VII

84.3

81.6

*

Region VIII

54.2

59.8

*

Region IX

41.3

51.4

*

Region X

55.2

59.1

*

Region XI

51.7

63.6

*

Region XII

39.0

57.4

*

Region XIII

43.5

54.1

*

Autonomous Region of Muslim Mindanao

3.5

10.7

*

Source: National Statistics Office

In the absence of a national identity card scheme, civil registration is the primary means for Filipinos to prove who they are and their eligibility for certain public services and social protection. When Filipinos try to access public services, such as when a child is being immunized, this is an opportunity to prompt them or the family of the need to register vital events to secure their rights and privileges.

To aid in greater coverage of civil registration the Philippines is one of the few countries in Asia and the Pacific to have an annual commemoration of civil registration. Since 1991, February every year is Civil Registration Month. As part of the celebrations, free civil registration services are offered and local civil registrars (LCRs) and provincial and national governments make an active effort to reach out to the public to educate about the importance of CRVS for the lives of Filipinos.

With so many islands and such a large population, it is challenging to provide civil registration within a reasonable distance of the whole population, and to register deaths in remote populations. Low registration levels have been observed in GIDAs, including mountainous areas and islands. There is therefore a need to continue to invest in and provide mobile civil registration services to GIDAs, and for a greater emphasis on death registration in mobile registration campaigns.

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Civil Registration and Vital Statistics Investment Plan 2015–2019

For a variety of reasons, civil registration coverage rates among Muslims, indigenous peoples and the poor are much lower than the national aggregates. However, for Muslims and indigenous peoples, it could be argued that this is largely because of geography rather than any institutional barriers or discrimination. The overwhelming majority of vital events among Muslims that go unregistered are within ARMM, where the security situation has created barriers for individuals to access most public services, including civil registration. Indigenous peoples, likewise, experience lower civil registration coverage rates in remote parts of the country.

Furthermore, there are some concerns about the quality of ascertaining both immediate and underlying causes of death and classifying these using ICD-10 coding, which greatly affects the reliability of mortality statistics and the overall burden of diseases in the Philippines. Some physicians and health workers have not had adequate training for ascertaining causes of death or using verbal autopsy, and if a deceased person has spent less than 12 hours in a hospital or 24 hours in a health facility, they will not certify the cause of death but instead provide a medical abstract.

Another factor inhibiting the quality of vital statistics is that the majority of deaths in the Philippines take place outside of a health facility, presenting a challenge for registering those deaths. Although a death certificate is a requirement for burial, only two thirds of deaths are registered. According to Islamic practices, a deceased Muslim should be buried within 24 hours. It is, therefore, crucial that there be a more active approach for identifying the occurrence of deaths outside of health facilities and a greater awareness raising of the importance of notifying authorities of deaths. In addition, complementary systems such as WOMB and MNDRS perform an important role to address this challenge.

A Quick Look at CRVS Initiatives in the Recent Past In 2000, the National Statistics Office had engaged into a Public-Private partnership (PPP) to computerize the civil registration system. Several systems were then developed such as the Barangay Civil Registration System (BCRS) that facilitates civil registration by providing Barangay officials with an information system to record and manage demographic and biographic information about residents by household; and the Philippines Civil Registry Information System (PhilCRIS) that was developed for local civil registrars to encode

one of the first Asian countries to complete a “ Ascomprehensive assessment, the Philippines has presented its experiences at several UNESCAP meetings in between 2009 and 2011.

�

-Consultant Report, 2012

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civil registration certificates, store civil registration records electronically as the local civil registry database, produce vital statistics and generate data files that can be transmitted to the Philippine Statistics Authority (PSA) for archiving and statistical purposes. The first national rapid assessment was then undertaken in the year 2009 and in 2012, the comprehensive assessment of the Philippine Civil Registration and Vital Statistics (CRVS) system done by the National Statistics Office and Department of Health with the support of the World Health Organization has been completed and has driven the PSA and the DOH to develop the CRVS strategic plan for 2015–2019.

2009 • First national rapid assessment • PhilCRIS introduced

2011 • Comprehensive CRVS assessment completed • Technical Working Group established

2012 • Strategic Plan initiated • Comprehensive national and subnational completeness study completed

2013 • Finalised national CRVS strategic plan

2014 • Draft – costed investment plan

Now on its last mile in attaining a complete, timely, and reliable CRVS system, the Philippine CRVS though constrained by challenges, has undertaken systematic analysis of completeness and coverage that can address known areas for improvement, including under registration by geography and under registration in marginalised, indigenous and Muslim populations.

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Civil Registration and Vital Statistics Investment Plan 2015–2019

1.4

Summary Investment Plan and Budget Implementation Period

Goal 1 – Improve coverage and quality of registration

2015

2016

2017

2018

$3 705 315

$6 146 980

$6 762 949

$3 053 054

2019

Total

$1 413 672 $21 081 970

OBJECTIVES: BY 2019 • Increase death registration from 66% to 80% and birth registration from 93.5% to 99.0% • Increase medical certification of deaths from 35% to 70% and decrease the proportion of ill-defined causes of death from 15% to 7% Goal 2 – Increase awareness and utilisation of Vital statistics

$121 815

$1 284 547

$454 201

$435 098

$108 500

$2 404 160

OBJECTIVES: BY 2019 • Quality VS is readily available and accessible for use on policy development, health planning, and program management across all levels Goal 3 – Enhanced support for strengthening CRVS

$287 673

$765 000

$546 204

$509 851

$327 630

$2 436 358

OBJECTIVES: BY 2019 • Governance and policy support mechanisms for civil registration are established….

• CRVS Development Plans are crafted and implemented Total by year 15% Adjustment for risk and uncertainty Adjusted Total

$4 114 803

$8 196 527

$7 763 354

$3 998 003

$617 220

$1 229 479

$1 164 503

$599 700

$4 732 023

$9 426 006

$8 927 857

$4 597 703

$1 849 802 $25 922 489 $277 470

$3 888 373

$2 127 272 $29 810 861

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Reaching the Hard To Reach to Get Every One In the Picture

PART 2: Detailed Investment Plan 2.1

Objectives for CRVS Strengthening

National CSRV Strategic Plan, 2014–2019 —

CRVS VISION “The Civil Registration and Vital Statistics System, with committed stakeholders, will be more responsive to the needs and rights of the Filipino people and produces quality data through timely, accessible and peoplecentric approaches complying with globally acceptable standards.”

CRVS MISSION “The Civil Registration and Vital Statistics System, as a network, is committed to collect, compile, process and generate quality data on vital records through an effective and efficient civil registration system to meet the needs of individuals, the nation, and global community.”

Philippines, National CRVS Strategic Plan, 2013

The overall objectives for CRVS are to improve

Coverage and quality of civil registration, Awareness and use of reliable vital statistics; and Governance to strengthen CRVS within the Philippines.

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Civil Registration and Vital Statistics Investment Plan 2015–2019

GOALS

Goal 1 – Improve coverage and quality of registration

OBJECTIVES

Priority

Improve death and birth registration

Improve proportion and quality of death certification

By 2019, quality VS is readily

available and accessible for use on policy development, health

development, health planning, and program management across all levels

Increase awareness of vital statistics Improve timeliness of vital statistics to shorten the release of vital statistics from 3 to 1.5years Increase dissemination and utilisation of vital statistics

By 2019, governance and policy

support/mechanisms for civil registration are established for both local and national level.

By 2019, the CRVS Development Plans are crafted and implemented

Improve CRVS governance structure and mechanism

Goal 2 – Increase awareness and utilisation of Vital Statistics

Goal 3 – Enhanced support for strengthening CRVS

Increase death registration from 66% to 80% and birth registration from 93.5% to 99.0% by 2019 Increase medical certification of deaths from 35% to 70% and decrease the proportion of illdefined cause of death from 15% to 7% by 2019

Craft a capacity development plan

One of the critical usage and application of the CRVS data is in planning and implementing the Health Agenda of a country. CRVS data in the health sector is used to: define patterns, trends and impact inclusive of the causes of mortality; understand emerging health issues and challenges; define appropriate and relevant health-sector reforms, poverty reduction and development efforts; define baseline levels and monitor and track progress towards both national and Millennium Development Goals (MDGs) and assess effectiveness of health programs.

Philippines, National CRVS Strategic Plan, 2013

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2.2

Program Logic for CRVS

OBJECTIVE

Improve death and birth registration

Implementing alternative schemes for registration

OBJECTIVE

Promoting death and birth registration

Increase medical certification of deaths from 35% to 70% and decrease the proportion of ill-defined cause of death from 15% to 7% by 2019

Improve proportion and quality of death certification

STRATEGIC ACTIONS

12

Improving death and birth registration processes

PRIORITY

STRATEGIC ACTIONS

Increase death registration from 66% to 80% and birth registration from 93.5% to 99.0% by 2019

PRIORITY

Goal 1: IMPROVED COVERAGE AND QUALITY OF REGISTRATION

Awareness- and capacitybuilding for physician on death certification

Improving cause-of-death certification in hospitals

Enhancement and integration of systems

Improving cause-of-death certification outside hospitals

Civil Registration and Vital Statistics Investment Plan 2015–2019

OBJECTIVE

Increase awareness of vital statistics

STRATEGIC ACTIONS

By 2019, quality VS is readily available and accessible for use on policy development, health development, health planning, and program management across all levels

PRIORITY

Goal 2: INCREASED AWARENESS AND UTILIZATION OF VS

Review vital Statistics process and data quality

Promote culture of evidence-based program planning and policy development

Improve timeliness of vital statistics to shorten the release of vital statistics from 3 to 1.5years

Maximize CRVS ICT infrastructure

Enhance human resource capacity

Increase dissemination and utilisation of vital statistics

Strengthen coordination Facilitate and colcompilation, laborations validation between and autoand among mation of CRVS stake- CRVS data holders

Ensure data accessibility, utilization and dissemination

Establish VS knowledge Hub to ensure that knowledge, evidence and expertise on VS are accessible and available

OBJECTIVE

Improve CRVS governance structure and mechanism

STRATEGIC ACTIONS

By 2019, governance and policy support/ mechanisms for civil registration are established for both local and national level.

PRIORITY

Goal 3: ENHANCED SUPPORT FOR STRENGTHENING CRVS

Advocacy for legislative/policy support including resource allocation

Develop/improve implementing mechanisms/structures

Establish Task Force dedicated as the continuous monitoring of the system

13

OBJECTIVE

Craft a capacity development plan

STRATEGIC ACTIONS

By 2019, the CRVS Development Plans are crafted and implemented

PRIORITY

Reaching the Hard To Reach to Get Every One In the Picture

2.3

Create CRVS capacity development plan: 1.

2.

3.

4.

Human Resource Infrastructure Governance Communication

Program Management

As it has been identified, the critical initial steps in achieving the CRVS goals are the assessment of the CRVS (particularly the birth and death registration process), development of a comprehensive CRVS plan and the propensity to implement and operationalize the plan. Creation of a properly designed program management structure is thereby essential to ensure efficient coordination and implementation of project activities in an environment that fosters interaction among the stakeholders. Moreover, the structure will help chart the direction to effectively assess, evaluate, develop and operationalize the CRVS system.

The management structure of CRVS reflects its multi-agency and multi-disciplinary makeup. Government sectors involved in the direct registration as well as non-government stakeholders and the academe are members of the management structure part while the Philippine Statistics Authority is the lead.

CRVS Steering Committee

CRVS Program Management Team

CRVS Technical Working Group

Program Implementation Structure

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Civil Registration and Vital Statistics Investment Plan 2015–2019

CRVS Steering Committee The National Steering Committee will be responsible for overseeing and coordinating the implementation of the CRVS Investment Plan. It shall also be in charge of establishing policies, direction and strategies and in resolving issues, concerns or problems and make necessary recommendations. An advocate agent to raise awareness and solicit participation /contribution to and use of CRVS while at the same time ensuring the full support and commitment of the member agencies to the agreed duties and responsibilities to achieve deliverables The committee will be spearheaded by the Civil Registrar General and co-chaired by the Department of Health. Members will include representatives from the Department of the Interior and Local Government, Department of Social Welfare and Development, academe and association of the local civil registrars and the municipal health officers.

CRVS Program Management Team The Management Team will oversee the operational aspects of the CRVS improvement program particularly the task designation of the Technical Working Groups on particular domains and priority actions. Also, they will be tasked to design task, risk, and change management plans and coordinate with member agencies, field units and stakeholders in the implementation and monitoring of the approved program plan including data collection, monitoring of program performance, evaluation and validation of health information and data registry and sharing.

The team will be comprised of representatives from various committees such as small working groups for fertility, mortality and population as well as partners from international organizations and the academe.

Technical Working Groups (TWGs) The technical working group will provide technical inputs; undertake activities such as planning, monitoring, assessment, among others. They will also be expected to review and recommend policy issues and concerns to the Steering committee.

Spearheaded by the official designate from the Philippine Statistical Authority (PSA) and Department of Health (DOH), the group may be expanded to include other stakeholders depending on the focus or subject matter being deliberated or at hand.

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Reaching the Hard To Reach to Get Every One In the Picture

2.4

Investment Framework

Based on the strategized priorities, the following activities have been structured to ensure logical implementation of the project.

16

Priority

Method

Outcome

Improve death and birth registration

1. Assess processes on death and -- Faster processing of birth and birth registration death registration 2. Improve death and birth registration -- Increase number of birth and guidelines death registration 3. Craft an information and education campaign program 4. Create pool of CRVS advocates 5. Advocate birth and death registration especially to low registration areas 6. Create alternative schemes for registration-related fees 7. Install civil registration desks in strategic areas 8. Integrate existing information systems for CR 9. Scale up implementation of mobile notification

Improve proportion and quality of death certification

1. Develop hospital guidelines on re-- Accurate and reliable coding cording, reporting and classification and decreased proportion of of causes of death ill-defined of causes-of-death 2. Regular quality check of recording, reporting and classification of causes of death in hospitals 3. Develop programs for eLearning resources and handy guides 4. Inclusion of death certification and ICD-10 in medical and residency programs 5. Train coders, physicians and medical records officers on ICD-10 6. Capacitate physicians on death certification and verbal autopsy

Increase awareness of VS

1. Review processes and data quality of Vital Statistics 2. Develop data quality enhancement plan 3. Scale-up advocacy campaign (esp. to LCROs, Local Officials etc.) on importance of VS 4. Require references and citations for guidelines, protocols, administrative issuances and other pertinent documents 5. Promote feedback mechanism among data producer and data user

-- Utilization of VS by LCEs in implementing programs/ projects especially relating to health, social, education services etc.

Civil Registration and Vital Statistics Investment Plan 2015–2019

Priority

Method

Outcome

Improve timeliness of VS to shorten the release of vital statistics from 3 to 1.5 years

1. Review business processes to de-- Improved frequency of VS termine areas in need of ICT interrelease to every 1.5years vention 2. Workload analysis of CRVS staff 3. Computerize LCROs 4. Standardize data structure, terminologies and messaging 5. Standardize CRVS inter-operability 6. Enhance validation and control procedures 7. Enforce compliance to CRVS protocols 8. Improve coordination and collaboration with stakeholders and academes

Increase dissemination and utilization of Vital Statistics

1. Creation of social media accounts -- Utilization of VS in program/ for VS project implementation of 2. Creation of marketing strategy for VS Stakeholders and LCEs dissemination 3. Develop web portal 4. Creation of helpdesk 5. Creation of info book 6. Conduct regular dissemination fora

Improve CRVS governance structure and mechanism

1. Develop a CRVS monitoring and -- CRVS Omnibus bills evaluation plan and performance -- Better implementation of standards CRVS guidelines 2. Develop an advocacy strategy and campaign plan 3. Develop quad-media advocacy plan 4. Develop lobby groups for senate/ congress/local legislative councils 5. Lobby for possible creation of Provincial Civil Registration Council 6. Establish national CRVS committee 7. Develop incentive system for compliance 8. Hold fora, conferences among CRVS stakeholders 9. Facilitate regular meeting between LCRs and health facility staff

Create capacity development plan

1. Assess training needs of CRVS staff and develop training program 2. Develop activities for human resource, infrastructure, governance, and communication capacity development 3. Establish pool of trainers for CRVS-related courses

-- Capacitated CRVS Staff -- Improved CRVS system

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Reaching the Hard To Reach to Get Every One In the Picture

CRVS Leadership Forums commence At the national level, the stakeholders of CRVS have a very healthy working relationship. This may not be true for most of the subnational and local levels. The civil registration team and the local health units for the most part, do not work as a team.

To address this issue, the Department of Health, together with the Philippine Statistics Authority (PSA) and the World Health Organization (WHO) Philippine Country Office organized a Civil Registration and Vital Statistics System (CRVS) Fora for three major geographical clusters - Luzon, Visayas and Mindanao. This is intended for stakeholders in the subnational and local levels to raise awareness and build appreciation for the critical role of vital statistics and overall CRVS strengthening towards better health in the local, national and global arena.

The objectives of the forum were as follows:

1. Increase appreciation for the value of the CRVS among local stakeholders 2. Recognize and learn from local best practices in CRVS 3. Build partnership and collaboration among individuals and agencies involved in CRVS at the local level 4. Identify ways to increase awareness and utilization of vital statistics among local stakeholders

2.5

Analysing the Investment Strategy

Figures 1–3 illustrate a breakdown of the USD $25 922 488 investments required over the 5-year period from 2015 through 2019. The most significant costs are associated with the first goal to maximize coverage of civil registration to the hard-to-reach populations (Figure 1). Annual breakdown of necessary costs highlight ramping up in 2016–2017 before more sustainable training is implemented from the necessary technical assistance and support (Figure 2). The most significant costs are associated with ICT investments to support scaling up and sustaining the PhilCRIS and other ICT-enhanced solutions across the Philippines to ensure the greatest coverage and access to data and vital statistics (Figure 3).

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Civil Registration and Vital Statistics Investment Plan 2015–2019

Figure 1. Summary of 5-year costs by objective $2 436 358, 10%

$2 404 161, 9%

$21 081 970, 81%

Improve coverage and quality of registration Increase awareness and utilization of vital statistics Enhance governance and support for strengthening CRVS

Figure 2. Annual costs by objective $ 8 000 000 7 000 000 6 000 000 5 000 000 4 000 000 3 000 000 2 000 000 1 000 000 $2015

2016

2017

2018

2019

Improve coverage and quality of registration Increase awareness and utilization of vital statistics Enhance governance and support for strengthening CRVS

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Reaching the Hard To Reach to Get Every One In the Picture

Figure 3. Summary by type of 5-year costs $1 090 530, 7% $2 369 660, 9%

$3 584 430, 14% $15 029 318, 58%

$3 848 550, 15%

Infrastructure, ICT, Equipment Training Technical Assistance Meeting Support Communications

There are a number of priority actions costed in the development of this investment plan to be addressed in the immediate and short term, as outlined below: Immediate Priorities QQ

QQ QQ

Improve birth registration among marginalized populations / death registration throughout Improve proportion/quality of death registration (underlying cause of death) Connect relevant MNCH monitoring systems with CRVS systems to address losses to follow up and accuracy (birth/death certifications)

Short-term Priorities QQ QQ

QQ QQ

Increase awareness and utilization of vital statistics Improve timeliness of VS to shorten release of vital statistics from 3 to 1.5 years— by decreasing the time lag Analysis of business processes for improvements Improve CRVS governance structure and mechanisms

Development partners can assist the Philippines with targeted technical assistance by engaging with government in sustainable “quick win” opportunities while more comprehensive plans and actions emerge. The piloted Barangay CRVS system has demonstrated success in reaching the hard to reach and is ready to be scaled across

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Civil Registration and Vital Statistics Investment Plan 2015–2019

43 000 Barangays with convergence with health sector notification and registration of events. Some additional technical assistance opportunities identified include the following: QQ

QQ QQ QQ

Specialized training, capacity building (Cause of Death, ICD-10 coding, verbal autopsy) Learning about best practices / alternatives for registration from other countries Expert review of SOPs, regulations, policies Optimizing ICT investments—interoperability, scaling, architecture, infrastructure

Partners can benefit from reuse of good practices in Philippines across the region. The Philippines has much yet to achieve to reach the last mile in CRVS strengthening and this investment plan outlines the roadmap to reach the hard to reach.

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Reaching the Hard To Reach to Get Every One In the Picture

ANNEXES ANNEX 1: Draft Special Order CRVS Management Structure

ANNEX 1. DPO of CRVS Management Structure

SPECIAL ORDER No.: 2014 - _________ SUBJECT: Creation of a Management Structure for the Philippine Civil Registration and Vital Statistics (CRVS) system The Civil Registration and Vital Statistics generates births, deaths and causes of death information. It highlights the importance of vital statistics in monitoring the leading causes of death and the overall health status, developing programs to improve public health, and evaluating the effectiveness of interventions. The CRVS envisions addressing the rights of every Filipino to be recognized and registered in all their vital events in life while at the same time underscoring the importance of committed multi-sectoral stakeholders.

CRVS is tasked to ensure continuous, timely, accurate, consistent and complete registration and reporting of all human beings’ life vital events highlighting the facts of birth and the causes of death.

Specifically, the following are the goals of the system: • • •

Improved coverage and quality of registration Increased awareness and utilization of Vital Statistics Enhanced support for strengthening CRVS

It has been identified that the critical initial steps to achieving the above-stated goals are assessment of the CRVS particularly the birth and death registration process, development of a comprehensive CRVS plan and the wherewithal to implement and operationalize the plan.

To undertake the aforementioned goals, the following committees are hereby created to provide direction, assess, evaluate, develop and operationalize the CRVS system.

I. COMPOSITION AND FUNCTIONS OF THE COMMITTEES A. CRVS Steering Committee. This is made up of the principals of the aforementioned agencies designated to provide direction for the CRVS and shall meet twice a year.

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Chairperson Dr. Lisa Grace S. Bersales

National Statistician, Philippine Statistical Authority

Co-Chairperson Dr. Enrique A. Tayag

Assistant Secretary, Department of Health

Civil Registration and Vital Statistics Investment Plan 2015–2019

Members 1. Dir. Manuel Q. Gotis 2. Usec. Alicia Bala 3. Ms. Lucena Flores 4. Dr. Joy Natividad

Department of Interior and Local Government Department of Social Welfare and Development President, Association of Local Civil Registrars University of the Philippines Population Institute

B. CRVS Project Management Team. This committee is made up of officially designated representatives from DOH, PSA and primary stakeholders tasked to oversee CRVS activities Chairperson Dep. NS. Paula MoninaCollado

Philippine Statistical Authority

Co-chairperson Dir. Crispinita A. Valdez

Department of Health

Members (representatives from): 1. National Economic and Development Authority 2. Philippine Statistical Authority 3. Philippine Statistical Authority 4. World Health Organization 6. University of the Philippines Population Institute 7. Secretary, National Commission on Muslim Filipinos 8. Chairperson, National Commission on Indigenous People 9. President, Philippine Statistics Association, Inc.

C. Technical Working Groups (TWGs). These committees will provide technical support and operationalize the CRVS system.

Chairperson Ms. Aurora Reolalas

Philippine Statistical Authority

Co-chairperson Ms. Charity Tan

Department of Health

1. Philippine Statistical Authority 2. Department of Health 3. Plan Philippines 4. Association of Local Civil Registrars 5. Philippine Statistics Association, Inc.

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Reaching the Hard To Reach to Get Every One In the Picture

II. DUTIES AND RESPONSIBILITIES OF THE COMMITTEES A. CRVS Steering Committee 1. Oversee overall conduct of CRVS improvement program to ensure that the strategic objectives are met 2. Establish policies, direction and strategies to be implemented 3. Resolve issues, concerns and/or problems, make recommendations and decisions that may affect the project implementation in terms of strategic direction 4. Ensure full support and commitment of the member agencies to the agreed duties and responsibilities to achieve deliverables 5. Approve the recruitment of new members to the network 6. Raising awareness of and encouraging/soliciting participation in/contribution to and use of CRVS 7. Meet twice a year and whenever necessary B. Program Management Committee 1. Oversee the operational aspects of the CRVS improvement program particularly the task designation of the Technical Working Groups on particular domains of the project 2. Design project plan and coordinate with member agencies, field units and stakeholders in the implementation and monitoring of the approved project plan including data collection, monitoring of project performance, evaluation and validation of health information and data registry and sharing 3. Establish and sustain collaborative relationships with members and expand membership of the network to include other stakeholders 4. Facilitate the mobilization of resources to support the implementation of the program 5. Meet once a month and whenever necessary C. Technical Working Group 1. Provide technical inputs in the development of the CRVS 2. Review and recommend policy issues and concerns to the Steering Committee 3. Evaluate and accept deliverables of the project and forwards the same to the Project Management Committee 4. Undertake necessary activities such as planning, monitoring, data collection, among others 5. Meet on a regular basis and whenever necessary This order shall take effect immediately upon approval. Expenses incurred during the conduct of meetings and other activities shall be charged against the funds of the Philippine Statistics Authority and the Department of Health.

LISA GRACE S. BERSALES, Ph.D. National Statistician and Civil Registrar General

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