Table 1. Article characteristics, listed by country of implementation.
| Article | Country (Region) | National birth registration rate | National death registration rate | Policy category | Policy description | Geographic scale | Time period | Vital events | Comparator used | Outcomes |
|---|---|---|---|---|---|---|---|---|---|---|
| Skiri, 2012 [74] | Albania (Europe) | 98.6 | 8 | Supply | Computerisation of the civil status registers in civil status offices. This consisted of software development, setting up the hardware, and training of local staff. | National | 2002–2004 | Births and deaths | N/A | Qualitative |
| UNICEF, 2010 [72] | Bangladesh (Southeast Asia) | 20.2 | Not reported | Supply, Demand, Incentive | Bangladesh implemented multilevel interventions to improve birth registration. In 2004, they legally required that individuals show a birth certificate for proof of age when accessing social services like school, marriage registration, and inheritance. They also decentralised the civil registration system by integrating it into Union Parishads, schools, and the immunisation programme. Finally, they raised awareness through campaigns and announcing a national registration day. | National | 1996 on | Births | Baseline year | Quantitative and qualitative |
| World Bank, 2015 [71] | Botswana (Africa) | 72.2 | Not reported | Supply, Demand, Incentive | Botswana introduced a multipronged strategy to improve death registration encompassing (1) cessation of all late registration fees for destitute persons, orphans, and vulnerable children, (2) relaxation of legal documentation for remote area dwellers, (3) decentralisation to district and subdistrict levels and introduction of on-site birth and death registration, (4) ad hoc campaign in Ghanzi, Maun, and Lethakeng districts, (5) information, education, and communication through electronic media, radio, and television, (6) birth certificate required for school enrollment and death certificate required for burial, and (7) national ID number provided at birth. | National | 2003 on | Births and deaths | N/A | Qualitative |
| Hunter, 2011 [62] | Brazil (Americas) | 95.9 | 93 | Incentive | In 2001, Brazil established the social welfare programme Bolsa Familia. It provides cash transfers to poor families conditional on school enrollment of their children. In 2003, it expanded to require basic healthcare practices as well. The programme requires a birth certificate of the child or children in order for the family to enroll. | National | 2001 on | Births | N/A | Qualitative |
| UNICEF, 2010 [72] | Brazil (Americas) | 95.9 | 93 | Supply, Demand, Incentive | The Brazilian government implemented various policy interventions to improve birth registration. After the legal reforms in 1997 to make birth certification free, changes to the civil registration system occurred from 2000 to 2011. In 1999, the Ministry of Health conducted an information campaign for birth registration. In 2000, the government created monetary incentives for civil registrars and health facilities to register births. This initially mandated states to create the monetary compensation themselves at state and local levels so that birth certificates would be issued without a fee. Later, the Ministry of Health issued the monetary incentives to hospitals directly for every birth registered. In addition, birth registration systems were integrated into maternity wards using outreach units. This project was accompanied by training of maternity ward staff. From 2004 to 2008, an online registration system was integrated with the maternity ward processes. | National | 1997–2008 | Births | Baseline year | Quantitative and qualitative |
| UNICEF, 2013 [70] | Brazil (Americas) | 95.9 | 93 | Supply, Incentive | Brazil introduced a multipronged strategy to improve birth registration encompassing (1) expansion of the network of civil registration in states with low registration rates through outreach units of notaries within maternity wards, (2) informatic linkage of civil registrars and maternity wards in one state, (3) USD 1.72 (2000 exchange rate) monetary incentive provided to hospitals for each child registered at maternity wards and provided with a birth certificate prior to discharge. | National | 1998–2008 | Births | Baseline year | Quantitative and qualitative |
| Woodward, 2003 [64] | Canada (Americas) | 100 | 100 | Penalty | In 1996, the Ontario government enacted a law that allowed municipalities to charge administrative fees for birth registration. | Ontario | 1996 | Births | Baseline year | Quantitative |
| Lu, 2002 [65] | China, Taiwan Province of China* (Western Pacific) | Not reported | 98 | Supply | Because most deaths occur at home in Taiwan, many doctors without a formal medical degree began to conduct home-based death certification as a full-time job and often certified over 100 deaths/year. | Taiwan | 1994 | Deaths | N/A | Qualitative |
| Silva, 2016 [46] | Ethiopia (Africa) | 6.6 | 65 | Supply | Use of community health workers for birth reporting and death reporting of children under 5 years of age. In Ethiopia, health extension workers were used who also provide preventive/curative healthcare and promotion. They were incentivised to also report vital events with a monthly transportation allowance (USD 12) and given backpacks and initial training. | Jimma, West Hararghe | January 2012–March 2013 | Births and deaths | N/A | Qualitative |
| Prata, 2012 [57] | Ethiopia (Africa) | 6.6 | Not reported | Supply, Demand | Community health workers, including community-based reproductive agents, birth attendants, and priests, were made responsible to report all births and deaths found in the community to the local health post. These workers were trained on how to educate and motivate families to report births and deaths that occur in the community. The registrations were then processed at the health post and recorded in government logbooks. These workers would locate new births or death through both household and clinic visits. | Tigray region | 2010–2011 | Births and deaths | N/A | Qualitative |
| UNICEF, 2010 [72] | The Gambia (Africa) | Not reported | Not reported | Supply, Demand | The Gambian government integrated birth registration processes into maternal and child health clinics starting in 2004, while decentralisation of registration duties began as early as 1996. All public health officers from district health facilities were required to register births and issue birth certificates. Many health facilities integrated birth registration with their immunisation services. Additionally, birth registration awareness campaigns have been used in conjunction with health promotion. In 2003, a campaign promoted and provided mobile birth registration along with the provision of treated mosquito nets. | National | 1996–2006 | Births | Baseline year | Quantitative |
| Fagernas, 2013 [54] | Ghana (Africa) | 70.5 | Not reported | Supply, Demand | The Ghanaian government developed and implemented a registration campaign from 2004 to 2005 to improve birth registration. Most of the campaign consisted of public education. Children were registered during community events using community registration volunteers. Birth registration was simultaneously strengthened in the health sector by incorporating it into child health promotion weeks and training healthcare workers. The campaign was accompanied by other changes, such as extending the deadline to register a birth before incurring a late registration fee. This time period was legally extended from 21 days to 1 year just before the campaign. | National | 2004–2005 | Births | Baseline year | Quantitative and qualitative |
| Ohemeng-Dapaah, 2010 [63] | Ghana (Africa) | 70.5 | Not reported | Supply, Demand | Civil registration was integrated with health facilities and electronic medical records systems. Community health workers also conducted active surveillance of vital events in the community and referred individuals to the health facility for registration. During this implementation, the health sector infrastructure and work force was scaled up to increase access to health and social services: additional health facilities were opened to decrease distance and the ratio of health staff to local population was greatly improved. | Bonsasso village | 2007–2009 | Births and deaths | N/A | Qualitative |
| Singh, 2012 [58] | India (Southeast Asia) | 71.9 | Not reported | Supply | In 2005, the responsibility of civil registration shifted from police stations to primary health centres (PHCs). At the PHCs, medical officers became registrars and pharmacists became sub-registrars. Nurse midwives and community health workers supported the registration process as well. | Haryana | 2005–2009 | Births and deaths | Baseline year | Quantitative and qualitative |
| Mony, 2011 [61] | India (Southeast Asia) | 71.9 | 8 | Supply, Demand | Civil registration was strengthened through multiple interventions: nongovernmental partnerships, sensitisation of professionals involved in registration, active surveillance of vital events, awareness campaigns, and public education. Lay informers who participated in active surveillance were paid a small fee if they reported a vital event within 3 days of the event. | Five subdistricts in southern India | September 2007–August 2008 | Births and deaths | Baseline year | Quantitative and qualitative |
| UNICEF, 2010 [72] | India (Southeast Asia) | 71.9 | 8 | Supply | In Delhi, the health department supported the conputerisation of the birth registration process since 2003. Citizen Service Bureaus (CSB) were established in each zone of Delhi, which used the Online Institutional Registration (OLIR) system. Using this system, staff at hospitals or nursing homes register births and deaths online at the institution. The CSBs serve as a kiosk for individuals to access various identity-related services such as requesting a birth certificate. In 2006, Delhi also launched the project to link immunisation services with the birth registration process. Using maternity wards in Delhi, the registration and immunisation information systems were integrated. This way, healthcare workers at maternity wards provided both services together. This grew to include community-based services by midwives—which increased the coverage of the birth registration system. | Delhi | 2003 on | Births | N/A | Qualitative |
| WHO, 2013 [12] | India (Southeast Asia) | 71.9 | 8 | Supply, Demand | The intervention consisted of three main strategies: (1) awareness campaigns among the public to create demand for registration, (2) capacity building for officials responsible for registration, in turn improving access, and (3) stakeholder engagement to build support and hold the government accountable. | Four states of India | 2000 | Births | N/A | Qualitative |
| Modi, 2016 [43] | India (Southeast Asia) | 71.9 | 69 | Supply | Mobile-phone Technology for Community Health Operation (ImTeCHO) is an application that was implemented to help Accredited Social Health Activists (ASHAs) complete registration processes. This intervention streamlined registration processes for improved access to services. | Random sample of five villages in Gujarat | 2013 on | Births and deaths | N/A | Qualitative |
| Duff, 2016 [45] | Indonesia (Southeast Asia) | 68.5 | Not reported | Supply | 2013 legal amendment to eliminate fees for all civil registration documents. | National | 2013 | Births | N/A | Qualitative |
| Dababneh, 2015 [47] | Jordan (Eastern Mediterranean) | 99.1 | Not reported | Supply | The Ministry of Health (MOH) and partners implemented multifaceted improvements to the death notification system put forth by a five-point plan: establishing a cause-of-death coding unit, modifying the death notification form, training on the ICD and Related Health Problems, appointing focal points for supervision and quality control, and tabulation and reporting. | National | 2003 on | Deaths | Death notification forms received by MOH as a percentage of forms reported to the Civil Status and Passports Department | Quantitative |
| Toivanen, 2011 [60] | Liberia (Africa) | 24.6 | 53 | Supply | The Ministry of Health and Social Welfare (MOHSW) implemented mobile birth registration to computerise the registration process. A birth registration server is housed at MOHSW and receives data from text messages from mobile phones. Registrars (users of the software) were trained. | Bomi county | 2007–2010 | Births | N/A | Qualitative |
| Gadabu, 2014 [73] | Malawi (Africa) | 67.2 | 78 | Supply | An electronic register was developed and implemented for a rural village in Malawi. A low-power touch screen computer was provided to the village headmen. These headmen were trained on its use for 5 days. | Chalasa village, Traditional Authority Mtema, Lilongwe District | March 2013 | Births and deaths | N/A | Qualitative |
| Silva, 2016 [46] | Malawi (Africa) | 67.2 | Not reported | Supply | Use of community health workers for birth reporting and death reporting of children under 5 years of age. In Malawi, health surveillance assistants were used who also provide preventive/curative healthcare and promotion. These workers were incentivised with quarterly airtime for phone calls, data review meetings, and given a participation allowance of USD 11 per data review meeting (every 3 months). These workers were given a village health register, cell phone, and backpack. | Balaka, Salima | January 2010–December 2013 | Births and deaths | N/A | Qualitative |
| Singogo, 2013 [51] | Malawi (Africa) | 67.2 | Not reported | Supply | The Malawian government introduced paper-based village registers in 2007 in an effort to decentralise the civil registration system. All districts were using village registers by 2011. The village headpersons (VHs) are responsible for keeping and updating the registers with birth and death events that occur in their villages. | Traditional Authority Mwambo, Zomba District | 2007–2011 | Births and deaths | Maternity registers (for birth events only) | Quantitative and qualitative |
| Silva, 2016 [46] | Mali (Africa) | 84.3 | 91 | Supply | Use of community health workers for birth reporting and death reporting of children under 5 years of age. In Mali, lay volunteer health workers were used who also provide health promotion. These workers were incentivised with USD 10 per month and USD 2 for airtime per month. They received registers and food/transport to attend quarterly review meetings. | Barroueli, Niono | July 2012–September 2013 | Births and deaths | N/A | Qualitative |
| Lhamsuren, 2012 [56] | Mongolia (Western Pacific) | 99.3 | 92 | Demand | The Mongolian government developed and implemented the strategy, Reaching Every District (RED). RED is package for both health and social services for the urban poor. Specifically, a nurse in each local area is tasked to walk house to house and request new clients to register any vital events, and direct them to the health facility or registration office for registration. Under the RED strategy, local areas were identified through an analysis of social vulnerability and were targeted with a package of services. | Socially vulnerable areas | 2009–2010 | Births and deaths | N/A | Qualitative |
| Prybylski, 1992 [67] | Papua New Guinea (Western Pacific) | Not reported | 98 | Supply | As a part of a multipurpose birth registration scheme, a new computerised health information system was established and a new birth certificate/registration form was introduced to clinics that provided antenatal, postpartum, and well-child care. The birth certificate was intended to promote supervised delivery because it was offered to the mother for free if she delivered in a health facility or under supervision of a midwife. Otherwise, a small fee has to be paid to obtain the birth certificate. | Southern Highlands Province | 1988 | Births | N/A | Qualitative |
| Curioso, 2013 [55] | Peru (Americas) | 96.7 | Not reported | Supply | Peru implemented a system that allowed for real-time online registration of birth events while the mother was in the delivery room. | National | 2012–2013 | Births | N/A | Qualitative |
| WHO, 2013 [12] | Peru (Americas) | 96.7 | 69 | Supply, Demand | The Peruvian government, led by the Ministry of Women and Social Development (MIMDES) and the Alliance for Citizens’ Rights, developed and implemented an advocacy campaign to increase birth registration coverage. The campaign was designed from a community-based strategy and changed the legal framework that ‘discriminated against unmarried women and their children’. For example, the new bill made it possible for single women to declare the name of the father (a required piece of information) during registration without the father present. The advocacy campaign delivered the message that ‘every child has the right to two last names’. The campaign consisted of mass media activities over the course of 4 weeks. | National | 2004–2006 | Births | N/A | Qualitative |
| IDB, 2009 [68] | Peru (Americas) | 96.7 | 69 | Supply, Demand | Peru adopted the National Civil Registry and Identification Organization (RENIEC) in 1993 and has undergone changes in the late 1990s and early 2000s. This organisation is autonomous from the Peruvian government, which allows it to evolve in response to its own technical needs. RENIEC implements rigorous training programmes to professionalise staff working on civil registration and identification. It spawned its own training institute, the Center for Higher Education in Registration (CAER). RENIEC has worked to improve the infrastructure surrounding registration, such as registration offices, auxiliary registry offices in public hospitals, call centres, home services for handicapped people, and free identity document campaigns for underserved populations. RENIEC conducts mobile registration using internet-based services in rural parts of Peru. | National | 1993 on | Births and deaths | N/A | Qualitative |
| Garenne, 2016 [44] | Republic of South Africa (Africa) | 85 | 91 | Supply, Demand, Incentive | Combination of financial incentives, advocacy through campaigns and wide-scale information sharing, and reorganisation of CRVS to strongly involve health personnel. One major financial incentive was that a birth certificate is required for child support grants, which provides mothers with substantial financial support. | Agincourt (rural area) | 1992–2014 | Births and deaths | Baseline year | Quantitative and qualitative |
| Joubert, 2013 [52] | Republic of South Africa (Africa) | 85 | Not reported | Supply | Multifaceted initiatives to scale up CRVS took place after the passing of the Births and Deaths Registration Act of 1992 and the Interim Constitution of South Africa in 1993. These initiatives include a new death notification form, task teams in each province to assist in the adoption of the new form, new guidelines for birth and death registration, birth registration forms made available for mothers at their delivery, and training health workers to support mothers in how to submit the birth registration forms. | National | 1992 on | Deaths | Baseline year | Quantitative |
| WHO, 2013 [12] | Republic of South Africa (Africa) | 85 | 91 | Supply, Demand, Incentive | After Apartheid, the South African government used a mixture of interventions to improve birth and death registration. Using leadership, political commitment, advocacy campaigns, and governmental partnerships, they were able to make birth registration universal. Government agencies raised awareness about registration and conducted outreach among communities, including local village chiefs. Staff involved in registration underwent training. To increase access among hard-to-reach populations, the registration office used mobile facilities. Some government services were made to require a birth certificate, such as child support grants or school enrollment. | National | 1997–2004 | Births and deaths | N/A | Qualitative |
| Upham, 2012 [59] | Republic of South Africa (Africa) | 85 | 91 | Supply, Demand, Incentive | Department of Health established a National Health Information System. Department of Home Affairs introduced new registration forms, raised awareness, and performed outreach to communities and village chiefs. Birth certificates were required for school enrollment. Community interventions included working with village chiefs through the registration process, providing child support grants to registered births, and setting up mobile registration sites. | National | 1997–2004 | Births and deaths | Baseline year | Quantitative and qualitative |
| Rao, 2004 [69] | Republic of South Africa (Africa) | 85 | 91 | Supply, Demand | Multi-stakeholder provincial task teams facilitated the introduction of a new death notification form, distributed manuals and trained relevant personnel nationally, and developed strategies to improve registration. | National | 1990 on | Deaths | Baseline year | Quantitative |
| Kabengele, 2014 [50] | Switzerland (Europe) | 100 | 8 | Supply | Collecting mortality data from funeral homes instead of from the conventional Federal Statistics Office. | Canton of Geneva | 2005–2010 | Deaths | N/A | Qualitative |
| Kabadi, 2013 [75] | Tanzania (Africa) | 26.4 | Not reported | Supply | A computer application was developed to receive text messages from community civil registration officers when a death or birth occurred. The text would consist of all the information required on the notification form and would be sent to the district registrar’s office. The Village Executive Officer accessed this application and viewed trends in notifications, and saw when a notification was made but no certificate was acquired. This helped the Village Executive Officer to follow up with specific families to complete the registration process. Staff were recruited and trained. | Rufiji District | September 2012–March 2013 | Births and deaths | Baseline period | Quantitative and qualitative |
| Tangcharoensathien, 2014 [76] | Thailand (Southeast Asia) | 99.4 | 84.9 | Incentive | Computerised civil registration system integrated with national unique ID (that has utility for a range of government services) and sharing and interoperability among member databases held by three insurance schemes. | National | 2001 on | Births and deaths | N/A | Qualitative |
| Ozdemir, 2015 [49] | Turkey (Europe) | 98.8 | 4 | Supply | The Turkish Statistical Institute Death Reporting System (TURKSTAT-DRS) has undergone various governmental reforms since 2009. For example, the TURKSTAT system was integrated with the Central Population Administrative System (MERNIS) reporting form. This was useful because many rural areas lacking health practitioners only report the cause of death with this simple one-line MERNIS form, and register the deaths with the village headman instead. These new reforms reconcile between the TURKSTAT and MERNIS system by implementing routine system procedures for interoperability. Additionally, there has been enhanced coordination between the various local agencies responsible for death registration—with the main aim of improving registration completeness. | National, Izmir | 2001–2013 | Deaths | Baseline period | Quantitative |
| Starr, 1995 [66] | United States (Americas) | 100 | Not reported | Supply | Many US states began adopting electronic birth certificates (EBCs) in the 1980s–1990s. Different registration areas implemented different EBC systems, and coverage varied from 1% to 100%. | 46 states; New York City; and Washington, DC | 1980–1994 | Births | N/A | Qualitative |
| Tripp, 2015 [48] | US (Americas) | 100 | 100 | Supply | The Utah State Office of Vital Records and Statistics implemented an electronic death registration system to facilitate swifter death certification and registration. The system is used by funeral directors, physicians, and medical examiners and health department officials. The system overall helps government registrars to spend less time and resources on registration because it eliminates paper-based systems. | Utah State | 2006 on | Deaths | N/A | Qualitative |
| Robertson, 2013 [53] | Zimbabwe (Africa) | 43.5 | Not reported | Incentive | Households selected at random were enrolled into a conditional cash transfer programme (CCT), an unconditional cash transfer programme (UCT), or neither. In the UCT group, households received USD 18 and USD 4 per child every 2 months. In the CCT group, households received the cash transfer if they had complied with a set of conditions related to social welfare. One such condition is that the family had to have applied for a birth certificate within 3 months for any children in the family not yet registered. If the household complied with all the conditions, they received a card that they could bring to a pay point every 2 months to receive their cash transfer. | Manicaland | 2010–2011 | Births | Control group | Quantitative |
*Taiwan has not held a seat in the United Nations since China’s rights were restored in 1971 by Resolution 2758/26. Moreover, the 1979 US-PRC Joint Communique switched US diplomatic recognition from Taipei to Beijing and recognised the Government of the People’s Republic of China as the sole legal government of China. The United Nations Population Division reports estimates for this region as ‘China, Taiwan Province of China’.
Abbreviations: CRVS, civil registration and vital statistics; ICD, International Classification of Diseases; ID, identification card; IDB, Inter-American Development Bank; N/A, not applicable; UNICEF, United Nations Children’s Fund; USD, United States dollar