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Death Registration
Ghana
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Ghana
Death Registration
Declaration and Notification
Declaration and Notification
Informants
Who is designated as the primary informant for natural deaths that occur in a health facility?
Nearest relative
Recommended Practice based on International Guidelines
The informant is the person who reports to the local registrar the occurrence of a vital event within the prescribed time limit. The law should establish, clearly and unequivocally, one person primarily responsible for providing the information needed for death registration to the civil registrar. The law may designate alternative informants and establish the order in which each of them must assume his or her responsibilities. For natural deaths occurring in health facilities, the head of the health facility or other health staff should be primary informant. Alternative informants, in order of priority, are: the nearest relative/next of kin or any adult with knowledge of the facts. Additionally, the legislation should explicitly state what type of facility is considered a “health facility” for purposes of being an informant.
There is a two-step process for deaths that occur in a health facility. In terms of Section 23 of the Registration of Births and Deaths Act, the medical practitioner or health practitioner in charge of the health facility must record the death and notify the District Registrar of the death within 7 days of its occurrence.
There is a separate requirement under Section 28 of the Act for certain persons to furnish the particulars of death to the District Registrar regardless of the place of death: the nearest relative of the deceased present at the time of death or in attendance at the last illness of the deceased, a relative of the deceased residing or being within the registration district, an occupier of the premises where the death occurred if the occupier has knowledge of the death, an adult who was present at the time of death or who has knowledge of the death or a coroner who has been notified of the death and has made or held an inquiry in respect of it. It is not clear if all of these persons have an equal duty to report the death or if the duty applies in sequence; however, since the nearest relative is listed first, this appears to be the primary informant.
Who is designated primary informant for natural deaths occurring outside a health facility?
Relative present at the time of death
Recommended Practice based on International Guidelines
In the case of death outside health facility but under medical supervision, the most effective approach is to designate the health professional as primary informant. Alternative informants, in order of priority, are: nearest relative, or any other adult having knowledge of the facts.
In terms of Section 23 of the Registration of Births and Deaths Act, where a death occurs outside a heath facility and the deceased is brought to the health facility, the medical practitioner or health practitioner in charge of that health facility must record the death and, where possible, the immediate and underlying cause of death, and notify the District Registrar of the death within 7 days of its occurrence.
There is a separate requirement under Section 28 of the Act for certain persons to furnish the particulars of death to the District Registrar regardless of the place of death: the nearest relative of the deceased present at the time of death or in attendance at the last illness of the deceased, a relative of the deceased residing or being within the registration district, an occupier of the premises where the death occurred if the occupier has knowledge of the death, an adult who was present at the time of death or who has knowledge of the death or a coroner who has been notified of the death and has made or held an inquiry in respect of the death. It is not clear if all of these persons have an equal duty to report the death or if the duty applies in sequence; however, since the nearest relative is listed first, this appears to be the primary informant.
Who is designated as the primary informant for unnatural or suspicious deaths?
Specified officer of the medicolegal system
Recommended Practice based on International Guidelines
To ensure that unnatural and suspicious deaths are registered, legislation should clearly specify who is responsible for reporting the death to the registrar. The primary informant for an unnatural or suspicious death should be an officer of the mediolegal system, regardless of whether the death occurred with or without medical supervision.
Such officers may include: coroners, medical examiners, police or other medicolegal officers. Responsibility should not be placed on the family, as that may result in the death not being declared to the registrar.
When a dead body is found, or when a person has died a violent or other unnatural death or a death of an unknown cause, it is the duty of any person who finds the body or becomes aware of the death to give immediate notice to the officer in charge of the nearest police station. It is the duty of the person in charge of any prison, lock-up, mental asylum or public institution other than a hospital to give immediate notice of the death of a person detained there, from any cause, to the coroner for the district where the death occurred. The person in charge of any hospital in which a person has died an unnatural death must give immediate notice to the coroner for the district.
Thus, a coroner could be notified of a death via several routes. In terms of section 28(e) of the Registration of Births and Deaths Act, a coroner who has been notified of a death and has made or held an enquiry into that death has a duty to furnish the particulars of the death to the District Registrar. Thus, the coroner is the informant for unnatural or suspicious deaths.
What is the role of the health sector in death registration for natural deaths occurring in health facilities?
Notification
Providing Medical Certificate of Cause of Death
Recommended Practice based on International Guidelines
When a death occurs in a healthcare facility,designating the head of the health facility as the informant, is the most effective way of ensuring that all deaths in health facilities are registered in a timely and accurate manner. In some countries the health facility performs a notification function, collecting relevant information about the death and passing it to the civil registrar. In that situation, the informant (usually the nearest relative) still needs to declare the death to the civil registrar in order for the death to be registered. When the health facility is the notifer, the health facility will usually be required to provide the family with some form of evidence or record of the death to be used by the informant for registration. In some countries, the health sector is neither informant nor notifier, but instead simply issues a document to the family that serves as proof of the death. Finally in some countries, specified health staff may be designated as registrars or assigned some registrar functions, which helps bring registration closer to the people.
For information on the role of health facilities in determining cause of death and completing medical certificates of cause of death, see the "Cause of Death" topic.
Where a death occurs inside a health facility, the medical practitioner or health practitioner in charge of the health facility must record the death and notify the District Registrar of the death within 7 days of its occurrence in terms of Section 23(1) of the Registration of Births and Deaths Act.
In addition, under Section 29 of the Act, regardless of the place of death, a medical practitioner who was in attendance during the illness of the deceased must issue a medical certificate of cause of death to the person who must notify the death to the District Registrar. If a health practitioner rather than a medical practitioner was in attendance during the illness of the deceased, the health practitioner must give notice of the death to the supervising medical practitioner, who must issue a medical certificate of cause of death to the person who must notify the death to the District Registrar. The person who receives the medical certificate on cause of death must submit the certificate to the District Registrar, who must then register the particulars of the deceased in the register of deaths
According to Section 48 of the Registration of Births and Deaths Act, a "medical practitioner" includes a physician, surgeon or other person approved as a “medical practitioner” under the Health Professions Regulatory Bodies Act, while a “health practitioner” includes a nurse, midwife, physician assistant or other person approved as a “health practitioner” under that Act.
What is the role of the health sector in death registration for natural deaths occurring outside health facilities?
Notification
Providing Medical Certificate of Cause of Death
Recommended Practice based on International Guidelines
The health sector can play an important role in notifying vital events, such as deaths, that occur outside health facilities where health workers attend patients and their families in the community. Countries may designate medical officers or community health workers as informants for deaths that occur in the community. Or Alternatively, the health care worker may notify the civil registrar of the facts of death, but the nearest relative still needs to register declare the death to the civil registrar in for the death to be registered. Finally, in some countries health workers may only provide a document, such as a notice of death, to the nearest relative as official evidence of the death, which the informant submits when declaring the death.
Where a death occurs outside a heath facility and the deceased is brought to the health facility, the medical practitioner or health practitioner in charge of that health facility must record the death and where possible, the immediate and underlying cause of death, and notify the District Registrar of the death within 7 days of its occurrence in terms of section 23(1) of the Registration of Births and Deaths Act.
In addition, under Section 29 of the Act, regardless of the place of death, a medical practitioner who was in attendance during the illness of the deceased must issue a medical certificate of cause of death to the person who must notify the death to the District Registrar. If a health practitioner rather than a medical practitioner was in attendance during the illness of the deceased, the health practitioner must give notice of the death to the supervising medical practitioner, who must issue a medical certificate of cause of death to the person who must notify the death to the District Registrar. The person who receives the medical certificate on cause of death must submit the certificate to the District Registrar, who must then register the particulars of the deceased in the register of deaths.
According to Section 48 of the Registration of Births and Deaths Act, a "medical practitioner" includes a physician, surgeon or other person approved as a “medical practitioner” under the Health Professions Regulatory Bodies Act, while a “health practitioner” includes a nurse, midwife, physician assistant or other person approved as a “health practitioner” under that Act
What role do local leaders or local authorities have in the registration process for deaths that occur in the community?
Unclear
Recommended Practice based on International Guidelines
In some countries, there may be remote locations where the health system is not readily accessible. In such instances, responsibility may be assigned to a local leader to act of informant, or to notify the registrar of the fact of death (but not cause of death). If a local leader is the informant, the family may be required to provide additional information to the registrar in order to register the death. In some instances, a local leader, such as a village chief, may act as a facilitiator, helping the family member (the informant) complete the death registration application and submitting this form to the local civil registrar.
Under Section 9 of the Registration of Births and Deaths Act, Registration Officers are appointed by each District Assembly (the local government authority) in consultation with the National Registrar of Births and Deaths; these Registration Officers are tasked to collect and collate information on births, fetal deaths and deaths in each sub-district. Under Section 10, the National Registrar also designates a Registration Assistant for each zone in a district, who has a duty to conduct outreach to individual households and to assist with the completion of forms on notification of births, fetal deaths and deaths.
In terms of section 12 of the Act, a District Assembly must keep and maintain a community population register which is to be used as demographic data for development planning in the district. A community may assist the Registration Assistant in the registration of births, foetal deaths and deaths for the purposes of generating a community population register. According to Ghana’s Births and Deaths Registry, the community registers are intended to serve as reference documents for the official registration of births and deaths by Registration Officers.
Does the law require that funeral, burial, and cremation services share records with civil registrar?
Yes
Recommended Practice based on International Guidelines
In countries where death registration is not a precondition for issuing a permit to dispose of bodies, custodians of funeral facilities, crematoriums and burial sites may be required to maintain a record of all deaths and to report the deaths to the civil registrar, which would alert the registrar of fact of death when death has not been registered.
A person who conducts a burial or other disposition of a dead body must inspect the death certificate and burial permit before proceeding with the burial. The owner or manager of a burial ground or any other disposition facility, including a crematorium, must endorse the burial permit with the required particulars and return it to the District Registrar of the district in which the burial or disposition takes place. In addition, the owner or manager of a burial ground or any other disposition facility must provide a monthly report to the District Registrar on the details of the burials that took place in the burial ground or disposition facility during that month. This report records the name of the person buried, the date of burial, the place of death, the registry office where the death was registered, the location of the grace space, the date on which the grave space was granted, and the person who made the grant.
