Recommended Practice based on International Guidelines

The law should clearly establish an agency with responsibility for managing the civil registration system. The structure of the civil registration system varies across countries. Some countreis have a centralized system (controlled at the central government level). Others have a decentralised system (controlled at the sub-national government level). Often, control of the system is shared between the national government and subnational governments. However, even in a fully decentralized system, there should be an agency at the national level to enforce minimum standards or to work cooperatively with decentralized jurisdictions and offices to ensure generally uniform practices and procedures.

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 birth registration to the civil registrar. The head of the health facility should be the primary informant for live births occurring in a health facility. Alternative informants, in order of priority, are: mother, father, nearest relative of the mother, any adult having 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.

Recommended Practice based on International Guidelines

For births that occur outside a health facility, the most effective approach is to designate the birth attendant - e.g., doctor, nurse, or midwife - as the informant. For births occurring outside a health facility without a birth attendant, an effective approach is to designate community health workers (including vaccination workers, nurses, doctors and other health professionals who see newborns for paediatric visits) as informants to register the birth of children that are unregistered and visited by them. Alternatively, some countries follow a two-step process, wherein the healthcare workers notify the birth to the civil registrar; however, the parent or other informant must still declare the birth to the civil registrar in order to register the birth.

Recommended Practice based on International Guidelines

For births occurring in health facilities, the most effective approach is to designate the head of the institution (or designee) as informant. Some countries follow a two-step process, in which the health sector notifies the registrar of the birth (providing some, but no all, needed information), but he parents must still declare the birth to the registrar in order for the birth to be registered. This two-step approach is considered less effective in ensuring high registration rates. In some countries, the health sector is neither informant nor notifier, but instead simply issues a document to the parent(s) that serves as proof of the birth. The health sectors limited role in this third option is not recommended practice. 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.

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.

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.

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.

Recommended Practice based on International Guidelines

Tracking stillbirths and other fetal deaths is important for statistical and public health planning. If stillbirths are tracked through the health sector, the law (or guidelines and SOPs) should require the health sector to report fetal deaths to the central health ministry. For in-facility stillbirths, reporting responsibility should fall on the head of the health facility or attending medical professional. For community stillbirths, reporting responsibility is place on the birth attendant, who may be required to report the ministry of health directly, or may report through a local health facility.

Recommended Practice based on International Guidelines

UN guidelines provide that the head of the health facility is the preferred informant for stillbirths. Where the stillbirths are registered via the civil registration system this should be specified in the law. As with live births, some countries require the health sector to notify information about stillbirths even where the designated informant is the mother and/or father. Where the mother and/or father is the primary informant, the health sector would usually be required under the law to provide a notice of some sort as evidence of the stillbirth for the purposes of registration.