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Death Registration
Tunisia
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Tunisia
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?
Unclear
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.
Article 46 of the Law No. 1957-3 of 1957 makes the director or administrator of hospitals or health facilities responsible for notifying deaths that occur in them. A definition of "health facility" is not contained within the Law No. 1957-3 of 1957.
Additionally, Article 44 states that a death certificate shall be drawn up by the registrar on the basis of a declaration by a relative of the deceased or by a person who has the most accurate and complete information possible on the deceased's civil status. While the law is not entirely clear, Articles 44 and 46 taken together can be interpreted to mean the family is the informant and the health facility is the notifier (as is the practice).
Who is designated primary informant for natural deaths occurring outside a health facility?
Nearest relative
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.
Article 44 states that a death certificate shall be drawn up by the registrar on the basis of a declaration by a relative of the deceased or by a person who has the most accurate and complete information possible on the deceased's civil status.
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.
What is the role of the health sector in death registration for natural deaths occurring in health facilities?
Issuing evidence 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.
Article 46 of the Law No. 1957-3 of 1957 makes the director or administrator of hospitals or health facilities responsible for notifying deaths that occur within them.
Decree No. 99-1043 of 17 May 1999 establishes the model for the medical certificate of cause of death (MCCD) and the information it must contain, requiring the doctor who certifies the cause of death to complete the entire MCCD. This form contains both the Notice of Death and the MCCD. The form is given to the family, with the MCCD portion folded and sealed to protect privacy.
Under Article 44, the family is responsible for reporting the death to the civil registrar. The family brings the form to the civil registrar for death registration. Therefore, under the Civil Status Law (Article 46), the health sector is a notifer. However, under the Decree, the health sector only issues evidence of death; and this is what actually happens in practice.
What is the role of the health sector in death registration for natural deaths occurring outside health facilities?
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.
Decree No. 99-1043 of 17 May 1999, establishes the model for the medical death certificate and the information it must contain, requiring the doctor who certifies the death to complete the entire medical death certificate. If the deceased dies outside of a health facility and had a treating physician, the treating physician would use this form for medical certifcation of cause of death and give the form (with the MCCD portion sealed) to the family, for use in registration.
What role do local leaders or local authorities have in the registration process for deaths that occur in the community?
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.
Tunisia does not have a role for local leaders in death registration.
Law Source
Does the law require that funeral, burial, and cremation services share records with civil registrar?
No
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.
