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Death Registration
Zambia
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Zambia
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?
Other
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.
The law makes no distinction between the notification of deaths inside and outside health facilities. The primary informant for deaths in every case is “every relative” present at the death or in attendance during the last illness of the deceased. In the absence of such relatives, the duty passes next to every relative dwelling within the district in which the death occurred. No particular relatives are specified. In the absence of relatives, the duty passes to each person present at the death, to all persons who reside in the house where the death took place (which would obviously not apply in the case of deaths in health facilities), and of any person who has buried or caused the burial of the body of the deceased. All of these persons have a duty to report in the absence of notification by a relative; the duty does not apply in sequence.
Who is designated primary informant for natural deaths occurring outside a health facility?
Other
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.
The law makes no distinction between the notification of deaths inside and outside health facilities. The primary informant for deaths in every case is “every relative” present at the death of or in attendance during the last illness of such person. In the absence of such relatives, the duty passes next to “every relative” dwelling within the district in which the death occurred. No particular relatives are specified. In the absence of both of these groups of relatives, the duty passes to each person present at the death, to all persons who reside in the house where the death took place, and of any person who has buried or caused the burial of the body of the deceased. All of these persons have a duty to report in the absence of notification by a relative; the duty does not apply in sequence.
Who is designated as the primary informant for unnatural or suspicious deaths?
Other
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.
If a person has died in circumstances that could necessitate an inquest, any person becoming aware of the death has a duty to immediately inform a coroner, police officer, chief, headman or district messenger. If the notice is given to anyone other than a coroner, that person must convey the information to the coroner. The usual duties to notify a death to the Registrar of the district where the death occurred also apply in such circumstances.
In addition, any person who finds an “exposed body", any person taking charge of such a body and any person causing such a body to be buried all have a duty to give notice of the death to the relevant Registrar.
What is the role of the health sector in death registration for natural deaths occurring in health facilities?
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.
In terms of Section 18(1) and (3) of the Births and Deaths Registration Act, a registered medical practitioner in attendance during the deceased’s last illness must provide a medical certificate of the cause of death to any person with a duty to notify the death. That person must deliver the certificate to the Registrar of the district where the death occurred within 48 hours of receiving it.
According to Rule 34(4) of the Births and Deaths Registration (General) Rules, a Registrar is not allowed to register a natural death without a medical certificate of cause of death. This is reinforced by the form for giving notice of a death (Form XIII), which states that the informant must include the original medical certificate of the cause of death for a death that occurred in a health facility.
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.
In every case of death (whether inside or outside a health facility), Section 18(3) of the Births and Deaths Registration Act requires a registered medical practitioner who has attended the deceased during his or her last illness, to provide a medical certificate of the cause of death to any person with a duty to notify the death. That person must deliver the certificate to the Registrar of the district where the death occurred within 48 hours of receiving it.
According to Rule 34(4) of the Births and Deaths Registration (General) Rules, a Registrar is not allowed to register a death without a medical certificate of cause of death or a coroner’s certificate provided at the conclusion of an inquest. However, the form for giving notice of a death (Form XIII) appears to contemplate the alternative of a letter from a traditional leader regarding cause of death for home deaths.
What role do local leaders or local authorities have in the registration process for deaths that occur in the community?
Issuing evidence of death
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.
Districts for the purposes of death registration are identical with the administrative districts of Zambia. All District Secretaries for administrative districts are deemed to have been appointed as Registrars of Births and Deaths for their districts, and all Assistant District Secretaries are deemed to have been appointed as Deputy Registrars of Births and Deaths for their districts. The Minister must appoint suitable persons to be Assistant Registrars of Births and Deaths at district sub-centers. Assistant Registrars have a duty to assist informants within their areas to complete and sign notices of deaths.
When a death occurs at home, the notice of the death must include a letter from a traditional leader regarding the cause of death. There are no directions on what form this letter must take, or what information it must include.
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.
Rule 39 of the Births and Deaths Registration (General) Rules requires anyone who effects the disposal of a body to complete a notification of disposal and deliver it to the Registrar immediately after the disposal. In addition, Section 18(2) of the Births and Deaths Registration Act requires the custodian or person in charge of any burial place to furnish returns to the Registrar from time to time. These returns must indicate the full name, date of death and date of burial and any other particulars that may be prescribed in respect of any person buried in that burial place. Rule 40 provides that where these returns have not been supplied for a period of thirty days, the Registrar must make inquiries with the custodian or person in charge. In terms of the Public Health (Crematoria and Cremation) Regulations, the superintendent of every crematorium is responsible for keeping of a register of all cremations and must send a notification of each cremation to the relevant Registrar within 96 hours of the cremation.
