2011年-世界发展银行全球_Tajikistan_-_Improving_Statistics_for_Childrens_Births_and_Deaths_30页_516kb

Summary of the Document: Improving Statistics for Children's Births and Deaths in Tajikistan

Core Content

This document outlines the challenges and recommendations for improving the accuracy of vital statistics related to children's births and deaths in Tajikistan. It highlights the importance of reliable data for achieving the Millennium Development Goals (MDG), particularly MDG 4, which aims for a two-thirds reduction in child mortality. The study was conducted by the World Bank in collaboration with various stakeholders and focuses on the structure and performance of the Health Information System (HIS) and civil registration processes.

Main Findings

Health Information System (HIS) in Tajikistan

• The HIS in Tajikistan was established during the Soviet era and involves multiple ministries and government institutions.
• Goskomstat (State Committee of Statistics) is the main body responsible for producing and disseminating statistical information, including health data.
• Goskomstat is legally mandated to use international methodologies to ensure objective and reliable statistics.
• ZAGS (Office of Civil Registration) is an independent entity within the Ministry of Justice and is responsible for civil status records, including births and deaths.
• RCMSI (Republican Center for Medical Statistics and Information) is under the Ministry of Health and manages health statistics, including child births and deaths.

Structure and Reporting

• Goskomstat collects data from local rayon offices, which aggregate information and send it to oblast offices, and then to the central office in Dushanbe.
• ZAGS collects birth and death data at the local level through rayon and city branches, as well as Jamoats, and sends it to the oblast level for aggregation and verification.
• RCMSI collects data from all medical facilities, aggregates it, and sends it to the central office. Five main forms are used for birth and death registration within the health system.

Legal Framework

• The Law on State of Registration of Acts of Civil Status governs birth and death registration in Tajikistan.
• Birth registration requires a Medical Certificate of Birth issued by the medical facility or a healthcare provider present during the delivery.
• If no medical personnel attended the delivery, a statement from the person present is accepted.
• In cases where no such documentation exists, a court decision is required to confirm the birth.

Key Issues Identified

• Inconsistent data collection: Health facilities and national agencies report different data compared to nationally representative surveys such as MICS and TLSS.
• High unregistered birth rates: A significant proportion of births, especially in rural areas, are not registered. For example, in 2005, 18% of children aged 0-11 months were unregistered.
• Inaccurate vital statistics: The data on child mortality and infant mortality rate (IMR) differs significantly between agencies, such as Goskomstat and RCMSI.
• Poor registration procedures: The process is complex, time-consuming, and often discourages timely registration.
• Lack of coordination: There is no clear leadership or ownership for improving vital statistics among government agencies.
• Low awareness: Many individuals are unaware of the importance of birth and death registration.
• Financial and logistical barriers: High costs and long distances to registration offices are major deterrents to registration.

Recommendations

• Establish a central coordinating agency: The Ministry of Justice, which oversees the civil registration system, should take the lead in coordinating and owning the vital statistics improvement process.
• Standardize definitions and procedures: All agencies should adopt the International Live Birth Definition (ILBD) and align their procedures with WHO recommendations.
• Simplify registration processes: Procedures should be made more accessible and user-friendly, especially for rural populations.
• Improve data collection methods: Health facilities and local agencies should use consistent methods and sources for data collection.
• Enhance training for health workers: Personnel responsible for data collection and reporting should be trained on new definitions and procedures.
• Increase public awareness: Campaigns should be launched to educate the population on the importance of birth and death registration, including the associated costs and procedures.
• Improve data quality: Strengthen the reporting and collection of child health data, especially for child mortality, to support evidence-based policy-making.

Conclusion

The study concludes that improving the accuracy and completeness of vital statistics for children's births and deaths is critical for achieving the MDGs and enhancing the effectiveness of health policies. The current system suffers from inconsistencies, lack of coordination, and poor public awareness, which hinder the reliability of data and the ability to monitor health outcomes. Addressing these issues requires a unified approach, legal reforms, and enhanced collaboration between government agencies and international partners.

References

• Aleshina & Redmond (2003)
• Plan International (2009)
• Danel & Bortman (2008)
• Inter-agency Group for Child Mortality Estimation [IGME], (2011)

Annexes

• Annex 1: Study Objective and Methodology
• Annex 2: Health Statistical Reporting Forms for Vital Registration in Tajikistan
• Annex 3: Summary of Projects to Improve HIS in Tajikistan