Journal of Health Science 2015, 5(2): 32-41

DOI: 10.5923/j.health.20150502.02

Evaluation of the Effect of Birth and Death Registration

on Health Service Delivery (A Case of Tolon District of
Ghana)
Abdul-Aziz Ibn Musah1,*, Zakaria Abdulai2, Mohammed Dawuni1, Abdulai Abdul-Hanan1

1
Department of Statistics Mathematics & Science, Tamale Polytechnic, Ghana
2
C/o Zakaria Meri, School of Hygiene, Tamale

Abstract Birth and death registration is one of the most widely used national and local data for identifying and
addressing major public health concerns. This study evaluated the effect of birth and death registration on health service
delivery. The study was conducted in the Tolon District where the District Births and Deaths Registry, the Planning Unit of
the District Assembly and the District Health Directorate were selected for the study from March to July 2014. The study
employed the survey research design where questionnaire administration was used for data collection. Stratified random
sampling was used to identify the various sample points. Preliminary data exploration was used with the Statistical
Software SPSS for windows (version 21) to analyse the data generated from the questionnaire. Multiple response analysis
was used to generate frequencies to determine the combined effect of responses. The study made use of percentages, means
and ranking. Descriptive statistics was used to present diagrams, tables and charts. The objectives of the study were: factors
influencing birth and death registration, contribution of birth and death registration to health service delivery, challenges
associated with birth and death registration and strategies for enhancing birth and death registration. It was found out that
86.9% of responses showed that education, distance, future employment, school enrollment, voting, obtaining a passport,
cause of death, insurance benefits, settlement of pension claims and the calculation of death rate influence birth and death
registration. Also, 80.0% of the responses showed that birth registration contributes to vaccination, family planning
interventions and that death registration contributes to measuring and monitoring child and maternal mortality rates,
calculation of death rate and determination of cause of death. Beside, 84.3% of the responses confirmed that cost, children
born to nomads, lack of support from the District Assembly and distance are challenges to birth and death registration.
Finally, 86.0% of the responses point to the fact that tying registration to health care, public awareness campaign, the use of
mobile phones for registration and building partnerships with other organizations are strategies for birth and death
registration. The study recommended that the District Births and Deaths Registry, the District Education Directorate, the
District Health Directorate and the District Assembly collaborates to improve birth and death registration for enhanced
health service delivery.
Keywords Evaluation, Birth and Death registration, Health service delivery

the relevance of birth and death registration. It is in light of

1. Introduction this that the study was undertaken to evaluate the effect of
birth and death registration on health service delivery in the
Every district in Ghana needs to know how many of its district.
people are born and die each year and the main causes of The importance of accurate (or near accurate) population
their deaths to have a well - functioning health system. figures in every district in Ghana under-pins the delivery of
Birth and death registration is very crucial to health service its health services. The outcome of this study revealed the
delivery. This is because when deaths go unaccounted and effect of birth and death registration on health service
the causes of death are not documented, districts cannot delivery in the Tolon District of Ghana. The study also
design effective public health policies or measure their revealed factors influencing birth and death registration and
impact. In the Tolon District, there is a misconception about the contribution of birth and death registration to health
service delivery in the Tolon District. The study also
* Corresponding author:
[email protected] (Abdul-Aziz Ibn Musah)
identified challenges associated with birth and death
Published online at http://journal.sapub.org/health registration and strategies that will enhances birth and death
Copyright © 2015 Scientific & Academic Publishing. All Rights Reserved registration in the district. The outcome of the study will go
 Journal of Health Science 2015, 5(2): 32-41 33

a long way to add to the existing body of knowledge in the The disparities persist even as national levels of birth
subject matter studied. registration rise. In Cameroon, where 61 per cent of
children under five is registered, children whose mothers
have a primary education are more than twice as likely to be
2. Material Studied registered as those whose mothers are uneducated.
In the third place, according to UN (2012), birth and
2.1. Factors Influencing Birth and Death Registration death registration is an integrated information system that
Birth and death registration is very important to every primarily generates legal, administrative and statistical
person since it is a human right. information that benefits individuals, households,
In the first place, according to WHO (2013), birth and communities, government institutions and
death registration brings multiple benefits. An individual's non-governmental, regional and international organizations
right to be counted at both extremes of life is fundamental engaged in various socio-economic and other human
to social inclusion. Without insurance or inheritance, death development endeavours. Every nation, whether developed
registration and certification are often required prerequisites or developing, has built such a system or is striving to build
for burial, remarriage, or the resolution of criminal cases. one as an integral part of their efforts for human
In the second place, according to UNICEF (2013), development. In Africa, some countries have histories of
registering children at birth is the first step in securing their birth and death registration dating back over 100 years.
recognition before the law, safeguarding their rights, and However, in most cases, the system intended to serve the
ensuring that any violation of these rights does not go interests of the colonizers. In Some instances, birth and
unnoticed. Birth registration also serves a statistical purpose. death registration served as an instrument aimed at
Universal birth registration is an essential part of a system controlling the movement of people and a source of
of vital statistics, which tracks the major milestones in a information for managing the people under colonial rule.
person's life - from birth to marriage and death. Such data
2.2. Contribution of Birth and Death Registration to
are essential for planning and carrying out development
Health Service Delivery
policies and programmes, particularly in health, education,
housing, water and sanitation, employment, agriculture and According to WHO (2012), decision-makers in the health
industrial production. In 2002, the General Assembly sector - including managers and practitioners such as
resolution 'A World Fit for Children' reaffirmed physicians and others - require an up-to-date understanding
governments' commitment to ensure the registration of all of levels and causes of mortality. This information is
children at birth and to invest in, care for, educate and essential for monitoring trends, evaluating the impact and
protect them from harm and exploitation. To achieve these effectiveness of health programmes, and forecasting the
goals, governments must have accurate data from which burden of disease. Planners and managers need to be able to
they can plan. Birth registration is not only a fundamental report reliably on key indicators and targets set out in
right in itself but also a key to ensuring the fulfillment of national health-sector and poverty-reduction plans,
other rights. including reporting on progress towards the Millennium
A variety of factors including; government commitment, Development Goals (MDGs). They also need to be able to
a country's legislative framework and whether existing understand emerging health challenges, such as the
infrastructure can support the logistical aspects of birth prevention and management of non-communicable diseases.
registration, influence birth registration levels, especially in The data produced by facility-based information systems
remote areas. can help to meet these information needs, but such systems
Mothers with some education are more likely to know are insufficient as they only generate data on the users of
how to register a child than their uneducated peers, and the health-care services, not on those who need but do not use
proportion of registered children is highest between those them. For example, data on mortality and causes of death
whose mothers have a secondary education. In Nigeria, for are mainly drawn from hospital records, but in settings
example, data show that 21 per cent of children whose where many deaths occur outside hospitals these data are
mothers have no education, 42 per cent of children whose not representative of the whole population.
mothers have a primary education, and 67 per cent of Also, Isabel and Ruth (2008) show that the third Global
children whose mothers have a secondary education are Partners Forum (GPF) meeting in 2006 was convened to
registered. Likewise for India, birth registration levels provide input into the United Nations General Assembly
increase with a mother's education, at 24 per cent, 47 per Special Session on HIV/AIDS (UNGASS) review of
cent and 63 percent, respectively. In Ethiopia, where achieving universal access to prevention, treatment, care
national birth registration is only 7%, birth registration and support for children affected by HIV and AIDS. The
levels increase substantially as a mother's education level GPF identified birth and death, and particularly birth
rises - from no schooling (4 percent of children registered) registration to be one strategic area of importance to
to primary education (7 per cent registered) to secondary building a comprehensive response for children affected by
education or higher (33 per cent registered). HIV and AIDS.
34 Abdul-Aziz Ibn Musah et al.: Evaluation of the Effect of Birth and Death Registration
on Health Service Delivery (A Case of Tolon District of Ghana)

Isabel (2008) contends that birth and death registration is dramatically - from 12 per cent in 2006 to 31 per cent in
a significant statistical and legal tool as it helps policy and 2011. This improvement was prompted by a range of
decision-makers meet the challenges of HIV and AIDS by advocacy and programmatic actions, from the development
monitoring the number of AIDS related deaths, HIV of a legislative framework to a national birth registration
infected adults and children, and the number of orphaned campaign and the strengthening of institutions. The 2004
and other children made vulnerable by HIV and AIDS. This Birth and Death Registration Act, which came into force in
help States and donors to design, plan and programme for 2006, provides a legal basis for the use of a birth certificate
effective interventions, including allocating appropriate as proof of age to gain access to services, including passport
funds and effectively distributing prevention, treatment, applications, school admissions and marriage registration. It
care and support services for both adults and children. The also mandates that the registration structure be established
data compiled by birth and death registrations further within the country's decentralized government
provides the foundation for achieving the Millennium administration and obliges service providers, particularly in
Development Goals, such as MDG 4, reducing child health and education, to ease birth registration. The 2004
mortality, and MDG 6, combating HIV and AIDS. Act was amended in 2013 to expedite the establishment of a
permanent structure within the government to oversee birth
2.3. Challenges Associated with Birth and Death registration. And in 2009, an online Birth Registration
Registration Information System was put in place, enabling local
Furthermore, according to WHO (2013), many barriers registrars and embassies abroad to register births and deaths
prevent people from registering births and deaths. Many and issue official certificates through a web-based
countries do not have the necessary laws or infrastructure to application. All birth and death records are transmitted to
make it obligatory to register births and deaths. In some and securely stored in a central database.
countries, only people who live in cities have access to According to UNICEF (2013). National birth registration
registration services. rates have also improved steadily in Brazil, increasing from
Also, according to UNICEF (2013), a significant barrier 64 per cent in 2000 to 93 per cent in 2011. A birth
to birth registration is the distance to the nearest registration certificate is the first step towards citizenship in Brazil: It is
facility. Distance is influenced by location and terrain, only with this document that one obtain other important
existing infrastructure and the availability of transportation. papers, apply for social protection or graduate from school.
The greater the distance to the registration centre, the higher Legal reforms, including national legislation guaranteeing
the financial and opportunity costs for the family. Urban the right to birth registration, were enacted in 1997, making
populations are less subject to such constraints, as it free of charge. And in 2002, the Ministry of Health began
confirmed by the differences in urban and rural registration providing a financial incentive to all maternity hospitals that
rates for almost all regions. Globally, children living in kept an advanced birth registration post on their premises,
urban areas are one and a half times more likely to be allowing new parents to start the registration process before
registered than their rural counterparts. going home. The following year, the Human Rights
Beside, Kingsley (2009) contends that major challenges Secretariat began partnering with civil society to raise
associated with birth and death registration include: Low awareness of the issue. The first National Birth Registration
utilization of vital statistics for policy decisions, limited Mobilization Day was established, a campaign that became
access to registration facilities, low public knowledge about permanent and marked the beginning of a national
importance of registration, inadequate staff and inability to movement. In 2007, a national policy was established to
attract and retain highly qualified personnel due to low pay promote collaboration between birth and death registration
and poor service conditions. Also, inadequate funding for authorities and the health sector, and a long-term budget
the Registry in Ghana, difficulty in motivating registration was allocated. Subsequently, birth and death registration
volunteers, lack of logistics such as accommodation, services in public hospitals went online, with information
vehicles, required statistical software and programmes, fed into a national database. The greatest improvements
absence of training opportunities for sector staff and weak have been observed in underserved northern states, partially
monitoring and supervision mechanisms all hamper as a result of outreach registration programmes. In 2007, the
effective birth and death registration. Brazilian government committed itself to achieving birth
registration rates of 95 per cent in all 27 states by 2011,
2.4. Strategies that will Enhances Birth and Death although some areas are still falling behind.
Registration In recent years, the Government of Benin has made
According to the WHO (2013), one campaign strategy important advancements in refining its birth and death
has been to tie registration more closely to the; provision of registration system, which helped boost birth registration
health care. For instance, midwives and health workers levels from 60 per cent in 2006 to 80 per cent in 2011-2012.
were instructed to register children during child health For example, public awareness campaigns and training for
campaigns. civil servants have been established, along with the
Also, according to UNICEF (2013). In Bangladesh, the computerization of birth and death registration systems in
rate of registration of children under five increased some municipalities. The primary reason for the rise,
 Journal of Health Science 2015, 5(2): 32-41 35

however, is an increase in the number of attended births. countrywide.

Trained midwives and other health personnel now have a The World Day of Prayer and Action for Children has a
legal obligation to complete and forward a birth sheet to a universal and free birth registration as one of its advocacy
civil status centre for every child delivered in a birthing goals, and encourages religious leaders to work with their
centre. congregations to promote birth registration and to support
In Senegal, the percentage of children under five whose its members in the process. In Belize, a communication for
birth is registered grew from 55 per cent to 75 per cent development approach was used to inform community
between 2005 and 2010-2011. Many different initiatives leaders and families about birth registration, using group
were introduced by the Senegalese government and its discussion and radio shows.
partners during those years, including mass campaigns on In Paraguay, football games were used to draw attention
the importance of birth registration, the reduction of fees to to non-registration, while in Nicaragua, a 'crowd-sourcing'
obtain a birth certificate, and the creation of new challenge, a social medium tool, had as its aim an increase
registration offices throughout the country. These initiatives in demand for birth registration among indigenous families.
have been consolidated in a national strategy and action Realizing every child's right to birth registration - despite
plan that is expected to be carried out in 2014. sometimes overwhelming obstacles - have to be at the core
According to UNICEF (2013). South Africa has seen a of every country's policy. Several programmatic actions are
spectacular rise in birth registration within the first year of available to achieve this: Legislative review can ensure that
life, increasing from 24 per cent in 1991 to 50 per cent in births registration is free, universal, and confidential and
2001, 75 per cent in 2005 and 95 per cent in 2012. The incorporated into the birth and death registry.
government has focused its efforts on addressing the needs Communication for development efforts that work with
of rural communities by establishing fixed service centres community leaders and parliamentarians can promote a
as well as hospital registration points, mobile units and broader understanding of the process. Mobile and digital
Multi-Purpose Community Centres. A major incentive to technology can be used to obtain timely, accurate and
early registration is the requirement that a birth certificate permanent records. And working through programmes in
be presented to obtain social protection grants, including a other sectors can ease broader reach of the system.
Child Support Grant. Many of these strategies are now being adopted in
In Uganda, national birth registration rose from 21 per Yemen, with support from UNICEF and the European
cent in 2006 to 30 per cent in 2011. The increase can be Union, to raise low birth registration levels, ease glaring
attributed in part to collaborative efforts between disparities, and help the country recovers from recent civil
government and its partners to extend coverage. A new unrest.
approach, recently launched, is enabling trained personnel
to capture birth declarations submitted by parents on mobile
phones or computers and transmit the information directly 3. Method
into the birth and death registry.
In the United Republic of Tanzania, the registration of This study adopted the case study approach. The study
children under five doubled between 1999 and 2010 - from used the survey research design since the focus was on the
6% to 16 % - but the proportion of those with a birth staff and volunteers of the District Births and Deaths
certificate remained unchanged. In the past, parents would Registry, nurses under the District Health Directorate and
have to travel to district headquarters to collect the staff of the Planning Unit of the District Assembly.
certificate 90 days after registering a birth. For most A questionnaire was administered to the staff and
families, travel costs as well as the fee for a birth certificate volunteers of the District Births and Deaths Registry, nurses
made registration prohibitively expensive. The fact that a working in the district's health facilities, and staff of the
birth certificate was not required to gain access services Planning Unit of the District Assembly.
contributed to the low rates of certification. To address
3.1. Area of Study
these challenges, the government piloted a new birth
registration system in 2012 in the country's mainland. The study concentrated on the Tolon District of the
Assistant registrars were trained at ward levels, in local Northern Region of Ghana. Tolon District (formally
government offices as well as in hospitals and health clinics, Tolon/Kumbungu) was carved out of the then Western
allowing children to be registered at birth or at the same Dagomba District in 1998. Tolon is the administrative
time as immunization. The process was also simplified: In capital of the Tolon District. The district share borders with
one step, parents are able to register their child and receive North Gonja to the West, Kumbungu District to the North,
a birth certificate, which is now free of charge for children Central Gonja to the South and to the East with Tamale
under five. Birth registration data are transmitted Metropolis.
instantaneously to a centralized system through SMS (text The study specifically focused on staff and volunteers of
messaging) and can be continuously monitored. Following a the District Births and Deaths Registry, nurses in the
successful pilot, the new system was launched in 2013 in district's health facilities and staff of the Planning Unit of
one region and is now in the process of being rolled out the District Assembly.
36 Abdul-Aziz Ibn Musah et al.: Evaluation of the Effect of Birth and Death Registration
on Health Service Delivery (A Case of Tolon District of Ghana)

3.2. Population for the Study 3.4. Sample Size Determination

Population for the study included: the District Births and The method used for sample size determination is as
Deaths Officer, births and deaths volunteers, nurses and the 𝑁
follows: n = where n = sample size, N = total
District Planning Officers. Table 1 below is a summary of 1 + 𝑁 (𝑒 2 )
the population for the study. population and e = error.

Table 1. Staff category, population and sample size 3.5. Data Collection Techniques
SAMPLE The study used the survey method for data collection,
CATEGORY POPULATION
SIZE specifically questionnaire administration. This method
Births and deaths permanent staff 1 1 helped gather primary data while online materials and
Births and deaths volunteers 35 32
consultation of archives and databases offered secondary
data for a healthy analysis in this study.
Nurses 74 61
Staff of the District Assembly
6 6 3.6. Data Analysis
Planning Unit
The statistical software SPSS for windows (Version 21)
TOTAL 116 100
was used to analyse the data generated from the
Source: Researcher’s Field Survey, 2014. questionnaire. Preliminary data exploration was employed
in the data analysis. Multiple response analysis was used to
3.3. Sampling Method generate frequencies to determine the combined effect of
Stratified random sampling was used in the study. This is responses. The study made use of percentages, means and
where the population was divided into sub-groups based on ranking. Descriptive statistics was employed using
their unique characteristics and randomly selection was diagrams, tables, and charts.
made from each group.
Table 2. Demographic Information of Respondents

Characteristics Category Frequencies Percentages (%)

Male 59 58.59
Sex Female 41 41.41
Total 100 100.00
Below 20 years 5 5.0
20 – 40 years 90 90.0
Age
40 – 60 years 5 5.0
Total 100 100.0
Single 36 36.0
Married 63 63.0
Marital Status
Divorced 1 1.0
Total 100 100.0
Junior High School 9 9.0
Senior High/ Advanced level 24 24.0
Highest level of College 54 54.0
education Polytechnic 4 4.0
University 9 9.0
Total 100 100.0
Birth and Death Officer 1 1.0
Nurse 61 61.0
Occupation /Profession Birth and Death Volunteer 32 32.0
Planning Officer 6 6.0
Total 100 100.0

Source: Researcher’s Field Survey, 2014.

 Journal of Health Science 2015, 5(2): 32-41 37

Table 3. Factors influencing births and deaths registration with their percentages of response

Responses Percentage (%)

Distance influencing birth registration 98.0
Obtaining a passport influencing birth registration 95.0
School enrolment influencing birth registration 94.0
Education influencing birth registration 89.0
Future employment influencing birth registration 88.0
Voting influence birth registration 78.0
Settlement of pension claims influencing death registration 93.0
Insurance benefits influencing death registration 86.0
Calculation of death rate influencing death registration 83.0
Determination of cause of death influencing death registration 65.0

Source: Researcher’s Field Survey, 2014.

Table 4. Factors influencing births and deaths registration with their means and rankings

Mean Ranking
Birth Registration
Distance influencing birth registration 1.02 1
Obtaining a passport influencing birth registration 1.05 2
School enrolment influencing birth registration 1.06 3
Education influencing birth registration 1.07 4
Future employment influencing birth registration 1.12 5
Voting influence birth registration 1.22 6
Death Registration
Settlement of pension claims influencing death registration 1.07 1
Insurance benefits influencing death registration 1.14 2
Calculation of death rate influencing death registration 1.17 3
Determination of cause of death influencing death registration 1.35 4

Source: Researcher’s Field Survey, 2014.

Table 5. Contribution of birth and death registration to health service delivery with their percentages of response
Percentage
Responses
(%)
Birth registration contributing to vaccination 85.0
Birth registration contributing to family planning interventions 72.0
Death registration contributing to measuring and monitoring child and maternal
91.0
mortality rates
Death registration contributing to calculation of death rate 90.9
Death registration contributing to determination of cause of death 61.0

Source: Researcher’s Field Survey, 2014.

4. Results the respondents completed Junior High School, 24.0%

Senior High School/Advanced level, 54.0% completed
Out of 100 respondents, 58.59% of them were males College, 4.0% completed Polytechnic and 9.0% have a
while 41.41% were females. This indicates that more males University education. This shows that most of the
were reached than females. Out of 100 respondents, 5.0% of respondents completed college. One person was a births and
them were below 20 years of age, 90.0% were between the deaths officer representing 1.0%, 61.0% of the respondents
ages of 20 and 40, and 5.0% were also between 40 and 60 were nurses, 32.0% were births and deaths volunteers and
years of age. Thirty six per cent (36.0%) of the respondents 6.0% represented planning officers in the District Assembly.
were single, 63.0% were married and 1.0% divorced. Most This shows that most of the respondents were nurses.
of the respondents were married. Nine per cent (9.0%) of It was found out that the following factors influence birth
38 Abdul-Aziz Ibn Musah et al.: Evaluation of the Effect of Birth and Death Registration
on Health Service Delivery (A Case of Tolon District of Ghana)

registration: 98.0% said distance, 95.0% said obtaining a Respondents ranked birth registration contributing to
passport, 94.0% said school enrolments, 89.0% said vaccination as the highest followed by birth registration
education, 88.0% said future employment and 78.0% said contributing to family planning interventions. Death
voting. For factors influencing death registration: 93.0% registration contributing to measuring and monitoring of
said settlement of pension claims, 86.0% said insurance child and maternal mortality rates and calculation of death
benefits, 83.0% said calculation of death rate and 65.0% rate was ranked equally while death registration
said determination of cause of death. contributing to determination of cause of death was ranked
Respondents ranked distance as the highest factor lowest as showed by the table above.
influencing birth registration followed by obtaining a
Table 8. Overall effects of responses regarding the contribution of birth
passport, school enrolments, education, future employment and death registration to health service delivery
and voting. For death registration, settlement of pension
Responses N per cent
claims was ranked highest followed by insurance benefits,
calculation of death rate whiles determination of cause of Yes 399 80.0
No 100 20.0
death was ranked the lowest factor as showed by the table 4
Total 499 100.00
above.
Eighty five per cent (85.0%) of the respondents said birth Source: Researcher’s Field Survey, 2014
registration contributes to vaccination, 72.0% said birth
registration contributes to family planning interventions, The overall effect of the responses regarding the
91.0% said death registration contributes to measuring and contribution of birth and death registration to health service
monitoring child and maternal mortality rates, 90.9% said delivery shows that 80.0% agreed that birth and death
death registration contributes to calculation of death rate registration contributes to health service delivery.
and 61.0% said death registration contributes to Table 9. Challenges associated with birth and death registration with their
determination of cause of death. This means that the above percentages of response
contribute to health service delivery. Responses Percentage (%)
Table 6. Combined effects of responses regarding factors influencing birth Children born to nomads 87.0
and death registration
Distance 86.0
Responses Number Per cent Lack of support from the District Assembly 84.0
Yes 869 86.9 Cost 80.0
No 131 13.1
Total 1000 100.0 Source: Researcher’s Field Survey, 2014.

Source: Researcher’s Field Survey, 2014. Eighty seven (87.0%) of the respondents said children
born to nomads is a challenge to birth and death registration,
The combined effect of the responses shows that out of
86.0% said distance is a challenge, 84.0% said lack of
869 responses, 86.9% point to the fact that education,
support from the District Assembly is a challenge whiles
distance, future employment, school enrolments, voting and
80.0% mentioned cost.
obtaining a passport influence birth registration.
Determination of cause of death, insurance benefits, Table 10. Overall effects of responses regarding the contribution of birth
settlement of pension claims, and calculation of death rate and death registration to health service delivery
also influence death registration. Responses Number per cent
Yes 399 80.0
Table 7. Responses regarding contribution of birth and death registration
to health service delivery with their means and rankings No 100 20.0
Total 499 100.00
Reponses Mean Ranking
Source: Researcher’s Field Survey, 2014
Birth Registration
Birth registration contributing to vaccination 1.15 1 Table 11. Challenges associated with birth and death registration with their
means and rankings
Birth registration contributing to family planning
1.28 2
interventions Mean Ranking
Death Registration Children born to nomads 1.13 1
Death registration contributing to measuring and Distance 1.14 2
1.09 1.5
monitoring child and maternal mortality rates
Lack of support from the District Assembly 1.16 3
Death registration contributing to the calculation of
1.09 1.5 Cost 1.20 4
death rate
Death registration contributing to the determination Source: Researcher’s Field Survey, 2014.
1.39 3.0
of cause of death
The overall effect of the responses regarding the
Source: Researcher’s Field Survey, 2014.
contribution of birth and death registration to health service
 Journal of Health Science 2015, 5(2): 32-41 39

delivery shows that 80.0% agreed that birth and death partnerships with other organizations as strategies for birth
registration contributes to health service delivery. and death registration.
Respondents ranked children born to nomads as the most
Table 15. Overall effects of responses regarding strategies for birth and
serious challenge, followed by distance and then lack of death registration
support from the District Assembly. Cost was however
Responses Number Per cent
ranked as a less serious challenge.
A Strategy 344 86.0
Table 12. Overall effects of responses regarding challenges associated Not a Strategy 56 14.0
with birth and death registration
Total 400 100.0
Responses Number Per cent
Source: Researcher’s Field Survey, 2014
A Challenge 337 84.3

Not a Challenge 63 15.7

Total 400 100.0 5. Discussion
Source: Researcher’s Field Survey, 2014. It was found out that the following factors influence birth
registration: 98.0% said distance. Distance is linked with
The overall effect of responses regarding challenges location and terrain. The longer the distance to the
associated with birth and death registration shows that registration centre, the lower the motivation for parents to
84.3% agreed that cost, children born nomads, lack of get the births of their children registered. This is attested to
support from the District Assembly and distance are by UNICEF (2013) the greater the distance to the
challenges. registration centre, the higher the financial and opportunity
Table 13. Responses regarding Strategies for birth and death registration costs for the family. Urban populations are less subject to
with their percentages of response such constraints, as confirmed by the differences in urban
Responses Percentage (%) and rural registration rates for almost all regions. Globally,
children living in urban areas are one and a half times more
Public awareness campaign 99.0
likely to be registered than their rural counterparts. Ninety
Building partnerships with other organizations 95.0
five (95.0%) said obtaining a passport. This is because
Tying registration to health care 91.0 many parents register the births of their children in order
The use of mobile phones for registration 59.0 that the children can obtain passports to travel overseas. The
Source: Researcher’s Field Survey, 2014. reason is that, presentation of a birth certificate is a basic
requirement for passport processing in Ghana. This fact is
Ninety nine (99.0%) said public awareness campaign is a supported by Assefa (2005) that birth registration is
strategy, 95.0% said building partnerships with other fundamental to the realisation of several rights and
organizations, is a strategy, 91.0% of the respondents said practicable needs such as a child's right to a nationality and
tying registration to health care is a strategy whiles 59.0% a passport. Seventy eighty (78.0%) said voting. This is
said the use of mobile phones for registration is a strategy because many parents in Ghana register the births of their
for birth and death registration. children so that the children can get the opportunity to cast
their ballots in democratic elections. This is again attested
Table 14. Responses regarding Strategies for birth and death registration
with their means and rankings to by Assefa (2005) that in 2002, Somaliland held
municipal elections and subsequently, in 2003, presidential
Responses Mean Ranking
elections. The voting age was set at 18 years old, but the
Public awareness campaign 1.01 1
absence of birth registration made the voting process
Building partnerships with other organizations 1.05 2 problematic. Many young people, both male and female,
Tying registration to health care 1.09 3 participated in the elections, but the lack of proper age
The use of mobile phones for registration 1.41 4 certification made it difficult to decide who was eligible to
Source: Researcher’s Field Survey, 2014.
vote. Ultimately, this could jeopardise the very integrity of
the elections.
Respondents ranked public awareness campaign as the For factors influencing death registration: 93.0% said
most effective strategy for birth and death registration settlement of pension claims. A significant number of
followed by building partnerships with other organisations people in Ghana register their deaths to make the settlement
and then tying registration to health care. The use of mobile of pension claims possible. This is supported by Centres for
phones for registration was however ranked as a less Disease Control and Prevention (2004) that the death
effective strategy. certificate provides important information about: the
The overall effect of responses regarding strategies for decedent (such as age, sex, race, education, date of death,
birth and death registration shows that 86.0% saw tying his or her parents, and, if married, the name of the spouse),
registration to health care, public awareness campaign, the the circumstances and cause of death, and final disposition.
use of mobile phones for registration and building This information is used in the application for insurance
40 Abdul-Aziz Ibn Musah et al.: Evaluation of the Effect of Birth and Death Registration
on Health Service Delivery (A Case of Tolon District of Ghana)

benefits, settlement of pension claims, and transfer of title promote public awareness of and responsibilities towards
of real and personal property. Sixty five (65.0%) said registration of births and deaths. Fifty nine (59.0%) said the
determination of cause of death. This is because a greater use of mobile phones for registration is a strategy for birth
number of people register their dead to determine the cause and death registration. This is because some community
of death. This is again supported by Centres for Disease based volunteers in the Tolon District of Ghana have been
Control and Prevention (2004) that the death certificate given mobile phones by the Noguchi Memorial Institute for
provides important information about: the decedent (such as Medical Research to ease registration of births and deaths in
age, sex, race, education, date of death, his or her parents, their communities. This is as well attested to by UNICEF
and, if married, the name of the spouse), the circumstances (2013) that in Uganda, national birth registration rose from
and cause of death, and final disposition. 21 per cent in 2006 to 30 per cent in 2011. The increase can
Ninety one (91.0%) said death registration contributes to be attributed in part to collaborative efforts between
measuring and monitoring child and maternal mortality government and its partners to extend coverage. A new
rates. This is because government of Ghana requires approach, recently launched, is enabling trained personnel
families register their dead in order that such data can be to capture birth declarations submitted by parents on mobile
included in the formulation of heath policies. This is phones or computers and transmit the information directly
supported by Rao, et al (2004) that information on child and into the civil registry.
adult mortality rates and causes of death is clearly important
to inform regional and national health policies, and to
monitor the impact of interventions and progress towards 6. Conclusions
goals such as the Millennium Development Goals. Eighty
Eighty six 86.9% of responses showed that education,
five per cent (85.0%) of the respondents said birth
distance, future employment, school enrollments, voting,
registration contributes to vaccination. This is because a
obtaining a passport, determination of cause of death,
greater number of parents register the births of their
insurance benefits, settlement of pension claims and
children to make it easier for the children to be vaccinated
calculation of death rate influence birth and death
against diseases such as polio and measles. This is again
registration. Also, eighty( 80.0%) of the responses show
attested to by Assefa (2005) that in some countries, a child
that births registration contributes to vaccination, family
without proof of citizenship will also be denied access to
planning interventions and that death registration
free or subsidized vaccination programs.
contributes to measuring and monitoring child and maternal
Eighty seven (87.0%) of the respondents said children
mortality rates, calculation of death rate and determination
born to nomads is a challenge to birth and death registration.
of cause of death. Beside, 84.3% of the responses confirmed
This is because nomadic people move from place to place in
that cost, children born to nomads, lack of support from the
search of feed and water for their animals and as a result
District Assembly and distance are challenges to birth and
does not consider registration very relevant even though
death registration.
registration of births and deaths is mandatory in Ghana.
Finally, eighty six (86.0%) of the responses point to the
This is as well supported by Assefa (2005) that many
fact that tying registration to health care, public awareness
children are born to nomads, far from hospitals. This means
campaign, the use of mobile phones for registration and
that many births and deaths go unregistered. Eighty 80.0%
building partnerships with other organizations are strategies
mentioned cost as a challenge. This is because registration
for birth and death registration.
of children under one year is free of charge in Ghana but
registration of children above one year attracts a fee. This is
again confirmed by Assefa (2005) that registration may be ACKNOWLEDGEMENTS
costly for poor parents, either because there is a fee
associated with it or because there is a cost involved in Many thanks go to Hajia Sophia Mahama, District
travelling long distances to register a birth. Director of Health Services - Tolon, Madam Alice
Ninety nine (99.0%) said public awareness campaign is a Kuulonno, District Officer of the Births and Deaths
strategy for birth and death registration. This is because for Registry - Tolon and to the nurses, planning officers and
instance, during Child Health Promotion Campaigns and births and deaths volunteers who made time to respond to
Integrated Maternal and Child Health Programmes in the questionnaire.
Ghana, parent are encouraged in the media to register the
births of their children. This is further supported by Rao, et
al (2004) that in South Africa, there has been attempts to
develop an unofficial notified system involving midwives, REFERENCES
nurses, graveyard attendants, school teachers and religious
officials, which would increase community participation [1] Assefa, B (2005). Universal Birth Registration: The
challenge in Africa. Retrieved March 26, 2014, from:
through increasing awareness and enabling people to http://www/riatt-esa.org/sites/default/files/get_file_8f4ife7.p
become part of the registration process. In many countries, df <http://www/riatt-esa.%20org/sites/default/files/get_file
media campaign use news-papers, radio and television to _8f4ife7.pdf>.
 Journal of Health Science 2015, 5(2): 32-41 41

[2] Centre for Disease Control and Prevention (2004).Funeral [8] United Nations (2012): Reforming and Improving Birth and
Directors' Handbook on Death Registration and fetal Death death registration and Vital Statistics Systems in Africa.
Reporting. Second conference of African Ministers Responsible for
Birth and death registration, Durban.
[3] Isabel, B.C (2008). Birth and death registration in the
context of HIV and AIDS in Eastern and Southern Africa: [9] UNICEF (2013). A passport to protection: a guide to birth
Human's first and last right. Pretoria. Centre for the Study registration programming. Retrieved April 10, 2014, from:
of Aids. http://www.unicef.org/World Health Organization (2003).
Address to WHO staff. Retrieved April 8, 2014, from:
[4] Isabel, B.C and Ruth, M. (2008). Strategic analysis on birth <http://www.unicef.org/esaro/Technical-pepers-low-res-pdf
and death registration and children in the context of HIV >.
and AIDS. Retrieved March 28, 2014, from:
<http://www.unicef.org/Birth_registration_in_the_context_o [10] World Health Organization (2013). Birth registration and
f_Hiv_and_Aids.pdf>. access to health care: an assessment of Ghana's.
[5] Kinsley, A.A (2009). The Birth and death registration [11] Campaign success. Retrieved March 20, 2014, from:
System in Ghana/Coordination among the Registration, http://www.who.int/mediacentre/factsheets/fs324/en.
Statistics and Health Sectors. Retrieved March 28, 2014,
from: http:siteresources.worldsbank.org//060909TheCivilRe [12] World Health Organization (2013). Birth and death
gistrationSystemGhana.pdf. registration: why counting births and deaths is important.
Retrieved April 4, 2014 from:http://www.who.int/mediacent
[6] Mehta, D.C and Assie, J.B (1979). A programme for re/factsheets/fs324/en/.
Measurement of Life and Death in Ghana. Accra. Central
Registry. [13] World Health Organization (2012).Strengthening birth and
death registration and vital statistics for births, deaths and
[7] Rao, C., Bradshaw and Mathers, C.D. (2004). Improving causes of death: resource kit. Retrieve April 8, 2014, from:
death registration and Statistics in developing Countries: http://www.who.int/en/.
Lessons from Sub-Saharan Africa. Retrieved April 8, 2014,
from: http://www.commerce.uct.ac.za/organisations/Demogr
aphy.