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
Every district in Ghana needs to know how many of its
people are born and die each year and the main causes of
their deaths to have a well - functioning health system.
Birth and death registration is very crucial to health service
delivery. This is because when deaths go unaccounted and
the causes of death are not documented, districts cannot
design effective public health policies or measure their
impact. In the Tolon District, there is a misconception about
* Corresponding author:
dooziizu@gmail.com (Abdul-Aziz Ibn Musah)
Published online at http://journal.sapub.org/health
Copyright © 2015 Scientific & Academic Publishing. All Rights Reserved
this that the study was undertaken to evaluate the effect of
birth and death registration on health service delivery in the
district.
The importance of accurate (or near accurate) population
figures in every district in Ghana under-pins the delivery of
its health services. The outcome of this study revealed the
effect of birth and death registration on health service
delivery in the Tolon District of Ghana. The study also
revealed factors influencing birth and death registration and
the contribution of birth and death registration to health
service delivery in the Tolon District. The study also
identified challenges associated with birth and death
registration and strategies that will enhances birth and death
registration in the district. The outcome of the study will go
 Journal of Health Science 2015, 5(2): 32-41
a long way to add to the existing body of knowledge in the
subject matter studied.
2. Material Studied
2.1. Factors Influencing Birth and Death Registration
Birth and death registration is very important to every
person since it is a human right.
In the first place, according to WHO (2013), birth and
death registration brings multiple benefits. An individual's
right to be counted at both extremes of life is fundamental
to social inclusion. Without insurance or inheritance, death
registration and certification are often required prerequisites
for burial, remarriage, or the resolution of criminal cases.
In the second place, according to UNICEF (2013),
registering children at birth is the first step in securing their
recognition before the law, safeguarding their rights, and
ensuring that any violation of these rights does not go
unnoticed. Birth registration also serves a statistical purpose.
Universal birth registration is an essential part of a system
of vital statistics, which tracks the major milestones in a
person's life - from birth to marriage and death. Such data
are essential for planning and carrying out development
policies and programmes, particularly in health, education,
housing, water and sanitation, employment, agriculture and
industrial production. In 2002, the General Assembly
resolution 'A World Fit for Children' reaffirmed
governments' commitment to ensure the registration of all
children at birth and to invest in, care for, educate and
protect them from harm and exploitation. To achieve these
goals, governments must have accurate data from which
they can plan. Birth registration is not only a fundamental
right in itself but also a key to ensuring the fulfillment of
other rights.
A variety of factors including; government commitment,
a country's legislative framework and whether existing
infrastructure can support the logistical aspects of birth
registration, influence birth registration levels, especially in
remote areas.
Mothers with some education are more likely to know
how to register a child than their uneducated peers, and the
proportion of registered children is highest between those
whose mothers have a secondary education. In Nigeria, for
example, data show that 21 per cent of children whose
mothers have no education, 42 per cent of children whose
mothers have a primary education, and 67 per cent of
children whose mothers have a secondary education are
registered. Likewise for India, birth registration levels
increase with a mother's education, at 24 per cent, 47 per
cent and 63 percent, respectively. In Ethiopia, where
national birth registration is only 7%, birth registration
levels increase substantially as a mother's education level
rises - from no schooling (4 percent of children registered)
to primary education (7 per cent registered) to secondary
education or higher (33 per cent registered).
33
The disparities persist even as national levels of birth
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
registered as those whose mothers are uneducated.
In the third place, according to UN (2012), birth and
death registration is an integrated information system that
primarily generates legal, administrative and statistical
information that benefits individuals, households,
communities, government institutions and
non-governmental, regional and international organizations
engaged in various socio-economic and other human
development endeavours. Every nation, whether developed
or developing, has built such a system or is striving to build
one as an integral part of their efforts for human
development. In Africa, some countries have histories of
birth and death registration dating back over 100 years.
However, in most cases, the system intended to serve the
interests of the colonizers. In Some instances, birth and
death registration served as an instrument aimed at
controlling the movement of people and a source of
information for managing the people under colonial rule.
2.2. Contribution of Birth and Death Registration to
Health Service Delivery
According to WHO (2012), decision-makers in the health
sector - including managers and practitioners such as
physicians and others - require an up-to-date understanding
of levels and causes of mortality. This information is
essential for monitoring trends, evaluating the impact and
effectiveness of health programmes, and forecasting the
burden of disease. Planners and managers need to be able to
report reliably on key indicators and targets set out in
national health-sector and poverty-reduction plans,
including reporting on progress towards the Millennium
Development Goals (MDGs). They also need to be able to
understand emerging health challenges, such as the
prevention and management of non-communicable diseases.
The data produced by facility-based information systems
can help to meet these information needs, but such systems
are insufficient as they only generate data on the users of
health-care services, not on those who need but do not use
them. For example, data on mortality and causes of death
are mainly drawn from hospital records, but in settings
where many deaths occur outside hospitals these data are
not representative of the whole population.
Also, Isabel and Ruth (2008) show that the third Global
Partners Forum (GPF) meeting in 2006 was convened to
provide input into the United Nations General Assembly
Special Session on HIV/AIDS (UNGASS) review of
achieving universal access to prevention, treatment, care
and support for children affected by HIV and AIDS. The
GPF identified birth and death, and particularly birth
registration to be one strategic area of importance to
building a comprehensive response for children affected by
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
a significant statistical and legal tool as it helps policy and
decision-makers meet the challenges of HIV and AIDS by
monitoring the number of AIDS related deaths, HIV
infected adults and children, and the number of orphaned
and other children made vulnerable by HIV and AIDS. This
help States and donors to design, plan and programme for
effective interventions, including allocating appropriate
funds and effectively distributing prevention, treatment,
care and support services for both adults and children. The
data compiled by birth and death registrations further
provides the foundation for achieving the Millennium
Development Goals, such as MDG 4, reducing child
mortality, and MDG 6, combating HIV and AIDS.
2.3. Challenges Associated with Birth and Death
Registration
Furthermore, according to WHO (2013), many barriers
prevent people from registering births and deaths. Many
countries do not have the necessary laws or infrastructure to
make it obligatory to register births and deaths. In some
countries, only people who live in cities have access to
registration services.
Also, according to UNICEF (2013), a significant barrier
to birth registration is the distance to the nearest registration
facility. Distance is influenced by location and terrain,
existing infrastructure and the availability of transportation.
The greater the distance to the registration centre, the higher
the financial and opportunity costs for the family. Urban
populations are less subject to such constraints, as
confirmed by the differences in urban and rural registration
rates for almost all regions. Globally, children living in
urban areas are one and a half times more likely to be
registered than their rural counterparts.
Beside, Kingsley (2009) contends that major challenges
associated with birth and death registration include: Low
utilization of vital statistics for policy decisions, limited
access to registration facilities, low public knowledge about
importance of registration, inadequate staff and inability to
attract and retain highly qualified personnel due to low pay
and poor service conditions. Also, inadequate funding for
the Registry in Ghana, difficulty in motivating registration
volunteers, lack of logistics such as accommodation,
vehicles, required statistical software and programmes,
absence of training opportunities for sector staff and weak
monitoring and supervision mechanisms all hamper
effective birth and death registration.
2.4. Strategies that will Enhances Birth and Death
Registration
According to the WHO (2013), one campaign strategy
has been to tie registration more closely to the; provision of
health care. For instance, midwives and health workers
were instructed to register children during child health
campaigns.
Also, according to UNICEF (2013). In Bangladesh, the
rate of registration of children under five increased
dramatically - from 12 per cent in 2006 to 31 per cent in
2011. This improvement was prompted by a range of
advocacy and programmatic actions, from the development
of a legislative framework to a national birth registration
campaign and the strengthening of institutions. The 2004
Birth and Death Registration Act, which came into force in
2006, provides a legal basis for the use of a birth certificate
as proof of age to gain access to services, including passport
applications, school admissions and marriage registration. It
also mandates that the registration structure be established
within the country's decentralized government
administration and obliges service providers, particularly in
health and education, to ease birth registration. The 2004
Act was amended in 2013 to expedite the establishment of a
permanent structure within the government to oversee birth
registration. And in 2009, an online Birth Registration
Information System was put in place, enabling local
registrars and embassies abroad to register births and deaths
and issue official certificates through a web-based
application. All birth and death records are transmitted to
and securely stored in a central database.
According to UNICEF (2013). National birth registration
rates have also improved steadily in Brazil, increasing from
64 per cent in 2000 to 93 per cent in 2011. A birth
certificate is the first step towards citizenship in Brazil: It is
only with this document that one obtain other important
papers, apply for social protection or graduate from school.
Legal reforms, including national legislation guaranteeing
the right to birth registration, were enacted in 1997, making
it free of charge. And in 2002, the Ministry of Health began
providing a financial incentive to all maternity hospitals that
kept an advanced birth registration post on their premises,
allowing new parents to start the registration process before
going home. The following year, the Human Rights
Secretariat began partnering with civil society to raise
awareness of the issue. The first National Birth Registration
Mobilization Day was established, a campaign that became
permanent and marked the beginning of a national
movement. In 2007, a national policy was established to
promote collaboration between birth and death registration
authorities and the health sector, and a long-term budget
was allocated. Subsequently, birth and death registration
services in public hospitals went online, with information
fed into a national database. The greatest improvements
have been observed in underserved northern states, partially
as a result of outreach registration programmes. In 2007, the
Brazilian government committed itself to achieving birth
registration rates of 95 per cent in all 27 states by 2011,
although some areas are still falling behind.
In recent years, the Government of Benin has made
important advancements in refining its birth and death
registration system, which helped boost birth registration
levels from 60 per cent in 2006 to 80 per cent in 2011-2012.
For example, public awareness campaigns and training for
civil servants have been established, along with the
computerization of birth and death registration systems in
some municipalities. The primary reason for the rise,
 Journal of Health Science 2015, 5(2): 32-41
however, is an increase in the number of attended births.
Trained midwives and other health personnel now have a
legal obligation to complete and forward a birth sheet to a
civil status centre for every child delivered in a birthing
centre.
In Senegal, the percentage of children under five whose
birth is registered grew from 55 per cent to 75 per cent
between 2005 and 2010-2011. Many different initiatives
were introduced by the Senegalese government and its
partners during those years, including mass campaigns on
the importance of birth registration, the reduction of fees to
obtain a birth certificate, and the creation of new
registration offices throughout the country. These initiatives
have been consolidated in a national strategy and action
plan that is expected to be carried out in 2014.
According to UNICEF (2013). South Africa has seen a
spectacular rise in birth registration within the first year of
life, increasing from 24 per cent in 1991 to 50 per cent in
2001, 75 per cent in 2005 and 95 per cent in 2012. The
government has focused its efforts on addressing the needs
of rural communities by establishing fixed service centres
as well as hospital registration points, mobile units and
Multi-Purpose Community Centres. A major incentive to
early registration is the requirement that a birth certificate
be presented to obtain social protection grants, including a
Child Support Grant.
In Uganda, national birth registration rose from 21 per
cent in 2006 to 30 per cent in 2011. The increase can be
attributed in part to collaborative efforts between
government and its partners to extend coverage. A new
approach, recently launched, is enabling trained personnel
to capture birth declarations submitted by parents on mobile
phones or computers and transmit the information directly
into the birth and death registry.
In the United Republic of Tanzania, the registration of
children under five doubled between 1999 and 2010 - from
6% to 16 % - but the proportion of those with a birth
certificate remained unchanged. In the past, parents would
have to travel to district headquarters to collect the
certificate 90 days after registering a birth. For most
families, travel costs as well as the fee for a birth certificate
made registration prohibitively expensive. The fact that a
birth certificate was not required to gain access services
contributed to the low rates of certification. To address
these challenges, the government piloted a new birth
registration system in 2012 in the country's mainland.
Assistant registrars were trained at ward levels, in local
government offices as well as in hospitals and health clinics,
allowing children to be registered at birth or at the same
time as immunization. The process was also simplified: In
one step, parents are able to register their child and receive
a birth certificate, which is now free of charge for children
under five. Birth registration data are transmitted
instantaneously to a centralized system through SMS (text
messaging) and can be continuously monitored. Following a
successful pilot, the new system was launched in 2013 in
one region and is now in the process of being rolled out
35
countrywide.
The World Day of Prayer and Action for Children has a
universal and free birth registration as one of its advocacy
goals, and encourages religious leaders to work with their
congregations to promote birth registration and to support
its members in the process. In Belize, a communication for
development approach was used to inform community
leaders and families about birth registration, using group
discussion and radio shows.
In Paraguay, football games were used to draw attention
to non-registration, while in Nicaragua, a 'crowd-sourcing'
challenge, a social medium tool, had as its aim an increase
in demand for birth registration among indigenous families.
Realizing every child's right to birth registration - despite
sometimes overwhelming obstacles - have to be at the core
of every country's policy. Several programmatic actions are
available to achieve this: Legislative review can ensure that
births registration is free, universal, and confidential and
incorporated into the birth and death registry.
Communication for development efforts that work with
community leaders and parliamentarians can promote a
broader understanding of the process. Mobile and digital
technology can be used to obtain timely, accurate and
permanent records. And working through programmes in
other sectors can ease broader reach of the system.
Many of these strategies are now being adopted in
Yemen, with support from UNICEF and the European
Union, to raise low birth registration levels, ease glaring
disparities, and help the country recovers from recent civil
unrest.
3. Method
This study adopted the case study approach. The study
used the survey research design since the focus was on the
staff and volunteers of the District Births and Deaths
Registry, nurses under the District Health Directorate and
staff of the Planning Unit of the District Assembly.
A questionnaire was administered to the staff and
volunteers of the District Births and Deaths Registry, nurses
working in the district's health facilities, and staff of the
Planning Unit of the District Assembly.
3.1. Area of Study
The study concentrated on the Tolon District of the
Northern Region of Ghana. Tolon District (formally
Tolon/Kumbungu) was carved out of the then Western
Dagomba District in 1998. Tolon is the administrative
capital of the Tolon District. The district share borders with
North Gonja to the West, Kumbungu District to the North,
Central Gonja to the South and to the East with Tamale
Metropolis.
The study specifically focused on staff and volunteers of
the District Births and Deaths Registry, nurses in the
district's health facilities and staff of the Planning Unit of
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%

Out of 100 respondents, 58.59% of them were males
while 41.41% were females. This indicates that more males
were reached than females. Out of 100 respondents, 5.0% of
them were below 20 years of age, 90.0% were between the
ages of 20 and 40, and 5.0% were also between 40 and 60
years of age. Thirty six per cent (36.0%) of the respondents
were single, 63.0% were married and 1.0% divorced. Most
of the respondents were married. Nine per cent (9.0%) of
Senior High School/Advanced level, 54.0% completed
College, 4.0% completed Polytechnic and 9.0% have a
University education. This shows that most of the
respondents completed college. One person was a births and
deaths officer representing 1.0%, 61.0% of the respondents
were nurses, 32.0% were births and deaths volunteers and
6.0% represented planning officers in the District Assembly.
This shows that most of the respondents were nurses.
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
delivery shows that 80.0% agreed that birth and death
registration contributes to health service delivery.
Respondents ranked children born to nomads as the most
serious challenge, followed by distance and then lack of
support from the District Assembly. Cost was however
ranked as a less serious challenge.
Table 12. Overall effects of responses regarding challenges associated
with birth and death registration
Responses Number Per cent
A Challenge 337 84.3
Not a Challenge 63 15.7
Total 400 100.0
Source: Researcher’s Field Survey, 2014.
The overall effect of responses regarding challenges
associated with birth and death registration shows that
84.3% agreed that cost, children born nomads, lack of
support from the District Assembly and distance are
challenges.
Table 13. Responses regarding Strategies for birth and death registration
with their percentages of response
Responses Percentage (%)
Public awareness campaign 99.0
Building partnerships with other organizations 95.0
Tying registration to health care 91.0
The use of mobile phones for registration 59.0
Source: Researcher’s Field Survey, 2014.
Ninety nine (99.0%) said public awareness campaign is a
strategy, 95.0% said building partnerships with other
organizations, is a strategy, 91.0% of the respondents said
tying registration to health care is a strategy whiles 59.0%
said the use of mobile phones for registration is a strategy
for birth and death registration.
Table 14. Responses regarding Strategies for birth and death registration
with their means and rankings
Responses Mean Ranking
Public awareness campaign 1.01
Building partnerships with other organizations 1.05
Tying registration to health care 1.09
The use of mobile phones for registration 1.41
Source: Researcher’s Field Survey, 2014.
Respondents ranked public awareness campaign as the
most effective strategy for birth and death registration
followed by building partnerships with other organisations
and then tying registration to health care. The use of mobile
phones for registration was however ranked as a less
effective strategy.
The overall effect of responses regarding strategies for
birth and death registration shows that 86.0% saw tying
registration to health care, public awareness campaign, the
use of mobile phones for registration and building
39
partnerships with other organizations as strategies for birth
and death registration.
Table 15. Overall effects of responses regarding strategies for birth and
death registration
Responses Number Per cent
A Strategy 344 86.0
Not a Strategy 56 14.0
Total 400 100.0
Source: Researcher’s Field Survey, 2014
5. Discussion
It was found out that the following factors influence birth
registration: 98.0% said distance. Distance is linked with
location and terrain. The longer the distance to the
registration centre, the lower the motivation for parents to
get the births of their children registered. This is attested to
by UNICEF (2013) the greater the distance to the
registration centre, the higher the financial and opportunity
costs for the family. Urban populations are less subject to
such constraints, as confirmed by the differences in urban
and rural registration rates for almost all regions. Globally,
children living in urban areas are one and a half times more
likely to be registered than their rural counterparts. Ninety
five (95.0%) said obtaining a passport. This is because
many parents register the births of their children in order
that the children can obtain passports to travel overseas. The
reason is that, presentation of a birth certificate is a basic
requirement for passport processing in Ghana. This fact is
supported by Assefa (2005) that birth registration is
fundamental to the realisation of several rights and
practicable needs such as a child's right to a nationality and
a passport. Seventy eighty (78.0%) said voting. This is
because many parents in Ghana register the births of their
children so that the children can get the opportunity to cast
their ballots in democratic elections. This is again attested
to by Assefa (2005) that in 2002, Somaliland held
municipal elections and subsequently, in 2003, presidential
elections. The voting age was set at 18 years old, but the
1
absence of birth registration made the voting process
2 problematic. Many young people, both male and female,
3 participated in the elections, but the lack of proper age
4 certification made it difficult to decide who was eligible to
vote. Ultimately, this could jeopardise the very integrity of
the elections.
For factors influencing death registration: 93.0% said
settlement of pension claims. A significant number of
people in Ghana register their deaths to make the settlement
of pension claims possible. This is supported by Centres for
Disease Control and Prevention (2004) that the death
certificate provides important information about: the
decedent (such as age, sex, race, education, date of death,
his or her parents, and, if married, the name of the spouse),
the circumstances and cause of death, and final disposition.
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
of real and personal property. Sixty five (65.0%) said
determination of cause of death. This is because a greater
number of people register their dead to determine the cause
of death. This is again supported by Centres for Disease
Control and Prevention (2004) that the death certificate
provides important information about: the decedent (such as
age, sex, race, education, date of death, his or her parents,
and, if married, the name of the spouse), the circumstances
and cause of death, and final disposition.
Ninety one (91.0%) said death registration contributes to
measuring and monitoring child and maternal mortality
rates. This is because government of Ghana requires
families register their dead in order that such data can be
included in the formulation of heath policies. This is
supported by Rao, et al (2004) that information on child and
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
goals such as the Millennium Development Goals. Eighty
five per cent (85.0%) of the respondents said birth
registration contributes to vaccination. This is because a
greater number of parents register the births of their
children to make it easier for the children to be vaccinated
against diseases such as polio and measles. This is again
attested to by Assefa (2005) that in some countries, a child
without proof of citizenship will also be denied access to
free or subsidized vaccination programs.
Eighty seven (87.0%) of the respondents said children
born to nomads is a challenge to birth and death registration.
This is because nomadic people move from place to place in
search of feed and water for their animals and as a result
does not consider registration very relevant even though
registration of births and deaths is mandatory in Ghana.
This is as well supported by Assefa (2005) that many
children are born to nomads, far from hospitals. This means
that many births and deaths go unregistered. Eighty 80.0%
mentioned cost as a challenge. This is because 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
costly for poor parents, either because there is a fee
associated with it or because there is a cost involved in
travelling long distances to register a birth.
Ninety nine (99.0%) said public awareness campaign is a
strategy for birth and death registration. This is because for
instance, during Child Health Promotion Campaigns and
Integrated Maternal and Child Health Programmes in
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,
nurses, graveyard attendants, school teachers and religious
officials, which would increase community participation
through increasing awareness and enabling people to
become part of the registration process. In many countries,
media campaign use news-papers, radio and television to
promote public awareness of and responsibilities towards
registration of births and deaths. Fifty nine (59.0%) said the
use of mobile phones for registration is a strategy for birth
and death registration. This is because some community
based volunteers in the Tolon District of Ghana have been
given mobile phones by the Noguchi Memorial Institute for
Medical Research to ease registration of births and deaths in
their communities. This is as well attested to by UNICEF
(2013) that in Uganda, national birth registration rose from
21 per cent in 2006 to 30 per cent in 2011. The increase can
be attributed in part to collaborative efforts between
government and its partners to extend coverage. A new
approach, recently launched, is enabling trained personnel
to capture birth declarations submitted by parents on mobile
phones or computers and transmit the information directly
into the civil registry.
6. Conclusions
Eighty six 86.9% of responses showed that education,
distance, future employment, school enrollments, voting,
obtaining a passport, determination of cause of death,
insurance benefits, settlement of pension claims and
calculation of death rate influence birth and death
registration. Also, eighty( 80.0%) of the responses show
that births 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, eighty six (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.
ACKNOWLEDGEMENTS
Many thanks go to Hajia Sophia Mahama, District
Director of Health Services - Tolon, Madam Alice
Kuulonno, District Officer of the Births and Deaths
Registry - Tolon and to the nurses, planning officers and
births and deaths volunteers who made time to respond to
the questionnaire.
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