Count every birth in Nigeria | Improve the life of every 11th Child

Here’s why and how

You have 4 kids. One afternoon your 12-year-old daughter is tricked by a man twice her age to marry him. They go get married. Enraged, you go to the police and call out the bogus predator for attacking a 12-year-old. But you can’t prove she’s 12. They ask for her documentation. You don’t have it. Days later, your daughter is missing. You go to the authorities, and they can’t find her name in their system. As far as they’re concerned, she doesn’t exist.

But it’s fine. You have 3 more kids. No biggie.

Right now, we’re crossing our fingers that every 4th unregistered child won’t need to prove their identity. That the 100 countries without proper registration systems will figure things out, eventually. So will millions of citizens.

To almost two-thirds of the world, being counted is an afterthought. For the rest of the world, it’s the thought that will shape their future.

Birth registration is essential because:

  • It makes the child visible under the law. Functional civil registration is the foundation for national identity.
  • It helps protect the child from exploitation, child marriage, labour and human trafficking.
  • Birth certificates are the foundations for every other identification document. Documents are the difference between going to school, getting a job, opening a bank account, accessing health care services and travelling.
  • It lets the country understand how to distribute resources and build infrastructure. Imagine watering a garden but not knowing where you planted the seeds. Building an economy without knowing where people are over 923,768 km², guarantees inequality.

Right now, every 4th child under the age of 5 is invisible(source). 166 million children unregistered.

Half our unregistered children live in these five countries:

  • Nigeria(201m population)
  • The Democratic Republic of the Congo(86.7m population)
  • Ethiopia(112.1m population)
  • India(1.3b population)
  • Pakistan(216m population)

In other words, if we solve the problem in these 5 countries we solve 50% of the problem. From every 4th child to every 8th child.

The rest of the article is going to be zeroing in on Nigeria. We suspect that the solutions built in Nigeria will be able to execute in similar countries in the region.

Why Nigeria: the most populous country in Africa

Nigeria has a population of 201m. Followed by Ethiopia at 114m. At least 17 million Nigerian children are unregistered(source). Only 43% of children under age 5 are registered(2019). In urban areas, approximately 60 percent of births are registered(source) compared to 32% in rural regions.

From 2019–2030, 136 million Nigerians are estimated to be born, at 9 million births/year. From 2031–2050 there will be 224 million more(source). I.e., every 11th birth by 2050 will be in Nigeria. Birth registration rates must grow on average at least 5.7% /year until 2030 to reach 100%. The current mean annual growth is 1.14%.

The required documentation to register is simple and not requiring too much from the parents, unlike in other countries. Here’s a sample birth registration form & sample birth certificate). Technically no registration fee within the first 60 days

Current Process In Nigeria

Birth registration is mandatory by law though not enforced. The national body for registration in Nigeria is The National Population Commission. There are 3,810 NPC birth registration centres in Nigeria. There are 774 local government areas(LGA). Therefore there 4.9 NPC offices/local gov(source). Each registrar office gets paid $1,000 USD/month.

58% of children who reside within 5kms of a center were registered compared to 23% who reside 10 or more kilometres away(source). The median time necessary to go from home to the registration center by preferred transportation was 5 minutes (range: 1–120 minutes)(source)

NPC offices are located at National Population Commission registration centers at the local government headquarters, hospitals, health centers, or other areas.

Children get birth certificates at hospitals, then take them to the NPC to be registered. If they’re not born in a hospital, certain churches or local governments can sign an affidavit for their birth. They can take the affidavit to an NPC to get registered.

It should be noted that 60% of births in rural Nigeria are outside a hospital.

At the registration office, the parent submits the affidavit to the registration officer. They’ll likely ask for the child’s name, date of birth, place and type of birth and birth order; mother’s name, age at birth of child, marital status, education, ethnicity and place of residence; father’s name, age at birth of the child, marital status, education, ethnicity and place of residence.

They ask for:

  • Identification of the child’s father, Father’s presence at registration, Identification of the child’s mother, Mother’s presence at registration, Name of the child.
  • The mothers marital status and place of usual residence.

Then the birth is processed manually on paper.

Using a system called RapidSMS, the registration center records the registration of the birth but not the actual birth.

The rapid SMS system DOESN’T record, the child's name, parents or anything specific to the child except their gender and if they are under the age of 1 or 5 and the local government state. You can see all the rapid SMS data here. The rapid SMS system is for monitoring registration activities not recording the actual births. The system allows the NPC to see where there are discrepancies in registration rates to figure out where to send more resources or investigate.

Hospitals, churches, and local governments can issue birth certificates. However, these certificates must be taken to the NPC for registration.

Birth registration is free for the first 60 days. However, after talking to locals, we’ve noticed a hesitancy to travel to centers in fear of hidden costs or bribes.

Structure

Though the NPC is widely accepted as the body responsible for birth registration, the local government areas are also given birth registration responsibilities.

This is because there are two parallel legislations. One saying that birth registration is the responsibility of NPC while the other says it is the responsibility of LGAs. The government has yet to amend the laws.

The different laws cause a misalignment of incentives while the NPC is concerned with collecting data, LGA’s may ask for additional payments. This causes parents to be reluctant to visit in the first place.

The below diagram outlines the activities and roles for each level.

Image courtesy of Aduekwe, Nnamdi & Banjo, Olufunmilayo & Sangodapo, Mike. (2016). The Nigerian Civil Registration and Vital Statistics System: Contexts, Institutions, Operation. Social Indicators Research. https://www.researchgate.net/publication/308280653_The_Nigerian_Civil_Registration_and_Vital_Statistics_System_Contexts_Institutions_Operation

Once a month, registration forms are collected and cross-checked with the numbers on the rapidSMS database at the state registration center.

Every 3 months, the forms are sent to a data processing center, where they’re digitally entered into the national database.

Strageties to increase registration

Launched in 2009, MNCHWs are biannual campaign week focused on sharing maternal services, including birth registration, oral polio vaccines and other health interventions. Directed towards the under 5 age range.

The National Primary Health Care Development Agency sends their teams to use fixed locations in underserved areas. Their social mobilization teams spread birth registration messages to mothers, caregivers, traditional and religious leaders in the LGA. They distribute Maternal, and Child Health(MCH) handbooks that cover everything the child needs, those receiving these handbooks saw increased registration levels in Burundi(source).

According to the official country estimates (2018), Nigeria has a DTP3/vaccination coverage of 58%(source). Pairing notification and vaccine activities may be successful.

Registrars and health centers work together to time their registration activities has been very effective. There are roughly 25,000 health centers across Nigeria. By bringing people to these health locations, the registrars can quickly register the births in one location, spending less time going to individual locations (see image).

The programme saw a rise in the number of children registered under 5 annually, from 3 million in 2012 to 5 million by 2016. Registration rates themselves increased from 41.5% to 46.8% during the program.

The registration gap between high and low-income groups grew from 41.9% in 2007 to 64.9% in 2016.

What the programme did:

  • Media campaigns correlated with a 100–250% increase in registration rates
  • Provided birth registration forms
  • Create guidelines for benefits for officials and community leaders in 17 Nigerian states. The required procedure for birth registration was set.
  • Implemented rapidSMS in all 774 LGAs

What future programs need to improve:

  • Engagement of traditional and religious leaders
  • Scale-up of integrated birth registration with health services due to a lack of funding
  • Poor collaboration of birth registration processes across local governments;
  • The limited reach of media campaigns, 50% of parents say a key reason for not registering is community influences and indirect sources such as family, friends and neighbours(source)
  • Better resource allocation towards creating demand for birth registration, . Only 4% of programme support was allocated towards demand generation.

A new system is emerging called OpenCRVS that is similar to rapidSMS. However, it’s capable of registering more complex data.

OpenCRVS

Open Civil Registration and Vital Statistic(OpenCRVS) is a free open soruce framework and database for collecting population data. They’re active in Bangladesh, Kenya, Uganda, Pakistan and Indonesia, likely will be in testing in Nigeria. You can find the code here and site,

It works in multiple languages, can work offline and in low connectivity(update once connected to wifi). Let’s dive deeper into the solution that’s trying to scale internationally(special thanks to Aninna Wersun, PM @OpenCRVS).

General architecture for product:

  1. Notify a vital event

This is the first step going down the registration process, where a vital event like a live birth or a death occurs, and the database is notified. Well since they can not overlook the legal aspects of declaring something like this, they have to wait for confirmation through documents.

When the process waits on the official documents outlining the details of the event, it is considered an “incomplete application”.

2. Declaring a vital event

This is the complete part of the incomplete application, where the database collects all the legal forms for the “event” to be considered legit. OpenCRVS has different ways to collect the paperwork, here’s a few:

  • Sending agents out to health centers and have the applicants fill out necessary information there through easier to fill out forms. Traditional paperwork is often a huge turn off for people because often there’s just too many questions or they don’t have the information to provide.
  • In applications that have more access to digital tech, even from an office pc or laptop that can receive the form and fill it out themselves with their personal device.

3. Validating the vital event

Obviously, all can look good on paper and forms, but when reviewed by an official looks really sketchy. There’s a phase where they will have official registrars looking at the overall application including any supporting documents or details to either confirm the continuation of the process or stop it.

4. Getting the certificate + metrics

If the application makes it to the end, you will get a printable certificate with signatures. The database also provides the government partners with metrics to measure growth and understand where there is a lack of registration or where registrations are growing.

But why does this solution work over most other digital solutions?

It’s in the operations.

The key is that there is no silver bullet. It’s not a fit-all solution, and you can’t treat the problem like it has a silver bullet. OpenCRVS has a strong understanding of this. They work with local governments, different user groups in different locations, related social infrastructure to achieve their own product-market fit in a sense.

They’ve built a brand around adaptability and understanding, where they address the different needs even within different geographic locations in a country. They know that certain geopolitical areas won’t start from zero, but have the underlying infrastructure for them to build off rather than replace. Here’s how they currently approach pilots in new locations:

  1. 2-week scouting trip

Allows for the team to get a good sense of how operations are currently done for registering a birth so that they get a good sense of what gaps they need to fill for that specific area.

2. Digitisation & Debrief with Partners (3m)

Partners need to realize what’s going on and how exactly certain processes will change. The idea here isn’t to overwhelm existing leaders and stakeholders, it’s for them to facilitate the change. That’s the way they approach adoption.

To be more specific, this is where they understand the different layers of the product that OpenCRVS is providing. The react component of the front end isn’t as important but in terms of the database layers, systems like Hearth and InfluxData are used to manage important data volumes.

3. Configuration & Product testing (4m)

Getting up close and working with local teams to continuously adjust the product to match local landscape needs. This might mean changing data flows for the database layers or creating the forms based on existing form data.

Also, this usually where a local team can be assembled for the configuration for that specific location. Combination of local leaders and government officials and internal product team members, creating a balance that will even out perspective and allow for meaningful adaptability.

4. Pilot

But, why now? Why is this the best time to digitalize the birth registration process.

Opportunity

Data processing and handling are essential. It’s expensive and difficult to solve any problem if you don’t have proper structures initially set up.

That’s exactly the problem here. Old and crude methods are being used to handle huge data transaction volumes. It just doesn’t make sense.

The only solution that will tackle low birth registration rates at an effective rate will be the solution that has a concrete way of getting data from point A to point B consistently.

Here is the approach that OpenCRVS took:

  1. Agents for collecting data (field agents in a high concentration of vital events like hospitals)
  2. Agents for processing data (agents that review the applications)

This process has a low barrier to entry for national governments to use because it can easily be integrated with the way they currently do things. Nationally approved registrars can be processing data fed to them through the database of applications. At the same time, field agents can be hired village leaders or locals supplied with data collection tools to get the data.

Trends in internet penetration in rural Nigeria are key but often overlooked. The first thing that we looked into after we heard about digital solutions being implemented was internet penetration rates in rural Nigeria.

There is expected to be a 40 million increase in the number of people using the internet in the next three years, with actions being taken by federal governments, like the Broadband Plan for 2020 to 2025, to increase connectivity and penetration in rural regions.

The opportunity looks golden, but why isn’t there more action around this problem? What are companies not considering? Why might they be unsuccessful?

Here are some of the insights we’ve gotten from talking to local & foot teams.

  1. Bribes & other barriers to applying

Often the biggest thing that stops people from even applying in the first place, to current systems in place to record births, is the bribes and fares they have to pay to go through with the process and travel back and forth from different centers.

People have to travel to at least 3 different centers to get their child registered. Not to mention distance is also a huge factor. Given that 60% of births in rural Nigeria are outside hospitals, they have to travel just to get proof of birth, which is the preliminary step to start the process.

2. Lack of incentive

With all these additional circumstances, there isn’t a clear incentive that’s singled out by cultural leaders or by registrars. It makes it very unconvincing when they don’t know why they’re registering their child, which often becomes cyclic.

When the parent doesn’t get registered, they often believe their child won’t need anything outside of their rural community because they grew up with that culture. Since they’re not registered, they won’t have the paperwork to get their child registered, which acts as another roadblock.

Potential Next Steps

  • Strongly consider pioliting OpenCRVS in Nigeria.
  • While the OpenCRVS pilot is being implemented, continue to use RapidSMS data to identify disparities in registration. To reduce the culture of bribery, occasionally send staff to investigate potential bribes. Create a system of SMS reporting incidents.
  • Continue to work with healthcare centers, religious institutions and community centers to coordinate registration locations.
  • Create official training and policy based on the 2012 NPopC & the National Council on Health agreement to train more health workers on registration
  • Consider revising legislation around responsibilities for birth registration.
  • Create incentives for parents to register.
  • Send data electronically upward to each stakeholder in the structure figure.
  • Increase 60 day charge period, so parents are more inclined to register

Nigeria’s making incredible progress in terms of registration rates. It’s a matter of time and coordination of stakeholders until we see every Nigerian birth registered.

And every Nigerian birth registered will be every 11th birth. They’ll be visible under the law. Given the foundations to legal identity and be better shielded from exploitation and child marriage. They’ll be able to live a better life.

Put together by Eesha Ulhaq & Valmik Rao. Don’t hesistate to reach out if you know anyone working in the space. We’d love to chat and tackle this problem!

Playing around with blockchain and machine learning. 17. Trying to understand my self and the world.

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