Mobile birth registration in Uganda
UNICEF promotes birth registration as a human right and has had a pioneering role in advocating for, and successfully supporting birth registration programs in many parts of the world, leading to a level of commitment among governments and bringing about greater efficiency in systems that register births.
In the recent past, UNICEF has also taken lead in innovating for children through harnessing available low cost technologies. One such clear opportunity for innovation has been the development and use of mobile and internet technologies to support UNICEF and partners to deliver results for children more efficiently and effectively. In Uganda for example, a solution known as Mobile Vital Records Systems (Mobile VRS) was developed with support from UNICEF, under a public private partnership with Uganda Telecom. Mobile VRS uses low cost technology to capture births and deaths registration data at community and hospital levels, and transmit it into a central government server in real time using mobile phones and a web-based application respectively.
This system which is currently in use in all 135 government and missionary hospitals, and in half of the 112 district local governments, has in almost three years, increased national birth registration rates by an estimated 30 percent point increase from 30% in 2011 (UDHS 2011) to an estimated 60% at the end of 2014 (Mobile VRS/Administrative data). (See Annex 1)
UNICEF aims to support government of Uganda to scale up this solution to the remaining 54 districts and in over 200 Health Center IVs that were designated as birth and death registration districts in late 2014. Uganda has shared and continues to share this innovative best practice that could greatly improve delivery of, and access to birth registration services to all children including those in remote and hard to reach areas.
While birth registration is compulsory for all people in Uganda according to the Births and Deaths Registration Act of 1970, the reality is that recent estimates from Mobile VRS and administrative data indicate that about 2.8 million of the approximately 7 million children under the age of 5 years in Uganda are not registered. Without a legal identity that comes with birth registration, a child may not be able to prove their age, nationality and parentage, and as a result, they will not have institutional protection and are more vulnerable to exploitation, violence, neglect, early marriages, child labour, sexual trafficking and slavery. They may also not be able to claim basic services, such as access to education and health, as well as social protection.
Even though URSB is decentralizing the final birth registration services (issuance of long birth certificates) away from Kampala into its regional offices, to make them more accessible, they remain far from the communities, and the barriers of inaccessibility due to long distances, significant waiting times, registration fees and other associated hidden costs are only reduced slightly. In districts with manual and paper-based registration systems, it takes several months from the time a child is registered to the time they receive their birth certificates, particularly for children born out of hospitals.
With an estimated 1.5 each year million births in Uganda that needs to be registered, the requests pile up due to their quantity and the tardiness of the data processing in all involved units.
The birth registration process is also poorly understood, and many people do not know where and how to obtain a birth certificate. In a mobile phone survey conducted in 2012 by UNICEF Uganda, 60% of respondents did not know where to go to register a birth.
Lastly, birth registration data is an essential prerequisite for the implementation of adequate legislation, policies, as well as planning and delivery of basic social services for children. It will also soon be linked to the National ID as per the Registration of Persons Bill which was approved by Cabinet and whose intentions are to harmonize and consolidate the law on registration of persons, to provide for registration of individuals and to establish a national identification register. Birth registration is thus a critical contributor to good governance.
As a response, UNICEF partnered with Uganda Telecom under a Public Private Partnership, and supported Uganda Registration Services Bureau (URSB), the government institution responsible for Civil Registration, to develop a solution known as Mobile Vital Records System (Mobile VRS). This system uses local mobile and internet technology to capture births and deaths registration data at community and hospital levels respectively. Information on birth records is transmitted in real time using pre-registered mobile phones in the community, and a web-based application in hospitals and district local governments, into a central government civil registry server. This makes the birth registration process faster, more accessible and more reliable, and the system is currently used in all 135 government and missionary hospitals, and in 58 out of 112 district local governments.
Other planned actions include supporting development of a national policy on birth and death registration, capacity development of registrars and notifiers in the remaining 54 districts and over 200 Health Center IVs that have not yet started using Mobile VRS, system strengthening in the 135 hospitals and 58 districts that are already using Mobile VRS to register birth, advocacy with parliamentarians for increased government funding, builder partnerships with FBOs, CSOs and the private sector for improved service delivery and creating demand for birth registration through awareness creation on the importance of birth registration.
As part of South to South learning, Uganda has also shared with over 20 countries how the mobile and internet technologies can be used to improve delivery of real time birth registration services to all children, including those in hard to reach areas. Uganda will continue to share knowledge and experiences in the region and beyond, providing increased opportunities for effective registration services using innovative methods to millions of children.
Through this initiative, which is currently functional in all 135 government and missionary hospitals and in only 58 of the 112 district local governments, the percentage of birth registration in Uganda, has increased from 30% in 2011 to an estimated 60% by the end of December 2014. This estimated 30% increase in three years is a big improvement considering that national birth registration rates for under 5s increased by only 9 percent points over a 5 year period from 21% in 2006 (UDHS 2006) to 30% in 2011 (UDHS 2011).
Therefore scaling up the use of Mobile VRS in the remaining 54 local governments and introducing it to the approximately 200 Health center IVs which were gazetted as birth registration districts at the end of 2014, would provide a significant opportunity to increase the birth registration rates for all children including the under 5s, for a target of at least 90% registration has been set in the GOU-UNICEF Country Programme results of 2016 to 2020.
The design of the Mobile VRS system emphasizes cost effectiveness and long term sustainability. By building a system that leverages very high ownership rates of the most basic mobile phone handsets by designated “Notifiers,” initial investments significantly decreased and concerns about the replacement of old, lost or stolen phones are significantly decreased. UNICEF also supported URSB to acquire a single USSD code number 280 for Mobile VRS, which enables notifiers across different telecommunication networks (MTN, Uganda Telecom and Airtel) to use the same code over their respective sim-cards thereby cutting out the need to purchase and distribute mobile phones to notifiers.
The initial costs of setting up this system (hardware and software development, training, and initial system monitoring) is where the bulk of the investment lies. Recurrent, or ongoing costs, should be quite modest compared to the results achieved. The recurrent per transaction costs of capturing, digitizing and transferring the birth registration records is estimated at about only US$0.5 for every birth or death entered into the system.
The budget estimate is based on observed investment costs while supporting strengthening of the capacities of registrars in 58 districts and 135 hospitals that are already using Mobile VRS to register births. This budget will over technical support to government on birth registration, capacity development for staff and procurement and distribution of ICT equipment (Computer, printer, internet modem, data) to the remaining 54 districts and over 200 Health Center IVs to which Mobile VRS will be introduced, overall system strengthening, travel and administrative costs.
Funds from UNICEF core resources will be used to support policy development and legislative reforms, social mobilization for improved public awareness about the importance of birth registration, advocacy work with parliamentarians for increased government funding, as well as contribute to building and strengthening the capacity of URSB to plan, coordinate and give oversight to the entire national birth and death registration exercise.