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Civil Registration in Sultanate of Oman. Its Development and Potential Implications on Vital Statistics. Dr. Medhat K. ElSayed. Objectives. Health System in Oman – Brief Development of Civil registration – birth and death notifications - PowerPoint PPT Presentation
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Civil Registration in Civil Registration in Sultanate of Oman Sultanate of Oman Dr. Medhat K. ElSayed Development and Potential Implications Development and Potential Implications Vital Statistics Vital Statistics
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Page 1: Civil Registration in Sultanate of Oman

Civil Registration in Civil Registration in Sultanate of Oman Sultanate of Oman

Dr. Medhat K. ElSayed

Its Development and Potential ImplicationsIts Development and Potential Implicationson Vital Statisticson Vital Statistics

Page 2: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

2

ObjectivesObjectives

• Health System in Oman – Brief

• Development of Civil registration – birth and death notifications

• Reporting on Vital Events before and after Civil registration

• Status of Vital Events Data

• Implications on Mortality & Fertility Estimates

Page 3: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

3

Health System in OmanHealth System in Oman• Total area is 309.5 thousands Km2

–3% Plans–15% Mountains–82% Wadis & Desert

• 8 Governorates / Regions (now 9) with 60 Wilayates (61)

• 10 Health Regions (now 11)• Upper Middle Income • Total Government Expenditure millions

RO 4469.8 (≈US$11,579.8 millions)• Per Capita GDP RO 5321.5

(≈US$13,786)• Total Health Expenditure 3% of GDP• Per Capita Health Expenditure RO 84

(≈US$214)

Source: Monthly Statistical Bulletin, Ministry of National Economy, volume 18(4), April 30, 2007

Page 4: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

4

Health System in Oman … cont

• Population is about 2.6 millions; of whom 1.9 millions are Omanis (27% Expatriates)

• About 95% of enumeration areas are less than 1000 and present only 17.6% of the total Population

Page 5: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

5

Health System in Oman … cont

• Relatively young – 38.9% below 15 years of age– 11.9% below 5 yeas of age

• Relatively high fertility– TFR 3.14 per women 15049– CBR 24.75 per 1000 population

• Low Death Rates– CDR 2.53 per 1000 population– Life Expectancy at Birth 74.3

years– IMR 10.28 per 1000 Live Births

• Natural Increase Rate 2.2% • Expected to double in 30 years

80 +

75-79

70-74

65-69

60-64

55-59

50-54

45-49

40-44

35-39

30-34

25-29

20-24

15-19

10-14

5-09

0-04

0%2%4%6%8%10%

Males

0% 2% 4% 6% 8% 10%

Females

Page 6: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

6

Health System in Oman … cont

• Public Health System– Government finance and provide health care and health services– Public health expenditure accounts for 80% of total health expenditure– Public inpatient services 98%, public dental services 41% and public

outpatient services 81%– Government provides 93% of hospitals and 97.6% of hospital beds– Public health services has 78% of doctors 92.5% of nurses and 85% of

other paramedics

• Ministry of Health is the main health Care provider (49 H, 4549 B, 145 HC)

• Other health care providers: – Armed Forces Medical Services (AFMS) (3 H, 260 B, 31 C) – Royal Oman Police Medical Services (ROPMS) (1 H, 48 B, 3 C)– Sultan Qaboos Hospital (SQUH) (1 H, 307 B, 1 HC)– Diwan Medical Services (Diwan MS) (1 C)– Petroleum Development Oman Medical Services (PDOMS) (9 C)– Private Sector (5 H, 732 C)

H: Hospital, B: Beds, HC: Health Center, C: Clinics

Page 7: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

7

Health System in Oman … cont

• A modern state started with the Omani Renaissance in 1970

• Interests to document births and deaths started gradually after 1970

• During early 80’s age estimation for public employees

• Age may not be accurate for a considerable proportion of people above the age of 25 years

Page 8: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

8

Health System in Oman … cont

• Estimates for fertility and mortality indicators were based on surveys and studies with indirect statistical methods and models

• Events taking place were notified and certificates issued but no compulsory registration– Public Health Institutions: Issue certificates– Private Health Institutions: Notification of event to MOH– Home events: Notification of event by community leader

(Sheikh – Wali) to MOH

• Well established information system capturing service events– Deaths: hospital deaths, dead on arrival, A&E deaths– Births: hospital births, born before arrival

Page 9: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

9

Health System in Oman … cont

• Coverage of events registered could not be properly assessed

• Estimates could not be segregated by important parameters as age and sex

– Mortality Estimates• Age –sex specific death rates to allow for a life table analysis• Infant mortality Rate, Under 5 mortality Rate• Life expectancy

– Fertility Estimates• Age specific fertility rate for male and female births

separately to allow estimating reproduction rates

Page 10: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

10

Mortality EstimatesMortality Estimates

0

20

40

60

80

100

120

140

160

180

200

pe

r 1

00

0

0

10

20

30

40

50

60

70

80

90

100

yea

rs

CDR IMR U5MR e0

Projection based on

2003 Census

Survey data

Preceeding Birth

Technique

Based on IMR estimates Based on IMR

1993 Census

2003 Census

Page 11: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

11

Fertility EstimatesFertility Estimates

0

10

20

30

40

50

60

LB p

er 1

000

0

2

4

6

8

10

12

TF

R (

pe

r w

om

en

15

-49

)

CBR TFR

1993 census

Survey

2003 census

census +

service data

Page 12: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

12

Development of Civil Development of Civil RegistrationRegistration

• A Royal Decree (66/99) to develop a civil status was made in October 1999 but implementation took place only in May 2004

• The law has established the Directorate General of Civil Status (DGCS) at Royal Oman Police (ROP)– Develop the implementing regulations of the Law– Register civil status events

• Events: birth, death, marriage, divorce, citizenship, residence

– Issue certificates– Issue ID Cards

Page 13: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

13

Notification of Births and DeathsNotification of Births and Deaths

• Registration is based on notifications of events

• Establishment of a System of notification of vital events – Identification of all possible sources of notifications– One notification system

• Birth & Death Notification Forms :Consider requirements of CS Law and health sector

• Notification path

• Birth and Death Notification forms were developed by a body established by Minister of Health– Notifications considered needs: administrative needs,

health needs

Page 14: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

14

Possible sources of Possible sources of NotificationsNotifications

Place of birth or death Source of notifications

MOH Hospitals & HC MOH health institutions

AFMS Hospitals and dispensaries AFMS health institutions

ROP Hospitals and dispensaries ROP health institutions

SQU hospital & HC SQU hospital

Private hospitals & clinics Private health institution

Home Community leader (Sheikh – Wali)

Factors, companies, roads, transportation Nearest health institution –with ROP

Outside Oman Omani mission in country where event

Notification of Births and Deaths … cont

Page 15: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

15

Flow of NotificationsFlow of Notifications

Notification of Births and Deaths … cont

MOH: Ministry of Health; AFMS: Armed Forces Medical Services; Prvt HI: Private Health Institutions; ROPMS: Royal Oman Police Medical Services; CL: community leaders; OM: Omani Missions

MOH

SQUH

AFMS

Prvt HI

ROPMS

C L

O M

DG CS

Client

Cop

y o

f n

oti

fica

tion

form

s fr

om

pla

ces

oth

er

than

M

OH

Page 16: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

16

Assessment of 2006 Data Assessment of 2006 Data from Vital Events from Vital Events NotificationNotification• Missing segregation information• Pattern according to age• Completeness (coverage)

Page 17: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

17

Segregation of informationSegregation of information

32%30%

0%

10%

20%

30%

40%

Omani Expatriate

Assessment of 2006 Data from Vital Events Notification … contAssessment of 2006 Data from Vital Events Notification … cont

Gender unknown for 30% of notified deaths Gender unknown for 30% of notified deaths

Page 18: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

18

Segregation information … contSegregation information … cont

12.2%

9.6%

27.0%

5.8%

0.0%

10.0%

20.0%

30.0%

Omani Expatriate

Males Females

Assessment of 2006 Data from Vital Events Notification … contAssessment of 2006 Data from Vital Events Notification … cont

Unknown age of notified deaths Unknown age of notified deaths

Page 19: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

19

Segregation information … contSegregation information … cont

0.3%0.8%

0.0%

10.0%

Omani Expatriate

Assessment of 2006 Data from Vital Events Notification … contAssessment of 2006 Data from Vital Events Notification … cont

Sex of newly born un reportedSex of newly born un reported

Page 20: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

20

Segregation information … contSegregation information … cont

13.6%

5.0%

0.0%

10.0%

20.0%

Omani Expatriate

Assessment of 2006 Data from Vital Events Notification … contAssessment of 2006 Data from Vital Events Notification … cont

Un-reporting age of mother for newly bornUn-reporting age of mother for newly born

Page 21: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

21

Pattern according to Age Pattern according to Age and Sexand Sex

Assessment of 2006 Data from Vital Events Notification … contAssessment of 2006 Data from Vital Events Notification … cont

Natural log (ln) of ASDR for Males 2006

-1.000

0.000

1.000

2.000

3.000

4.000

5.000

6.000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Natural log (ln) of ASDR for Females 2006

-2

-1

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Page 22: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

22

Completeness or CoverageCompleteness or Coverage

-

0.0200

0.0400

0.0600

0.0800

0.1000

0.1200

0.1400

0.1600

- 0.0200 0.0400 0.0600 0.0800 0.1000 0.1200

Dx+/Nx+

Nx/

Nx+

Assessment of 2006 Data from Vital Events Notification … contAssessment of 2006 Data from Vital Events Notification … cont

Males Coverage 98%

Using Brass’s Growth Balance Method(preliminary analysis)

Females Coverage 97%

-

0.0200

0.0400

0.0600

0.0800

0.1000

0.1200

0.1400

- 0.0100 0.0200 0.0300 0.0400 0.0500 0.0600 0.0700 0.0800

Dx+/Nx+

Nx/

Nx+

Page 23: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

23

Mortality EstimatesMortality Estimates2006

Current estimate

2006 estimates using notifications of Vital

events

Omani Expat Omani Expat

CDR - Overall

2.48Not

available2.9 1.2

CDR - MaleNot

availableNot

available3.4 1.2

CDR- Females

Not available

Not available

2.3 1.1

e0 - Overall 74.29Not

available72.6 81.6

e0 - Male Not available

Not available

70.4 81.9

e0 - Females Not available

Not available

74.9 81.2

ASDR ProjectedNot

availableavailable available

Page 24: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

24

Mortality Estimates … contMortality Estimates … cont

2006 Current estimate

2006 estimates using notifications of Vital

events

Omani Expat Omani Expat

IMR - Overall 10.25Not

available10.1 8.1

IMR - MaleNot

availableNot

available11 9

IMR- FemalesNot

availableNot

available9.2 7.1

U5MR - Overall

11.02Not

available12.8 12.9

U5MR - MaleNot

availableNot

available13.8 13.5

U5MR - Females

Not available

Not available

11.8 6

Page 25: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

25

Fertility EstimatesFertility Estimates2006

Current estimate

2006 estimates using notifications of Vital

events

Omani Expat Omani Expat

CBR - Overall 24.17Not

available24.2 5.7

CBR - MaleNot

availableNot

available24.6 3.7

CBR- FemalesNot

availableNot

available23.7 13.4

TFR 3.19Not

available3.19 1.03

Sex ratio birthNot

availableNot

available105.8 101.7

GRR (females)Not

availableNot

available1.55 0.51

NRRNot

availableNot

available1.51 0.50

Page 26: Civil Registration in Sultanate of Oman

Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics

26

Obstacles and challengesObstacles and challenges

• Notifications by Community Leaders– Need to assess completeness– Data on notification forms need to be completed

especially health related data– Cause of death is an issue to consider

• Burial permit– No burial permit is required– Can affect completeness of death registration

• Cultural believes and attitudes for registration– Age estimation has been practice for a long time– Changes in believes about importance for registration

• Cause of death data– Physician and coders need training– Deaths outside health facilities: DOA, A&ED, Notified by

CL


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