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
Dec 10-12, 2007 Gender Statistics from Administrative Data: Civil Registeration & Vital Statistics
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Assessment of 2006 Data Assessment of 2006 Data from Vital Events from Vital Events NotificationNotification• Missing segregation information• Pattern according to age• Completeness (coverage)
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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
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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
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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
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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
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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
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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+
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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
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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
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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
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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