SeriesA scandal of invisibility: making everyone count by counting everyone
Section snippets
Who counts?
By posing this question, our goal is to focus worldwide attention on the need to recommit resources to the registration of births and deaths, and to certify the causes of death in the world's poorest countries. Published fertility, mortality, and cause-specific mortality figures for rich countries are based on data from functioning civil registration systems and can sensitively monitor long-term and short-term demographic changes, and give up-to-date population counts. Fertility and mortality
Sources of vital statistics
The administrative and technical functions of civil registration and vital statistics systems can be configured in many ways, and responsibilities for maintaining the system and obtaining the vital statistics vary from country to country.10, 11, 12, 13 Figure 1 shows levels and functions in civil registration and the production of vital statistics. Locally, individuals report births and deaths to civil authorities and receive legal documentation—birth and death certificates or burial permits.
Health sector demands for data
Several UN and WHO reports and publications have summarised the poor state of birth and death registration in poor countries.9, 10, 15, 16, 17 The table shows the estimated proportion and number of births in each WHO region that go unregistered every year. The inequalities in registration rates are large; developing countries account for 99% of the estimated 48 million unregistered births, with South Asia and sub-Saharan Africa together accounting for 79% of all unregistered births. According
The beneficiaries, benefits, and risks of registration
Civil registration and death certification with high and representative coverage is essential for individuals, national and sub-national authorities, and the international community. Other methods of registration and collection of data (eg, sample registration systems or research demographic surveillance sites) for cause of death address some statistical needs, but are clearly less useful than civil registration in the long term, and cannot provide the benefits that civil registration provides
Conclusions
The worldwide AIDS pandemic clearly shows that visibility demands accountability, which in turn generates the ability to count. In the 1990s the realities of people living with AIDS in heavily affected countries became visible, and the imperative of action became irresistible. In 2001, the international community put a price-tag on action, and decided that provision of pharmaceutical care at the same standard as developed countries to as many people as could be reached in developing countries
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