Integrating Services to Scale-up Birth Registration in Nigeria

Rose Wisdom rocks her baby girl back and forth. Mami is only two weeks old and appears uncomfortable with the heat and the bustle around her at the Hope for the Village Child Foundation Centre in Chikun, on the outskirts of Kaduna in Northern Nigeria. After having her newborn daughter registered, Ms. Wisdom is waiting in the queue for child immunization at the centre, which is part of the process of integrating health services and birth registration. Since 2010, many states in Nigeria have begun linking Maternal Newborn and Child Health (MNCH) weeks with birth registration efforts. MNCH weeks are intended to ensure that all children up to 59 months – or under 5, the target age for birth registration – are reached with oral polio vaccinations and other high-impact health interventions. To enable outreach to millions of children under age 5 across the country, including the most under-served and hardest to reach areas, the National Primary Health Care Development Agency has established fixed health posts and employed specialized teams. The Challenge In Nigeria, only 41.5 per cent of births are registered, according to the most recent Multiple Indicator Cluster Survey. While children in the poorest families have birth registration rates of less than 10 per cent, there is a steady increase in birth registration levels as household wealth increases. Children in the richest families have birth registration rates between 50 per cent and 70 per cent. In rural areas, birth registration rates are two to three times lower than in urban areas. Oyelowo Emmanuel, controller for childbirth registration responsible for Chikun Local Government Area (LGA), notes that there are a number of reasons for low compliance with birth registration, including the shortage and limited capacity of birth registrars, along with a lack of public awareness. Furthermore, mothers and caregivers see little benefit to registering in their wards – unlike with immunization, where the benefits are evident in the health and well-being of their children. “We find it difficult to convince so many of the villagers, because they believe we want to use their children’s name for something else,” Mr. Oyelowo says. The community-based strategy of using MNCH weeks offers the opportunity for registration of a wide cohort of under-five children, enabling identification of millions of unregistered children in Nigeria. Joining the efforts of health teams and birth registrars ensures a common strategy for communication and social mobilization at the ward level. The social mobilization teams promote birth registration messages to mothers, care givers, local leaders, and traditional and religious authorities within the LGAs. The Result So far, the strategy has been a success in Chikun, with a significant increase in birth registrations since the start of the programme. Local registrars have developed ‘movement charts’ to coordinate registration activities with local immunization days. During immunization days, more children under 1 year old are attending health centres compared to the rest of the year. Each registrar in Chikun LGA can cover multiple health centers on days with peak attendance and therefore increase overall figures. Mary Stephen, a birth registrar for 17 years, sees slow, steady progress in reaching more mothers. “I am happy that whenever they come for their weekly immunization, we take advantage to register their newborn children,” she says. “And they respond very positively in this regard.” As she leaves for the market with Mami strapped on her back, Rose Wisdom is ready for another day of hard work to ensure the survival of her family. And young Mami now has two cards in her name – one for immunization, one for birth registration. By Rabiu Musa and Geoffrey Njoku Courtesy: UNICEF