Civil registration is critical for human rights and effective governance. Globally, almost half of the world’s children, most of them in Africa, do not have their birth registered and are consequently invisible in the eyes of the law. Being invisible, they are vulnerable to many forms of abuse and neglect. They may also be unable to access to health services because their governments do not know they exist. It is not only births that go uncounted, around two-thirds of all deaths currently go unregistered, leaving the details of death unknown and potential responses to their causes impossible.
The digitization of Civil Registration and Vital Statistics (CRVS) has the potential to transform levels of both birth and death registration by extending registration coverage to the hard to reach, simplifying administrative processes, and sharing data between systems. CRVS systems help us to better understand how investments in health are impacting lives and provide a continuous source of mortality statistics. They also help us to more accurately plan for health interventions based on a clear understanding of the occurrence and characteristics of these events. The interaction between health systems and CRVS is very important. By leveraging health interactions as a source of civil registration information, the chances of universal civil registration multiply. Likewise, births and deaths identified in the community through the CRVS system can inform future health interventions.
Developed by Plan International and Jembi Health Systems, OpenCRVS is an open source digital CRVS solution that is free to use, adaptable to the country context, and interoperable with other government systems (e.g., health and ID systems). Prior to applying to Digital Square’s Notice B, OpenCRVS had documented requirements and business processes in a number of countries in Africa and Asia and developed a prototype application. Co-investment from Digital Square and DIAL has since accelerated product development, providing funding for an in-depth proof of concept in Bangladesh, including the technical feasibility testing of the essential health interoperability framework and establishing sustainability measures for OpenCRVS as a global good.
“The investments in OpenCRVS have helped us demonstrate the potential for a global public good that responds to the challenges of CRVS in low-resource settings,” says Edward Duffus, Head of Innovation at Plan International. “It will help us prove that civil registration can be made easy and accessible to all, it will raise the standard for CRVS globally, and it will demonstrate how CRVS can be used to recognise, protect, and provide for all individuals for a lifetime.”
In April 2019, Plan International demonstrated the OpenCRVS proof of concept in Bangladesh. The proof of concept was the product of working closely with the Cabinet Division and key CRVS stakeholders from across government, as well as extensive design research in the field. Following the principles of human centered design, the product reflects end-user inputs from various urban and rural contexts. It was tested iteratively with users in the field and updated to better reflect their needs. Following a very positive response to the proof of concept, the Government of Bangladesh requested a pilot of the system to start in 2020.
Annina Wersun, the OpenCRVS Product Owner, says “OpenCRVS is the direct result of listening to people who struggle to access and offer civil registration services, of observing their challenges, understanding their needs, and directly responding to these when we design and build the product. By putting users at the center, OpenCRVS works for those it serves.”
Due to the critical interaction between health systems and CRVS, OpenCRVS uses FHIR (Fast Healthcare Interoperability Resources), which is a set of standards for exchanging healthcare information electronically, developed by HL7. OpenCRVS makes innovative use of these standards by adapting them for use in a civil registration environment. The FHIR templates map the data needed for CRVS birth and death events and are available here. Data can be exchanged with OpenCRVS by posting FHIR documents directly to the FHIR API or by using the MHD profile of FHIR. MHD is the Mobile Health Document profile by IHE, another health data standard that defines the transactions to allow mobile devices, or other resource constrained systems, to access an information exchange.
By the end of 2019, the OpenCRVS system will be production ready, and in January 2020, a pilot of OpenCRVS will begin in two sub-districts of Bangladesh. The purpose of this pilot is to test how OpenCRVS can enable a new model of CRVS in Bangladesh, one that helps transform birth and death registration services in order to achieve universal registration of births and deaths and maximize the use of civil registration data for policy making and the provision of essential services such as health.
Plan and Jembi are also planning for the sustainable future of OpenCRVS. “The current thinking is to spin off from Plan International and create a new legal entity, which would manage core product development, build and train the open-source community, and accredit system integrators and implementations,” says Ed. “To create a sustainable model for OpenCRVS, we are looking keenly at ways that the organization can generate revenues so that it is not dependent on donor funding in the medium/long term.”
For more information about OpenCRVS, visit the OpenCRVS website.
This article was originally published in the Digital Square Global Goods Community Newsletter.