Introduction
The purpose of this report is to provide a brief introduction to the civil registration and vital statistics (CRVS) systems in Liberia.
The information was collected through a questionnaire completed by the Ministry of Health in January 2019 and supplemented by a desk review of available documents. The report presents country background, selected indicators relevant for CRVS improvement processes, stakeholders’ activities as well as resources available and needed to strengthen CRVS systems, coordination, among others.
Disclaimer: The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations.
Country profile
Liberia is a country located in West Africa. It is bordered by Sierra Leone to the northwest, Guineas to the north and Cote d’Ivoire to its east. It has a long coastline along the Atlantic Ocean to its south and south-west. Liberia is administratively divided into 15 counties.
1113691
4.28
2018
2.52%2
CRVS Dimensions
Birth
| Completeness of birth registration |
<25% (20183 ) |
| Children under 5 whose births were registered |
24.6% (20134 ) |
| Births attended by skilled health professionals |
61.1% (20134 ) |
| Women aged 15-49 who received antenatal care from a skilled provider |
95.9% (20134 ) |
| DPT1 immunization coverage among 1-year-olds |
99% (20165 ) |
| Crude birth rate (per 1,000 population) |
34 (20165 ) |
| Total fertility rate (live births per woman) |
4.6 (20165 ) |
| Adolescent fertility rate (per 1,000 girls aged 15-19 years) |
128.8 (20166 ) |
| Population under age 15 |
41.8 (20177 ) |
Death
| Completeness of death registration |
<5% (20183 ) |
| Crude death rate (per 1,000 population) |
8 (20165 ) |
| Infant mortality rate (probability of dying by age 1 per 1,000 live births) |
56 (20178 ) |
| Under five mortality rate (probability of dying by age 5 per 1,000 live births) |
75 (20178 ) |
| Maternal mortality ratio (per 100,000 live births) |
725 (20159 ) |
Marriages and divorces
| Marriage registration rate |
NA |
| Women aged 20-24 first married or in union before age 15 |
8.8% (20134 ) |
| Women aged 20-24 first married or in union before age 18 |
35.9 (20134 ) |
| Divorce registration rate |
NA |
Vital statistics including causes of death data
| Compilation and dissemination of CR-based statistics |
NA (N/A) |
| Medically certified causes of death data |
NA (N/A) |
Civil registration system
Legislative Framework
In Liberia, registration of vital events is governed by a number of legal instruments:
- Registration of births and deaths is governed by the Public Health Law of 1976 and the Executive Law of 1972. The country’s civil registration legislation provides for the compulsory registration of births and deaths within the country.
- Registration of marriages and divorces is mandated by the Executive Law of 1972 with respect to Traditional Marriage and Divorce Registration; and the New Domestic Law of Liberia of 1973 regarding Western Marriage and Divorce Registration. The Children’s Law of 2008 covers Adoption Registration.
Management, organization and operations
There is no specific ministry in charge of registration of all vital events. Rather, several ministries are responsible for the registration of births, deaths, marriages, divorces and adoptions. The registration of these events currently covers all segments of the population and all geographic areas of the country.
National CRVS systems coordination mechanisms
The CRVS improvement strategic plan of 2015 recommends setting up a standing inter-agency mechanism at the national level for coordinating the CRVS program but it has not yet been established. During the period leading to the preparation of the strategic plan, such an inter-agency technical committee was organized but the collaboration was weak. The coordination mechanism was reactivated in 2018 to prepare for the African CRVS Day (August 10) and met once in 2019 to ensure that the day was commemorated.
Administrative level registration centres
At present, there are 15 registration centers for births and deaths located in urban districts in each of the counties. Each center is manned by a registrar. The 15 counties are currently subdivided into 92 health districts. Not all the districts have registration offices. The CRVS improvement strategic plan of 2015 envisages to expand the registration centers in a phased manner from the county level to all districts10 . Birth and death registration centers have been reactivated in four hospitals in Monrovia and are expected to be functional in 15 of the 35 hospitals by the end of 2019.
Accessibility of civil registration services
In urban areas of Liberia, most households reside less than 5 kms from the district registration offices. In rural areas, most households are estimated to be 5 to 10 kms away from the urban district registration offices, which currently serve as the lowest level of registration offices.
The estimated time it would take most urban dwellers to reach a registration office by motorcycle or car ranges between 30 minutes to 2 hours, while it could take up to 5 hours for rural households. On the other hand, for those who opt to cover the distance on foot, the estimated time it could take an urban dweller is up to 2 hours and more than 8 hours for a rural dweller11 .
Registration of vital events
- Definitions of live births and deaths are aligned to international recommendations.
- Civil registration offices prepare legal and statistical paper records in a combined form.
- There is no fee for registering births, marriages, divorces and deaths.
- Birth certificates are issued for free, but charges are levied for certificates requested for late registrations. Fees for vital events certificates are given in Table 1.
Table 1: Direct costs associated with obtaining vital events certificates
|
Vital events |
Certificates in US Dollars |
Remarks |
|
Births |
3.05 |
For delayed birth registration (13 years and over) |
|
Marriages - Western |
180 |
A couple needs both bachelorhood and spinsterhood certificates (US$ 15 each) before they can get married. This has increased the cost from US$ 150 to US$ 180 |
|
Marriages - Traditional |
50 |
For traditional marriages, there is no need to obtain bachelorhood and spinsterhood certificates |
|
Divorces |
Not available |
|
|
Deaths |
3.05 |
All ages |
|
Source: MOH |
US$ 1= LRD 164 |
|
The Western/faith-based marriages and divorces system is under the Center for National Documents and Records Agency. The agency is decentralized and the county marriage registrar is responsible for registering marriages and divorces in each county. Based on customary laws, traditional marriages are registered centrally by the Ministry of Internal Affairs.
There is no link between the birth and death registration system and that of marriages and divorces.
Backlog of unregistered births
Interface with other sectors and operations
The civil registration and vital statistics systems in Liberia are not integrated among themselves or with other sectors. Several institutions are responsible for the systems as follows: birth and death registration system under MOH; marriage and divorce system under the Center for National Documents and Records Agency (CNDRA), and vital statistics production under both the MOH statistics department and the Liberia Institute for Statistics and Geo-Information Services (LISGIS). Liberia has a national identification system, which is not linked to the systems mentioned here.
Vital statistics system
The responsibility of compiling and disseminating registration-based statistics on births and deaths belongs to the Bureau of Vital Statistics (Bureau) in the Ministry of Health (MOH). The vital statistics system does not yet produce reliable statistics from civil registration data. However, some birth and death data is produced by the Bureau of Vital Statistics from reports and limited surveys. The Bureau does not collect and compile data on causes of death. However, the MOH has trained medical doctors in the use of the World Health Oorganization Medical Certification of Cause of Death (MCCoD) and is expected to implement the use of MCCoD by 2019. This will allow the collection and compilation of cause of death data for publication in 2020.
The Liberia Institute of Statistics and Geo-Information Services (LISGIS)’ mandate is to ensure coordination among statistics producers and users to report on national birth, death, marriage, and divorce registration figures and place birth and death, marriage, and divorce registration on the development agenda. LISGIS also serves as chair of the national vital statistics development steering and technical committees, which are major for the advocacy and awareness of birth and death registration.
Causes of death
Causes of deaths are recorded for deaths occurring in health facilities. The standard international form for a medical certificate of cause of death is expected to be rolled out to hospitals in 2019 and is expected to be used by all hospitals and health centers by the end of 2019.
The strategic plan for 2016-2020 shows the intention of the government to determine causes of deaths according to international standards and code and to record them using adopted ICD10 in real time. It is also planned to implement verbal autopsies for deaths in the community.
Digitization
Computerization
|
Computers used in |
Yes |
No |
Remarks |
|
All local registrations offices in the country |
X |
|
District registration offices |
|
Health facilities |
X |
|
|
|
Other, please specify |
X |
|
At the County Service Centers |
Mobile technology application
Mobile technology was recently introduced at the central level to register birth and pay for services through mobile money. It is expected to be used for death. Online registration for birth and death will be cascaded to all parts of the country by the end of 2019. The online platform is available at www.liberiabirthcertificate.com.
Sample registration forms
Improvement initiatives and external support
Improvement plan and budget
Strategic plan
In 2013, an assessment of births and deaths registration was conducted and in the same year, the Birth Registration Improvement Plan: 2014 – 2018 was developed. It was later revised and expanded as Improving Civil Registration and Vital Statistics in Liberia: Investment Case – 2016-202013 .
Budgetary requirements and allocations
- The estimated cost to implement the plan over 5 years was US$ 3 million.
- Government allocation for the current year was not available.
- Among development partners supporting national CRVS systems improvements, the Global Financing Facility has provided a grant of US$ 1 million for birth and death registration, United Nations Children’ Fund has provided over $200,000 for birth registration over the past 3 years (2015-2018) and the World Health Organization has been supporting death registration.
Activities identified in the national CRVS systems improvement as high priorities
|
High priority areas |
Estimated cost |
Expected government allocation |
Expected budget gaps |
Remarks |
|
Capacity development for marriages and divorces system |
Not available |
Not available |
|
|
|
Introduction of Verbal Autopsy for community deaths |
Not available |
Not available |
|
The objective is to determine the caused of death occurred outside of hospitals. |
|
Conduct of national birth registration census for children under five of age |
US$ 1,000,000 |
Nil |
US$ 1,000,000 |
The intent of the census is to reduce the number of unregistered births by 95%. |
|
Establishment of birth and death registration in 95% of hospitals and health district |
Not available |
Nil |
|
The goal is to reach underserved population and increase coverage of birth and death registration. |
|
Procurement of blank birth and death certificates |
US$ 250,000 |
Nil |
US$ 250,000 |
One million blank copies of birth certificates and 250,000 copies of blank death certificates needed. |
|
Source: MOH |
||||
Support from development partners
The development partners that provided and continue to support the civil registration and vital statistics systems improvement initiative are listed below.
Revision of registration forms; Development of manuals; Planning for death registration and recording of causes of death; Advocacy and awareness raising; Development and implementation of an integrated civil registration management information system; Expansion of registration points; Use of the Community Health Assistant program for the registration of community events; Performance-based component to target health facilities to incentivize birth and death registration
World Bank / Global Financing Facility
Death Registration including cause of death and introduction of ICD and Verbal Autopsy
World Health Organization (WHO)Proposals to improve coordination
Coordination was identified as a key element by MOH in the national CRVS systems landscape. The following suggestions have been provided to improve coordination and working arrangements among national stakeholders and development partners.
National CRVS stakeholders
- Political support towards CRVS from the highest office in the Country;
- Identification of a CRVS leader who is passionate and committed to CR development, resource mobilization and improved coordination and collaboration; and
- Promote CRVS nationally and create public awareness.
National institutes and development partners
- Provide partners with decision-making space regarding CRVS technical issues;
- Ensure transparency and accountability of CRVS resources; and
- Conduct regular coordination meetings
Additional Materials
Websites
Additional materials
Plan International-Ireland: Youtube presentation at https://www.youtube.com/watch?v=DrpdM9dxK1Y
The Guardian. 5 August 2016. Birth certificate: a vital document many Liberians have never heard of. https://www.theguardian.com/global-development/2016/aug/05/birth-certificate-a-vital-document-many-liberians-have-never-heard-of
World Bank. 2016. ID4D Country Diagnostic: Liberia, Washington, DC: World Bank License: Creative Commons Attribution 3.0 IGO (CC BY 3.0 IGO). http://documents.worldbank.org/curated/en/281811489660798714/pdf/113549-REPL-Liberia-ID4D-Diagnostics-Web.pdf
Conclusion
In line with recommendations of the Conference of African Ministers responsible for Civil Registration, Liberia has conducted an assessment of its CRVS systems environment and developed an improvement plan for the period of 2016 to 2020. The main areas identified for improvement, at the high level, were: Improving birth and death registration services; Expanding the coverage of the birth and death registration system; Increasing access to marriage and divorce registration services and information; Improving civil registration information systems; Strengthening legislation and raising awareness and advocacy; Providing human resources; and Coordinating national efforts and project management. When these priority areas are addressed, the CRVS systems in Liberia will show significant improvement. The resources available currently might not bring the required improvements by 2020 unless the government allocates a sufficient budget and resources are mobilized from development partners to address budget gaps.
Endnotes
- 1United Nations (2018). Demographic Yearbook - 2017. https://unstats.un.org/unsd/demographic-social/products/dyb/dyb_2017/. ST/ESA/STAT/SER.R/47.
- 2United Nations. 2017. World Population Prospects: The 2017 Revision, Volume I: Comprehensive Tables. Population Division. https://esa.un.org/unpd/wpp/Publications/Files/WPP2017_Volume-I_Comprehensive-Tables.pdf
- 3ab Questionnaire completed by Ministry of Health for the purpose of preparing this report. January 2019.
- 4abcde Liberia Institute of Statistics and Geo-Information Services (LISGIS), Ministry of Health and Social Welfare [Liberia], National AIDS Control Program [Liberia], and ICF International. 2014. Liberia Demographic and Health Survey 2013. Monrovia, Liberia: Liberia Institute of Statistics and GeoInformation Services (LISGIS) and ICF International. https://dhsprogram.com/pubs/pdf/FR291/FR291.pdf
- 5abcd UNICEF. 2017. The State of World’s Children 2017. https://www.unicef.org/sowc2017/
- 6World Bank. 2018. Adolescent fertility rate. https://data.worldbank.org/indicator/sp.ado.tfrt
- 7United Nations. 2017. World Population Prospects. Volume-II: Demographic Profile. Department of Economic and Social Affairs, Population Division. https://esa.un.org/unpd/wpp/Publications/Files/WPP2017_Volume-II-Demographic-Profiles.pdf
- 8ab United Nations Inter-Agency Group for Child Mortality Estimation (2018). UN IGME. Total Under-5 Mortality Rate, Infant Mortality Rate and Neonatal mortality database 2018. http://www.childmortality.org/
- 9World health statistics 2016: monitoring health for the SDGs, sustainable development goals. https://www.who.int/gho/publications/world_health_statistics/2016/en/
- 10Government of Liberia and World Bank. 2015. Improving Civil Registration and Vital Statistics in Liberia: Investment Case – 2016-2020.
- 11Estimate provided by Ministry of Health, Liberia in 2018.
- 12Liberia Health Systems Strengthening Project. 2015. Improving Civil Registration and Vital Statistics in Liberia: Investment Case (2016–2020)
- 13Government of Liberia and World Bank. 2015. Improving Civil Registration and Vital Statistics in Liberia: Investment Case – 2016-2020.