Introduction
The purpose of this report is to provide a brief introduction to the civil registration and vital statistics (CRVS) system in Zambia. The information was collected through a questionnaire completed by the Ministry of Home Affairs of Zambia in February 2020 and supplemented by a desk review of available documents. Among other things, the report presents:
- Background information on the country;
- Selected indicators relevant for CRVS improvement processes;
- Stakeholders’ activities; and
- Resources available and needed to strengthen CRVS systems and coordination.
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
The Republic of Zambia is a landlocked country in southern-central Africa. Its neighbours are the Democratic Republic of the Congo to the north, Tanzania to the northeast, Malawi to the east, Mozambique to the southeast, Zimbabwe and Botswana to the south, Namibia to the southwest, and Angola to the west.
Zambia is divided into 10 provinces for administrative purposes. Provinces are further divided into a total of 118 districts.
752,618
17,351,8221
2.92
563
CRVS Dimensions
Birth
| Completeness of birth registration |
11% (20144 ) |
| Children under 5 whose births were registered |
11.3% (20145 ) |
| Births attended by skilled health professionals |
63% (20146 ) |
| Women aged 15-49 who received antenatal care from a skilled provider |
55.5% (20147 ) |
| DPT1 immunization coverage among 1-year-olds |
94% (20188 ) |
| Crude birth rate (per 1,000 population) |
37 (20179 ) |
| Total fertility rate (live births per woman) |
4.6 (201810 ) |
| Adolescent fertility rate (per 1,000 girls aged 15-19 years) |
120 (201711 ) |
| Population under age 15 |
47% (201212 ) |
Death
| Completeness of death registration |
20% (201713 ) |
| Crude death rate (per 1,000 population) |
7 (201714 ) |
| Infant mortality rate (probability of dying by age 1 per 1,000 live births) |
40.5 (201815 ) |
| Under five mortality rate (probability of dying by age 5 per 1,000 live births) |
57.8 (201816 ) |
| Maternal mortality ratio (per 100,000 live births) |
213 (201717 ) |
Marriages and divorces
| Marriage registration rate |
Not available |
| Women aged 20-24 first married or in union before age 15 |
5 (201718 ) |
| Women aged 20-24 first married or in union before age 18 |
31 (201719 ) |
| Divorce registration rate |
Not available |
Vital statistics including causes of death data
| Compilation and dissemination of CR-based statistics |
Available (N/A) |
| Medically certified causes of death data |
Available (N/A) |
Civil registration system
Legislative Framework
The main legislative act that defines responsibilities and procedures for registration of births and deaths is the Birth and Death Registration Act Cap 51, from 1973. It provides a uniform law for the registration of all births and deaths in Zambia without distinction of origin or descent. The birth notification aspect of the registration process is decentralized to all districts in the country. All persons born after 14 March 1973 are required by law to obtain birth certificates, but historically low registration rates indicate that this provision has not been strictly enforced. The Adoption Act Cap 50, Marriage Act Cap 54, and Statutory Instrument no. 44 of 2016 define responsibility for registering marriages and adoptions. Birth and death definitions in the law are in line with United Nations standards, which is not the case for the definitions of marriage and adoption.
Management, organization and operations
The Department of National Registration, Passport and Citizenship (DNRPC), under the Ministry of Home Affairs, is the authority mandated to carry out civil registration. It has representation in each province and district, with facilities located at the district headquarters. Until recently, certification of registered births was centralized at the DNRPC headquarters in the capital, Lusaka; birth and death certificates could be obtained there. As part of ongoing reforms, DNRPC introduced a service that transports birth certificates produced at the capital back to the districts and distributes them to persons who ask to register a vital event. As a result of ongoing reforms, the certification part of the registration process is also being transferred to the provincial level.
National CRVS systems coordination mechanisms
In line with guidance from the Africa Programme on Accelerated Improvement of Civil Registration and Vital Statistics (APAI-CRVS), a national coordination mechanism has been set up to decide on the best way to advance a national CRVS system and to oversee the implementation of improvement policies. The coordination is entrusted to a high-level CRVS Steering Committee, made up of the Ministry of Home Affairs, Ministry of Health, Ministry of National Development Planning, and Zambia Statistics Agency. Also, dedicated CRVS technical working groups were set up to bring together appointed representatives from the following groups:
- Ministry of Home Affairs;
- Ministry of Health;
- Ministry of National Development Planning and Zambia Statistics Agency;
- Ministry of Local Government and Housing;
- Ministry of Chiefs and Traditional Affairs;
- Ministry of Community Development;
- UNICEF;
- World Health Organization;
- World Vision; and
- Expanded Churches Response.
Terms of reference define the duties and responsibilities of the technical working groups.
Administrative level registration centres
The DNRPC has established registration offices outside the capital city to improve access for registration and to bring registration services closer to the people. There are 615 registration offices: 75 are in urban centres and 540 are in the districts in rural areas.
Accessibility of civil registration services
To reach the closest civil registration office, household members in urban areas need to travel 5 to 10 km on average; in rural areas, this distance can exceed 10 km. Translated into travel time, in urban areas registration centres can be reached within less than one hour on foot. In rural areas, this might take four to eight hours on foot, or one to four hours by car.
Registration of vital events
The law defines that births should be registered within one month following birth, but a registration is considered late only after 12 months. Parents can initiate birth registration at the health facility where the child was born (if the facility provides such services) or at the DNRPC office in their district. As a first step in the registration process, parent(s) or guardian(s) must present their National Registration Card. After the applicants have been identified, registration agents at health facilities complete the Notice of Birth, to which they attach a document issued by the maternity ward. Registration agents at health facilities complete the Notice of Birth; these are transferred regularly to the DNRPC office in the appropriate district. Based on the notification of birth from health facilities, the district registrar enters a new registration record into the birth registration book.
If the birth did not take place at the health facility and the Child’s Clinic Card (known as the Under 5 Card) is not available, the registration can be completed only at the DNRPC office in the respective district. If there is no medical birth record or Under 5 Card, an Affidavit Form M can be used. If the birth is registered after 12 months, an Affidavit Reg – Form 12 needs to be completed for late registration. The form allows applicants to give reasons why the birth was not registered within the stipulated period. If the registration request is submitted at the district DNRPC office, the Notice of Birth and the entry in the birth registration book are done at the same time.
Birth registration applications from the districts are physically transferred to the provincial DNRPC offices or to the Lusaka DNRPC office for districts located within the capital city. At these centres, information from the registration forms is digitized using data entry. It is then transferred into a central birth register database. An authorized registration official verifies each newly entered digital record from the registration form, which gives the option to print birth certificates. Printed birth certificates are physically transferred back to the districts and from there to the respective health facility. The whole process from the moment of registration until the certificate is made available for collection at the original registration point takes about one month.
Based on the procedures, the beginning of the death registration process varies, depending on where a person dies. For a death in a health facility, a physician must provide information, including the medical cause of death certificate. If the death occurs outside of a medical facility — as, according to some estimates, nearly half of all deaths in Zambia do — a police report or a letter from the chief/headman must be provided. Deaths must be reported within 24 hours of their occurrence. The informant’s full name and address must be submitted, along with the deceased person’s medical cause of death, identity card, burial permit, occupation, age, and sex.
Zambian marriages are categorized as civil marriages solemnized by the Registrar General or customary marriages solemnized by the local courts. Civil marriages can be concluded by local council officials or at the church, as the law appoints both institutions as registration agents. The Registrar General needs to be notified within 21 days following the conclusion of civil marriage. Customary marriages are recognized by the decision of local courts. In times of divorce, the high court is responsible for civil marriage cases, while the local court decides on the dissolution of customary marriages.
Backlog of unregistered births
No information available.
Vital statistics system
Registration of vital events, other than the legal aspect, includes collecting the data required for producing vital statistics. Forms have been updated to ensure that statistical variables are included in the registration forms and that statistical data is collected, processed, and tabulated in aggregated form. The events data is anonymized for transition to the statistical authority, where a dedicated team processes data. The team is made up of officers from DNRPC and the Central Statistical Office (CSO).
Causes of death
About 65 percent of deaths occur in health facilities, while 35 percent take place outside health facilities. In 2017, HIV was the leading cause of death, accounting for about 24 percent of all health facility deaths. Gestational and fetal growth disorders were the most common cause of death among children aged 0 to 4 years. For non-communicable diseases, 29 percent of deaths were caused by cardiovascular diseases. Road traffic accidents accounted for about 29 percent of deaths outside health facilities.20
Sample Vital Registration with Verbal Autopsy (SAVVY) is a family of methods that MEASURE Evaluation and the U.S. Census Bureau developed. It allows the direct measurement of vital events and the determination of causes of death in a nationally representative sample of small areas, or in selected “sentinel” locations. In Zambia, the first phase of SAVVY was led by the CSO, in partnership with the Ministry of Health and other government institutions. The process of conducting verbal autopsies differs by country. Zambia uses employees of the Ministry of Health, who use WHO questionnaires and follow the standard SAVVY process of conducting verbal autopsies for deaths reported by key community informants. Once interviews are conducted, medical personnel certify the death and code the cause of death. Two doctors review the data: if the cause of death differs, the two doctors must reach a consensus. Responsibility for implementing SAVVY lies with the DNRPC, working with the CSO and the Ministry of Health.
- In 2016, ill-defined or unknown causes accounted for 63.7 percent of deaths. This reflects the fact that most of these deaths occurred outside of health facilities and thus the cause was not known.
- Protozoal diseases were among the leading causes, recorded at 4.9 percent.
- These causes were followed by tuberculosis at 4.1 percent and HIV at 4 percent.
- Chronic diseases such as hypertension and other forms of heart disease appeared in the top 10, at 1.7 percent and 1.5 percent, respectively.
- Other natural causes combined formed 12.3 percent of the total deaths registered.21
Digitization
To ensure the development of secure, efficient, and interoperable information and communications technology (ICT) systems among government stakeholders, the Zambian government set out plans to build and promote national ICT infrastructure: this is part of the Smart Zambia initiative. Through this initiative, the government shows its determination to move into the digital age: it aims to increasingly rely on innovative technologies to advance a national program for e-government, e-commerce, and information technology talent.
Computerization
The civil registration system is seen as a key part of designing a digitized identity management infrastructure that Zambian authorities are working on. The Integrated National Registration Information System, set up by the Ministry of Home Affairs, is designed to function as the database for the new e-ID. It will also host civil registration: birth and death registration, marriage registration, and adoption registration.
Smart Zambia was established under Government Gazette No. 836 of 2016 as an e-government division in the office of the President. This initiative aims to transform the country through ICT and electronic government services and processes for effective delivery of public services. As part of Phase I, the Zambian National Data Centre was created to host and provide safekeeping of all digital data that public authorities collect and process. Zambia’s main national data centre is located at the Information and Communication Technology Authority in Lusaka. The Authority’s cloud platform was designed to provide processing, networking, and storage facilities for government, public institutions, and commercial enterprise services.
Political commitment for developing ICT infrastructure will help with the digitizing of registration services, both for CRVS and for civil identification. Phasing out the physical transfer of birth and death registration books for data entry and expanding the number of data entry points in districts will go hand in hand with implementing ICT platforms at the provincial and district levels. Also, further development of an Integrated National Registration Information System (INRIS) will likely benefit from data hosting and cloud services that the national data centre(s) provides.
Online registration services at health facilities
No information available.
Mobile technology application
Mobile technology is not used in civil registration processes.
Unique identification number
No unique identification number is administratively and legally defined that could be used to uniquely identify a person or to link digital records of that person across different digital databases.
Population register
The DNRPC is responsible for both civil registration and identity management. Plans to link the two systems have been adopted; implementation is at an advanced stage. The Ministry of Home Affairs has yet to set up INRIS, but it is designed to function as the database for the new e-ID. It will also host civil registration (birth and death registration, marriage registration, and adoption registration). Combining civil registration and civil identification database management as part of the national identity management system will follow the example of many countries that have created a population register.
Digitization of historical civil registration records
A project to digitize historical civil registration records has not yet begun.
Link with the identification system
Most Zambians aged 16 and older hold the national ID, or National Registration Card. With the INRIS in the process of being set up, the government is planning to replace the National Registration Card with the more advanced e-ID. A contracted private vendor will supply personalization services. Field data-capturing solutions (including biometric data) and the platform for managing collected data will be implemented by the government through the National Registration Information System.
Interface with other sectors and operations
Setting up interoperability with other sectors has not been done yet. Registration data is not available in digital format.
Sample registration forms
Improvement initiatives and external support
Improvement plan and budget
Strategic plan
A five-year costed strategic plan expired in 2019. A second plan is being developed; it was expected to be finalized in the first quarter of 2020 to cover 2020 to 2024.
The budget estimated for the five-year period (2020–2024) is US$19 million.
Budgetary allocations and requirements
The government treasury allocation for the civil registration system for the 2020 fiscal year is projected to be US$121,000. Development partners will cover the remaining US$500,000.
Activities identified as high priorities
The CRVS activities identified as high priorities are in Table 1.
Support from development partners
The development partners that provided and continue to support the civil registration and vital statistics systems improvement initiative are listed in Table 2.
Additional Materials
Websites
Additional materials
DNRPC. 2018. Implementation of Sample Vital Registration with Verbal Autopsy (SAVVY) in Zambia. Dissemination of SAVVY Findings (19 April). Lusaka, Zambia.
Ministry of Home Affairs – Department of National Registration, Passports and Citizenship. 2015. National Strategic Action Plan for Reforming and Improving Civil Registration and Vital Statistics. Implementation Period 2014–2019. Republic of Zambia. crvs-dgb.org/wp-content/uploads/2015/11/Zambia-National-Strategic-Action-Plan-for-CRVS.pdf
Ministry of Home Affairs, Ministry of Health, and Central Statistical Office. 2018. Zambia SAVVY report 2015–16. Mortality and Causes of Death – Information from Verbal Autopsy. Lusaka, Zambia. zamstats.gov.zm/phocadownload/Demography/SAVVY%20Report%202015%20-16.pdf
Nyahoda, M. et al. 2018. Mortality and Cause of Death Profile for Deaths from the Civil Registration System: 2017 Facts and Figures. Health Press Zambia Bulletin 2:9: 17–25. znphi.co.zm/thehealthpress/wp-content/uploads/2018/10/research.pdf
Conclusion
Zambian authorities are committed to reforming and improving CRVS. They are making strategic decisions to ensure that health systems and local communities are better integrated into civil registration and are making better use of ICTs to improve CRVS. This approach includes enabling closer coordination with the Central Statistical Office. Increasing demand for civil registration through awareness campaigns and public education is seen as an important step in achieving this goal. The newly designed birth and death registration system relies on the existing system, but with some key innovations.
- Birth certificates can now be printed not only in Lusaka, but also at the DNRPC offices in the provinces where the registration took place.
- Health facilities within each district have been named as registration points, in addition to DNRPC offices in the provinces.
- A mechanism for ex officio communication between health facilities, district DNRPC offices, and the provincial offices or DNRPC headquarters in Lusaka was introduced. This makes the process less cumbersome for citizens.
To ensure the development of secure, efficient, and interoperable ICT systems among government stakeholders, the Zambian government has set out plans to build and promote national ICT infrastructure. This plan is part of the Smart Zambia initiative. Through this initiative, the government shows it is determined to move into the digital age: it will increasingly rely on innovative technologies to advance a national program for e-government, e-commerce, and IT talent. In such settings, INRIS, as envisaged in the strategic documents, will likely become the provider of identity data in support of the e-government and e-commerce platforms. This national informatization program will also support further digitizing of CRVS and the operation of INRIS.
Endnotes
- 1World Bank. 2019. Population, total – Zambia. data.worldbank.org/indicator/SP.POP.TOTL?locations=ZM
- 2World Bank. 2019. Population growth (annual %) – Zambia. data.worldbank.org/indicator/SP.POP.GROW?locations=ZM
- 3World Bank. 2018. Urban population (% of total population) – Zambia. data.worldbank.org/indicator/SP.URB.TOTL.IN.ZS?locations=ZM
- 4World Bank. 2014. Completeness of birth registration (%) – Zambia. data.worldbank.org/indicator/SP.REG.BRTH.ZS?locations=ZM
- 5UNICEF. 2017. Cross-sector Indicators: Percentage of children under age 5 whose births are registered. UNICEF Data: Monitoring the situation of children and women. data.unicef.org/resources/data_explorer/unicef_f/?ag=UNICEF&df=GLOBAL_DATAFLOW&ver=1.0&dq=.PT_CHLD_Y0T4_REG.&startPeriod=1970&endPeriod=2020
- 6World Bank. 2014. Births attended by skilled health staff (% of total) – Zambia. data.worldbank.org/indicator/SH.STA.BRTC.ZS?locations=ZM
- 7UNICEF. 2019. Antenatal care. UNICEF Data: Monitoring the situation of children and women. data.unicef.org/topic/maternal-health/antenatal-care
- 8UNICEF. 2018. Cross-sector indicators: Percentage of surviving infants who received the first dose of DTP-containing vaccine. UNICEF Data: Monitoring the situation of children and women. data.unicef.org/resources/data_explorer/unicef_f/?ag=UNICEF&df=GLOBAL_DATAFLOW&ver=1.0&dq=.IM_DTP1..&startPeriod=2015&endPeriod=2020
- 9World Bank. 2019. Birth rate, crude (per 1,000 people) – Zambia. data.worldbank.org/indicator/SP.DYN.CBRT.IN?locations=ZM
- 10World Bank. 2019. Fertility rate, total (births per woman) – Zambia. data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=ZM
- 11World Bank. 2017. Adolescent fertility rate (births per 1,000 women ages 15-19) – Zambia. data.worldbank.org/indicator/SP.ADO.TFRT?locations=ZM
- 12UN DESA Population Division. 2012. Country population by age. unstats.un.org/unsd/demographic/products/indwm/Dec.%202012/1b.xls
- 13Nyahoda, M. et al. 2018. Mortality and Cause of Death Profile for Deaths from the Civil Registration System: 2017 Facts and Figures. Health Press Zambia Bulletin 2(9): 17–25. znphi.co.zm/thehealthpress/wp-content/uploads/2018/10/research.pdf
- 14World Bank. 2019. Death rate, crude (per 1,000 people) – Zambia. data.worldbank.org/indicator/SP.DYN.CDRT.IN?locations=ZM
- 15World Health Organization (WHO). 2018. Maternal, newborn, child & adolescent health. who.int/data/maternal-newborn-child-adolescent/indicator-explorer-new/mca/infant-mortality-rate-(per-1000-live-births)
- 16UNICEF. 2018. Key demographic indicators – Zambia. UNICEF Data: Monitoring the situation of children and women. data.unicef.org/country/zmb
- 17UNICEF. 2017. Cross-sector indicators: Maternal mortality ratio (number of maternal deaths per 100,000 live births). UNICEF Data: Monitoring the situation of children and women. data.unicef.org/resources/data_explorer/unicef_f/?ag=UNICEF&df=GLOBAL_DATAFLOW&ver=1.0&dq=.MNCH_MMR+MNCH_LTR_MATERNAL_DEATH+MNCH_MATERNAL_DEATHS..&startPeriod=2016&endPeriod=2020
- 18World Health Organization (WHO). 2018. Global Health Observatory data repository. Women aged 20‒24 years married or in a union before age 15 and 18. apps.who.int/gho/data/view.main.GSWCAH45v
- 19World Health Organization (WHO). 2018. Global Health Observatory data repository. Women aged 20‒24 years married or in a union before age 15 and 18. apps.who.int/gho/data/view.main.GSWCAH45v
- 20Nyahoda, M. et al. 2018. Mortality and Cause of Death Profile for Deaths from the Civil Registration System: 2017 Facts and Figures. Health Press Zambia Bulletin 2(9): 17–25. znphi.co.zm/thehealthpress/wp-content/uploads/2018/10/research.pdf
- 21Central Statistical Office and Ministry of Home Affairs of Zambia. 2019. Vital Statistics Report 2016. zamstats.gov.zm/phocadownload/Demography/2016%20VITAL%20Statstics%20%20Report.pdf
Annex
