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Role of the Health Sector
Sri Lanka
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Civil Registration System
National Level Civil Registration Agency
National level Agency
Does the law designate a national level agency responsible for civil registration?
Yes, it is the Registrar General's Department
Recommended Practice based on International Guidelines
The law should clearly establish an agency with responsibility for establishing and/or managing the civil registration system. The stucture of that system varies. A centralized system has a lead agency or agencies at the central government level, with local offices. The lead central political executive exerts direct legal authority and control over major political subdivisions, such as states or provinces, which house local offices. A decentralized system will have a lead agency or agencies at the level of each major political subdivision, and sometimes even smaller political subdivisions. The smaller political subdivision offices report to the local, as opposed to the central government in centralized systems. This topic is designed to reflect a centralized national structure, or the structure of an individual state within a decentralized system.
In Sri Lanka, the national level entity responsible for civil registration is the The Office of Registrar General within the Ministry of Home Affairs. The Births and Deaths Registration Act designates a three-tiered civil registration structure, with the Registrar General at a national level, District Registrars at a middle level and Registrars of Divisions at a local level.
Birth Registration
Declaration and Notification
Informants
Who is designated the primary informant for births occurring in health facilities?
Either parent
Recommended Practice based on International Guidelines
The law should establish clearly and unequivocally one person primarily responsible for providing the information needed for the registration. Moreover, the law may designate alternative informants and establish the order in which each of them must assume his or her responsibilities. The head of the health facility should be the primary informant for live births occuring in a health facility. The law should also explicitly state what type of facility is considered a “health facility” for purposes of birth registration.
The primary informants for all births (regardless of whether they occur inside or outside health facilities) are the mother and the father. If parents are unable "by reason of death, illness, absence, or other inability recognized by the Registrar-General", the law assigns the role of informants to the "occupier of the house or building where the child was born, each person present at birth and the person having charge of the child". The duty to be informed of all births that occur in a division, lies also with the registrar of division under Section 10 though a registrar of division is not designated primary informant for births.
Birth Registration
Declaration and Notification
Role of the health sector
What is the role of the health sector in birth registration for births occurring in health facilities?
Issuing of evidence of birth, birth record or equivalent
Recommended Practice based on International Guidelines
For births occurring in health facilities, the most effective approach is to designate the head of the institution (or designee) as informant. Some countries follow a two-step process where the health sector notifies the registrar of the birth, but the registration must be completed by the parents. This approach is considered less effective in ensuring high registration rates.
While the BDRA does not assign a formal role to the health sector, a Ministry of Health circular issued in 2015 instructed all directors of health facilities to facilitate birth registration. Under this circular, the heads of health facilities are required to fill in a form (B148) with details of the birth (date, place, name, sex, weight and other data) and submit it to the Registrar. However, in practice, the B148 is filled in by hospitals and handed over to the family which, together with a form CR1 (filled out by family), submits both forms to the registrar of division for birth registration.
What is the role of the health sector in birth registration for births occurring outside health facilities?
None
Recommended Practice based on International Guidelines
For births occuring outside a health facility and without a birth attendant, an effective approach for birth registraton would be if the law designated health workers (including vaccination workers, nurses, doctors and other health professionals who see newborns for paediatric visits) as informants to register the birth of children that are unregistered and visited by them.
If health workers (such as vaccination workers, doctors, nurses) see an unregistered infant, they can use the opportunity to register the child or assist with the registration process. Legislation should allow for health workers to act as informants or notifiers in these circumstances.
In the case of community births or births occuring outside a health facility, the family must go to the Gram Niladhari (GN) who completes Form B23 and the family takes form B23 and CR1 (see above) to registrar to register birth.
Death Registration
Declaration and Notification
Informants
Who is designated as the primary informant for natural deaths that occur in a health facility?
Nearest relative
Recommended Practice based on International Guidelines
The law should establish clearly and unequivocally one person primarily responsible for providing the information needed for the registration. Moreover, the law may designate alternative informants and establish the order in which each of them must assume his or her responsibilities. . For natural deaths occuring in health facilities and in order of preference, the head of the health facility should be primary informant or the nearest relative/next of kin or any adult with knowledge of the facts. Additionally, the legislation should explicitly state what type of facility is considered a “health facility” for purposes of being an informant.
Under Section 29 of the BDRA, the "nearest relatives present at the death" are the primary informants for deaths occuring in a house or building. Health facilities are included interpretively, in the meaning of "buildings". By way of a Circular issued by the RG, hospitals are required to fill in form B33 whenever a death occurs in a hospital. This form is filled in triplicate and one copy is handed to the family. The second copy is sent to the RG's department, while the third copy is retained by the hospital. Alongside form CR2 (filled out by family), B33 is presented to the registrar for complete registration. Through this Circular, the hospitals themselves are made notifiers and not informants.
Death Registration
Declaration and Notification
Role of the health sector
What is the role of the health sector in death registration for deaths occurring in health facilities?
Issuing of evidence of death, death record or equivalent document
Recommended Practice based on International Guidelines
When a death occurs in a healthcare facility designating the head of the health facility as the informant, and establishing systems for the collection and recording of vital events, is the most effective way of ensuring that all deaths in health facilities are registered in a timely and accurate manner. In some countries the health facility performs a notification function, collecting relevant information about the death and passing it to the civil registrar. In that situation, the informant (usually the nearest relative) still needs to attend the registry office to undertake a declaration for the death to be registered. Where the nearest relative is the informant, the health facility will usually be required to provide them with some form of evidence or record of the death that should be used by the informant for registration. For information on the role of health facilities in determining cause of death and completing medical certificates of cause of death, see the "Cause of Death" topic.
In the case of deaths in hospitals, that are not unnatural and therefore not referred to Medicolegal Death Investigation authorities, the hospital issues a Form B33 (Declaration of Death) to the family. This Declaration of Death in Form B33 contains cause of death information and can only be filled by an attending medical officer. The family then submits this Form to the Registrar of Division alongside Form CR2 (also called Declaration of Death) which is filled out by the family. Together, Forms B33 and CR2 are required to register a death. The Forms stipulated in the Births and Deaths Registration Act have changed in practice but the law itself has not been updated. Forms B33 and CR2 have been issued by the Registrar General Department of Sri Lanka.
What is the role of the health sector in death registration for deaths occurring outside health facilities?
Providing Medical Certificate of Cause of Death
Recommended Practice based on International Guidelines
The health sector can play an important role in notifying vital events, such as deaths, that occur outside health facilities where health workers attend patients and their families in the community. Countries may designate medical officers or community health workers as informants for deaths that occur in the community. Or the health care worker may notify the civil registrar of the facts of death, but the nearest relative still needs to register the death. In some countries health workers may provide a document, such as a notice of death, to the nearest relative as official evidence of the death.
In the case of deaths that occur outside hospitals, in the community, and not referred to Medicolegal Death Investiation authorities, the Gram Niladhari (village headman) fills out a Form B24 (Report of Death) and provides this to the informant. A medical practitioner attending the deceased may provide a certification of cause of death on a letterhead or as Form B33 (Declaration of Death containing cause of death information filled out by a medical officer) to the Gram Nalidhari to accompany the B24.
Law Source
Stillbirth Reporting
Reporting through the Civil Registration System
Role of the health sector
What is the role of the health sector in stillbirth registration?
Notification
Recommended Practice based on International Guidelines
UN guidelines provide that the head of the health facility is the preferred informant for stillbirths. Where the stillbirths are registered via the civil registration system this should be specified in the law. As with live births, some countries require the health sector to notify information about stillbirths even where the designated informant is the mother and/or father. Where the mother and/or father is the primary informant, the health sector would usually be required under the law to provide a notice of some sort as evidence of the stillbirth for the purposes of registration.
Under the Birth and Deaths Registration Act, the role of the health sector is unclear. The only existing provisions are limited to specific geographic areas, and do not apply to the whole territory: - According to Section 47(5) of the Act, any medical officer who receives information on stillbirths occurring in "certain areas" (listed in Part V of the Act), shall report it to the registrar within 7 days. - Under Section 48 of the Act, for stillbirths occurring in "certain areas" (listed in Part V of the Act), the heads of health facilities shall send weekly information to the registrar about any stillbirths having taken place in their facilities. These provisions, anyway, are no longer enforced. Nonetheless, the role of the health sector in stillbirth registration has been expanded by Circular 2-155 of 2015. This circular requires the health sector to send a copy of the form "Declaration of Still Birth" to the Registrar General and give a copy of the declaration to the parent for use in registration.
A circular issued in 2015 by the Ministry of Health requires all health facilities, including private hospitals, to fill the form "Declaration of Still Birth" (B22) for every stillbirth (>28 weeks) that occurs in health facilities. Form B22 is submitted by the health facility to the registrar and a copy is given to parents. The parents are supposed to report the stillbirth to registrar for stillbirth registration to occur.
