Genesis studies why 30% of SA births go unregistered

Project name:
Implementation evaluation of the birth registration programme

Service:
Monitoring and evaluation

Sector:
Public and Social
Health

Area of Expertise:
Evaluation & impact assessment

Client:
Department of Planning, Monitoring and Evaluation, Department of Home Affairs (South Africa)

Date:
2016 - 2018

Country:
South Africa


The purpose of the evaluation was to understand why births are not registered within the first 30 days after birth and systematically uncover the constraints that hinder the registration of births within this legislated period.

The evaluation came up with three main recommendations to improve birth registration system. These were:

1. Promotion of the ERB programme’s strategic vision: Efforts to promote the strategic vision to register births as close to when they occur as possible should be reinforced and deepened. Genesis recommended that this be enhanced by facilitating strong partnerships between the involved stakeholders, particularly the Department of Home Affairs (DHA) and the Department of Health (DOH).

2. Strengthening the implementation of the strategic vision: This evaluation finds that the current MOU does not enable the achievement of the strategic vision. Therefore, the current MOU must be refined to better articulate the specific roles and responsibilities of DHA and DOH to ensure that the connected hospital footprint is strengthened and maintained.

This recommendation also focused on strengthening relationship with other  partners such as the Department of Social Development (DSD) to advance the registration of births of orphan and vulnerable children and children located in remote and marginalised communities. Finally, the recommendation was also directed at encouraging the establishment of an MOU between the DHA, DOH and the Department of Public Works (DPW) to elaborate on the roles and responsibilities contained within specific facility rental agreements to ensure that DHA office and HCF infrastructure is accessible and provides requisite comforts for mothers, babies and young children.

3. Improving the implementation and operability of the birth registration system: Genesis recommended that DHA should prioritise consolidating and maintaining the connected hospital footprint before continuing its expansion. In addition, DHA should improve the methodology by which targets are set to improve performance management and evidence-informed decision-making.

The South African birth registration system is complex. For this reason, Genesis used systems thinking for this evaluation to ensure that the evaluation considers the complex context within which the birth registration programme operates and how this environment affects the implementation of the DHA’s birth registration interventions.

With input from DHA officials, the programme theory of change was designed and used to better understand the DHA’s birth registration programme and its implementation. The analysis framework was guided by the OECD DAC evaluation criteria of relevance, effectiveness, efficiency, impact, and sustainability to assist in the development and categorisation of the key evaluation questions.

The evaluation data collection methods included key informant interviews with a range of government stakeholders across national and provincial levels. Before the data collection process, the team underwent data collection training where they were capacitated with necessary skills to conduct interviews with public service users and officials.

Data was also collected from site observations at DHA offices and at healthcare facilities. This was guided by structured observation forms. A rubric was used to assess the quality of sites across multiple dimensions. During site observations, public service users (parents) were interviewed. The purpose of parents’ interviews was to gain an understanding of their experiences and perspectives relating to the national birth registration process.

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