The COVID-19 pandemic has emphasised the importance of collaboration in leveraging data for effective decision-making. In Nepal, two initiatives, the Global Action Plan for Healthy Lives and Wellbeing for All (SDG3 GAP) and Health Data Collaborative (HDC), are working together to strengthen Nepal's civil registration and vital statistics system (CRVS) and national data systems. SDG3 GAP and HDC provide a collaborative platform that aligns technical and financial resources from various stakeholders to support the implementation of country-owned strategies and plans, focusing on SDG targets. Since 2019, Nepal has been a pilot country for SDG3 GAP implementation, focusing on data and digital strengthening, and in 2020 submitted a country position for HDC affiliation.
Amrit Dhoj Joshi, 67, waiting to receive the death certificate of his late mother at the local ward office of Lalitpur Metropolitan City in Bagmati Province, Nepal. Local registrar is maintaining dual record in online and register. ©WHO Nepal/Sujan Govinda Amatya
Joint mission: unifying actions to improve CRVS
In January 2023, a joint mission to Nepal was conducted by SDG3 GAP and HDC partners, co-lead by WHO, UNFPA, and UNICEF, in response to a request from the Nepalese government for assistance in enhancing Nepal's CRVS system, including through the integration of birth and death information into the civil registration process. The mission aimed to achieve three main objectives: to convene stakeholders from national, bilateral, and multinational partners in health and other sectors; to review ongoing activities and explore opportunities to expedite partners' collaborative support for Nepal CRVS Strategy 2019; and make recommendations for enhancing partners' alignment to Nepal's overall data and digital health objectives. Discussions also included support for Geographical Information Systems (GIS) for advancing national data systems. The meetings held as part of this joint mission showcased ongoing collaborative efforts that partners can leverage to accelerate progress.
A key example of effective collaborative action was the impact of the country stakeholders of the CRVS Data and Digital Health Accelerator Working Group, initiated by SGD3 GAP and HDC partners and led by the Ministry of Health and Population. Under the stewardship of the Ministry of Health and Population, the Working Group facilitated dialogue between the different national CRVS coordinating institutions and in-country stakeholders, leading to coherence in implementing the CRVS strategy. A notable outcome of this improved coherence is that different national agencies are beginning to establish data-sharing agreements with the Department of National ID and Civil Registration (DoNIDCR), bringing the country closer to the goal of digital interoperability.
Amrit Dhoj Joshi, 67, receiving the VERSP MIS generated death certificate of his late mother without any hassle from the Ward Secretary at the local ward office of Lalitpur Metropolitan City in Bagmati Province, Nepal. ©WHO Nepal/Sujan Govinda Amatya
Scaling up digitalisation and CRVS integration
Partners' joint work was also reflected in moving forward the data integration objectives of the CRVS strategy. Examples include the joint provision of technical assistance by World Bank, UNICEF and WHO to support development of the Vital Event Registration and Social Protection Management Information System (VERSP-MIS), which is the centralised repository for vital information that will also facilitate the data sharing and digital integration objectives of the CRVS strategy, leveraging on established data-sharing agreements between DoNIDCR and National Statistics Office. This data integration process aims to create a comprehensive network of interconnected systems, allowing efficient and streamlined data sharing among relevant sectors and institutions.
CRVS data integration within the health information system is already ongoing through joint work between GIZ, UNICEF, UNFPA, and WHO to develop and implement two essential systems: the Birth Registration Management System (BRMS) and the Medical Certification of Cause of Death (MCCoD) to enhance the reporting of vital events, such as births and deaths, from health facilities. Following successful pilots in Sudur Paschim and Koshi provinces, UNICEF, GIZ, and WHO have planned scaling up the two systems to other provinces and municipalities using joint financing and capacity-building. Once completed, these systems will enable automated digital notification and sharing of birth and death data from health facilities to the CRVS database. The partners are also actively supporting the Ministry of Health and Population to enhance the digital reporting capacity of health facilities across the country. This support aims to ensure that health services are well-prepared and equipped to meet the data needs of the CRVS system. To improve CRVS coverage, UNICEF and the World Bank have conducted awareness campaigns to promote demand for CRVS and connect eligible individuals to social support systems using civil registration as entry points.
Through these efforts, and under the leadership of the Ministry of Home Affairs, online registration has been successfully implemented in 96% of local registrars' offices, with 6,519 out of 6,743 offices now equipped with the necessary digital infrastructure provided by the Government of Nepal and the World Bank. Furthermore, an impressive milestone has been achieved, with over 19 million historical paper-based civil registration records digitised as of January 2023. This milestone will preserve and facilitate the accessibility of vital records for informed decision-making.
Establishing continuous quality improvement
Since 2020, the Government of Nepal has been actively using a Business Process Improvement Approach to enhance the quality of CRVS implementation. This strategic shift has been made possible through the in-country Data and Digital Health Accelerator Working Group that introduced and championed this innovative approach. In 2022, SDG3 GAP partners piloted a GAP monitoring framework in Nepal to track improvements in their collective efforts. This framework uses national government feedback to drive collaborative progress towards SDG3 goals. In 2022, feedback from Nepal highlighted collaboration best practices, such as the Nepal health sector-wide approach, that features partner alignment through pooled funding with the government. They also noted the benefits of aligning Joint Annual Reviews with national assessments, which reduces duplication, increase ownership, and enables further stakeholder engagement. These practices have enhanced collaboration, coordination, alignment with national plans and budget priorities, as well as partners' use of national monitoring systems. Challenges such as funding fluctuations, limited partner participation in pooled funding, and weak partner-government joint monitoring were identified as areas of much needed improvement. Addressing these issues will strengthen and accelerate progress towards Nepal's data and digital and broader health objectives.
Nepal is not only working to improve data availability, but also actively strengthening data use to improve health-related SDG outcomes through the WHO Delivery for Impact approach. As a pilot country for this initiative, the Government of Nepal implements a 100-day challenge with data-driven and impact-focused planning and prioritisation to boost progress. This effort focuses on advancing priority health indicators and effectively leveraging integrated platforms and multisectoral strategies to address critical gaps. Using data-informed acceleration scenarios, the Government of Nepal has identified five priority areas: maternal mortality, tuberculosis, suicide mortality, cervical cancer, and health emergency management to strategically drive measurable impact toward national targets by 2027.
What is the SDG3 GAP/HDC?
The Global Action Plan for Healthy Lives and Wellbeing for All (SDG3 GAP) is a set of commitments by 13 agencies that play significant roles in health, development, and humanitarian responses to help countries accelerate progress on health-related SDG targets. SDG3 GAP strengthens collaboration across the agencies to take joint action and provide more coordinated support aligned to country-owned and led national plans and strategies.
The Health Data Collaborative (HDC) provides a collaborative platform that aligns technical and financial resources to support country-owned strategies for data collection, storage, analysis, and utilisation, with a specific emphasis on SDG targets and marginalised communities. SDG3 GAP and HDC are interlinked through the SDG3 GAP Data and Digital Accelerator Working Group at the global and country level, and the support provided to countries on strengthening data systems is fully aligned and integrated.