Electronical Born Alive Certificate
State Evaluation and Management Area, Office of Planning and Budget

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The Program provides critical data in order to implement better health population policies while at the same time, strengthens the Vital Statistics System and the Civil Identification System of Uruguay as whole. The Program was focused on the association and preservation of each individual first clinical data and on guarantying the unique identification of all born alive, to promote the effective access to civil rights from the very beginning. Before the implementation of this Project born child to be identified trough the mother´s or guardian’s identification number plus an additional number referring to the order in which the child was born. In other cases born children rested unidentified until their parents or guardians decided to register them, fact that it could never happen in worst cases. It was very difficult to access to complete quality consolidated data plus to get it in time, in order to take decisions at almost every level. It was even difficult to localize the address of a born child just few days after the birth. One aspect that it was the key to this Project is that 99% of births in Uruguay occur at Maternity Units, this fact, has really contributed to obtain successful results. The Paper Born Alive Certificates, were delivered to the Civil Registry with confidential health records while The Electronical Born Alive Certificate, assures their confidentiality. Regarding the registry of Deceases, before the implementation of the Electronical Death Certificate, the certificates were made on paper and were delivered from the Civil Registry offices, sometimes after months to the Health Ministry in order to make the vital and sectorial statistics records. All in all, Uruguay was quite restricted in order to get complete quality critical data of its population in time, in order to elaborate health plans and policies and to take proper decisions. Besides it was limited in its capacity as a State to guarantee basic identity and social rights to its population.

B. Strategic Approach

 2. What was the solution?
Since 2011, 99% of children born in Uruguay have their Electronical Born-Alive Certificate with a unique identification number right after they are born. An on line access application designed to make electronic medical born-alive and death certificates generates a vital statistics data base. When the professional who assists delivery signs the certificate in electronic way, the system makes a connection with the National Direction of Civil Identificatio (DNIC)n and sends mother´s and child´s information receiving from the DNIC a unique child identification number shared, with the Civil Registry to make the birth certificate. Medical history is open with that child´s identification number. The Program is absolutely aligned to Health TIC´s trends since it has promoted the collaboration between different governmental organizations, including health actors, creating a information System that promotes the strengthening of cross processes and the access to quality critical data in order to improve health statistics, health programs and allowing the creation of multiple data geographical referential systems to be more assertive when defining epidemiological actions. The Program strengthens public health research and prevention programs generating alerts on all born alive children who have mothers with AIDS. The System has alerts that allow monitoring, diseases classified trough configurable risk criteria following CIE10’s categorization. In this way each time a death´s cause is of certain type according CIE10, an alerting mail is sent to the Epidemiology Director and to related Health Programs. Following this type of actions, when a born child has for example low weight a mail is sent to the related program in order to increase monitoring. The System is aligned with HL7 standards in order to guarantee interoperability. Born Alive Certificate guarantees to have access to clinical information about the mother and the child from the very beginning, which is a handicap in order to promote health care in vulnerable populations. Additionally personal data confidentiality is not only guaranteed, but is also classified separating clinical data, from familiar antecedent’s data.

 3. How did the initiative solve the problem and improve people’s lives?
Watch: http://www.iadb.org/en/videos/watch,2173.html?videoid=9450#.UmVB53DwQVQ

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The Program had two Phases, Phase 1, which consisted in the development and implementation of the Electronical Born Alive Certificate that took from August 2007 till November 2009 and Phase 2, that involved the development and implementation of the Electronical Death Certificate, that started in August 2010 and was roll out for the first time in November 2010. Actually the coverage of Electronical Death Certificates runs up to 40% of all deceases. The Public Health Ministry is working on making the registration of deceases through this System mandatory, in order to assure full death statistics coverage on line.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The actors involved with the platform are the general public, public agencies and platform administrators. The general public (i.e. Uruguayan citizens, foreign people and private companies) accesses e-government services through the internet using, for example, the E-Government Portal or Web Services exposed at the EGP.uy. Public agencies leverage the connectivity provided by REDuy, a high-speed network infrastructure, implemented over the MPLS (Multi Protocol Label Switching) network of ANTEL, to access and provide services and components in the EGP.uy. Finally, platform administrators deal with all the tasks concerned with the administration and operation of the platform.
 6. How was the strategy implemented and what resources were mobilized?
Nations' resources and IADB

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
This Program is critical in Uruguay as a channel to guarantee identity right and improving the information to define health policies and actions focusing at first on the new generations. This Program also puts in evidence the capacity of the organisms involved in order to join capacities and efforts to achieve synergic goals. The advantages of this system are: Strengthening of the mother-child binomial; Assures on line first health records associated with unique identification number; Immediate child´s access to social rights is guaranteed; Children who are not receiving medical care can be easily reached; Data base on line generation for vital birth and death statistics Electronic medical certificate of death works with the same logic on the same database as on line. When the professional in charge signs the death certificate, the non medical data are automatically received by the Registry Office, which proceeds to registration.

 8. What were the most successful outputs and why was the initiative effective?
This project was developing over the Uruguayan E-Government Platform (EGP.uy). EGP.uy has the general goal of enabling and promoting the development of e-government services in Uruguay. The platform, which follows a joined-up approach, consists of an Interoperability Platform and a set of Crosscutting Services. The Interoperability Platform, which comprises a hardware and software infrastructure along with legal and technical frameworks, facilitates to public agencies the implementation of e-government services and their access. On the other side, the Crosscutting Services provides specific utilities to citizen and/or public agencies. The EGP.uy is a key enabler for developing a joined-up e-government approach in Uruguay, implementing a service-oriented architecture, leveraging the Web Services technology, to expose, use and combine government functionality implemented by public agencies.

 9. What were the main obstacles encountered and how were they overcome?
To increase Death Electronical registration. To incorporate software with medical colloquial terminology containing codes for death causes to facilitate the registration of death causes. When incorporating that software we will improve the quality of data used to calculate the health sectorial statistics. To keep digitalizing Children Clinical History. The use of this system has opened a wide window towards interesting opportunities regarding health information systems. We are currently working with the support of UNPFA in the Child and Pregnancy Vital Statistics System (because of the acronym in Spanish SEVEN). The SEVEN aims at keeping on integrating other online information uploading systems. As a matter of fact the following projects which are close to be launched will be all integrated and will enhance and strengthen Vital Statistics System: The Children´s Electronical Clinical Card. An Electronical Vaccination Card. An Electronical Congenital Malformation Registry System. Home Medical Visit Registry System . We have also developed the Electronical Perinatal Clinical File and which we are piloting at present. With the same criteria, data are uploaded on line and the system provides alert issues if any sanitary risks are detected in mothers and/or the fetus. We would like to remark that all these systems will be accessed through any mobile device, such as phones, pads, etc. so as to take profit of the ICTs development. We can work offline and when connectivity is available, data will be automatically uploaded. Consequently, we are able to work from any place at any time.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Identification of individuals through a unique identity number, online, right after birth time, validating the data between the Public Health Ministry and the National Direction of Civil Identification at the same time that the Physician electronically signs the certificate, and submits it electronically. The validity of the certificates is attested through an electronic process. Assures higher quality clinical birth and mortality data via on line records Improved times of birth and death registration data Reduces errors of birth and death certificates. Helps to standardize statistic parameters related to birth and death registration Allows online verification of critical information about a born child clinical data, parental information or place of localization. Increased security and reliability of information. Enables to audit on line mortality causes quality records. Birth and Mortality data available for use as a statistic or surveillance tool Enables to get information about increasing mortality cause trends. Provides data that enables to make geo-referential systems in order to better identify individuals and populations in risk. Generates a Statistic Data Base in Real Time.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The Program can be replicated in other countries depending on the demographic and interconnectivity characteristics of each country. The software belongs to the Uruguayan State, not being licenses an obstacle to its replication. It can be easily customized to adapt to the needs of different legal requirements and clinical information specifications.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
The improvement of opportunity and quality of children´s clinical records, as well as the safe and early universal access to a legal unique identity, mean a great advance to the consecution of the millennium goals. Inter institutional cooperation, supported by a strong political leadership and the incorporation of ICTs are fundamental elements to improve public services facing toward citizens. The Electronical Born Alive Certificate in this context, being a legal medical document sums up to the achievement of lowering to zero the sub registry of new born children. On the same line, the Electronical Death Certificate, besides improving the opportunity and quality of deceased records collaborating with epidemiological statistics, improves the quality of the Civil Registry records.

Contact Information

Institution Name:   State Evaluation and Management Area, Office of Planning and Budget
Institution Type:   Government Agency  
Contact Person:   Cristina Tello
Title:   Cross Programs Coordinator  
Telephone/ Fax:   +5981508040
Institution's / Project's Website:  
E-mail:   ctello@agev.opp.gub.uy  
Address:   Liniers 1324 F5
Postal Code:   11000
City:   Montevideo
State/Province:   Montevideo

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