Volunteers vital for counting births and deaths in Ghana.

For Ghanaian civil servant Ofori Asante every day begins with an insurmountable challenge: how to document all the births and deaths taking place in the Northern Region of his country, an area extending 70 384 square kilometrers and containing a sparsely distributed population of two and a half million people. “The Northern Region is very large, the roads are very bad and the villages are very far apart,” says Asante, who works in the regional Births and Deaths Registry based in the city of Tamale. His task is made all the more difficult because of a chronic lack of funding, staff and equipment. For Kingsley Asare Addo, principal assistant registrar of Ghana’s Births and Deaths Registry in the capital Accra, this lack of resources is a key reason why only 65% of births and 22% of deaths are registered in this country of 24 million people. When civil registration started in Ghana in 1888, it covered colonial settlements and a few commercial towns. It was not until 1965, eight years after independence, that the Registration of Births and Deaths Law was passed making provision for compulsory registration for the whole population. But still, today, complete coverage has yet to become a reality in this West African country. Ghana is one of many developing countries struggling to address their peoples’ health needs with an incomplete picture of their health, that is, incomplete data notably on the number of births, deaths and causes of death by age, sex and geographical distribution. Without this information it is impossible to gauge the success of health programmes and to know whether the country is reducing child and maternal mortality, as articulated in the Millennium Development Goals (MDG) 4 and 5. Says Isaac Adams, director of Research Statistics and Information at the health ministry, “we need this information to design programmes and interventions to reduce untimely and preventable deaths”.