Assessment Report on Barriers to Birth Registration: Khomas and Omaheke Region. Ministry of Home Affairs and Immigration Namibia

Transcription

1 2010 Assessment Report on Barriers to Birth Registration: Khomas and Omaheke Region Ministry of Home Affairs and Immigration Namibia

2 P a g e 2 Table of Contents Contents Background... 3 Purpose... 3 Methodology and Data Collection Process... 3 Findings... 4 Cross cutting social factors... 5 Current Situation and Birth Registration Practices Khomas Region... 6 Cultural barriers... 8 Administrative and procedural barriers... 8 Current Situation and Birth Registration Practices... 9 Social barriers Administrative and procedural factors Summary findings Recommendations Proposed next steps... 13

3 P a g e 3 Background According to the UN convention on the Child s right - all children have the right to a legally registered name and nationality. The convention was ratified by the Namibian government shortly after independence in September A birth certificate proves the child s nationality, the child s age, where and when he/she was born, and the identity of the parents. Birth registration is also a mean to protect other rights. Without document to prove identity, children are unable to access health care, education and social grants. Registration is also crucial for preventing abuse, child trafficking, violence and exploitation. The child also loses its chances of getting adopted if orphaned. Later in life, the child will not be able to obtain a passport, an ID card, open a bank account, get a driver license, exercise its right to vote or get married. Despite the recognition of the right to a birth certificate for all children the most recent Demographic Health Service (DHS) from 2006 revealed that only 67, 1% of Namibian children under 5 years old had a birth certificate. This is a decrease from 2000 where 70, 5% held a birth certificate. The highest percentages of unregistered births are in the northern rural regions. The data also showed that the poorer the family is, the more unlikely it is that the children in the household hold a birth certificate. In terms of accessibility to birth registration considerable progress has been made since The Ministry of Home Affairs and Immigration (MHAI) has in partnership with Ministry of Health and Social Services (MoHSS) and with support from UNICEF opened 13 hospital-based facilities, and another 8 facilities will be opened before the end of The aim is to register 80% of babies before they are discharged from the hospital. Furthermore, MHAI has established 21 sub-regional offices, mainly in the rural areas, and conducted national mobile campaigns in the remote rural areas of the country. Despite this remarkable expansion, birth registrations in the newly opened hospital facilities do not match the birth rates. Births go unregistered for various reasons, differing from region to region. We know that local social and cultural name giving traditions plays a significant role in some regions, just as poverty prevent parents from registering their children, often due to the country s vast distances to service points. Additionally, there exist large knowledge gaps on birth registration services, importance and requirements. Purpose The purpose of this assessment is to identify barriers to birth registration in the Khomas region and Omaheke region, and propose the next steps toward reaching universal birth registration in Namibia. Methodology and Data Collection Process The data has been collected through mainly semi-structured interviews with a variety of stakeholders, including parents, staff members of MHAI, MoHSS and MGECW, CBO staff and one political leader.

4 P a g e 4 Interview guides were developed for these different groups. The interviews were all done in the Khomas region and the Omaheke region by MHAI staff during July The Khomas region was a naturally choice; since Windhoek, Namibia s biggest urban center, is located in the region. Windhoek is culturally, socially and economically diverse and all ethnic groups and income groups can be found in the town. On contrary, the Omaheke is a rural region, where majority of the people lives on the farms. It is also home to one of the largest groups of San people, one of the country s most marginalized groups. In the Khomas region 81, 2 % of children under 5 had a birth certificate in 2006, whereas only 68,1 % in the Omaheke region. The findings from the Khomas region are based on 45 short interviews, which were conducted with parents registering their children at the Katutura Hospital. 52 % of the babies were registered by their mother s, 33 % by the father, 5 % by health workers and 5% by relatives. 15 small interviews were conducted with parents or relatives registering children late at the Khomas Regional office. The children being registered was between the age of 1-18 years. 10 small interviews were done with parents in the Hakahana community, who all for different reasons have been unable to register their children. The parents are unemployed and are affiliated to the organization Family Hope Services (FHS). Amongst other things, FHS runs a bridging school for children that have fallen out of school or have never been to school. Finally, 3 interviews were carried out with project coordinators from Catholic Aids Action (Bernard North Camp), Hope Family Services and MGECW s interim and afterschool centre, which all works with vulnerable children. A 3 days fieldtrip was conducted in the Omaheke region in conjunction with a partnership meeting on birth registration. During the 3 day visit, the team interviewed staff from the Omaheke regional office, and visited the hospital birth registration facility, two local CBO s in Gobabis, the Health clinic in Epako, the sub-regional office in Talismanus, the health clinic in Talismanus, MGECW in Talismanus, and the counselors in Talismanus. Findings The assessment found that various cultural and social factors are influencing what age the child is registered. It was observed that people from socially vulnerable groups in many cases seem to get trapped in the procedures and practices of the Ministry of Home Affairs and Immigration. During the data collection process the team met several parents or caregivers with unregistered children, who had for various reasons had been denied access to school, because the parents or caregivers could not obtain a birth certificate for their children. The observed factors that can delay birth registration have for analytical purposes in this assessment report been divided into three main categories: Social and economical factors, cultural factors and internal administrative/procedural factors. However, all the factors are closely interlinked, and

5 P a g e 5 inseparable in many of the cases. Due to the format of this assessment, it is likely that not all barriers to birth registration have been covered. The majority of the social factors observed turned out to be cross cutting for both the regions. In this section all the cross cutting barriers have been listed, whereas region specific factors have been listed and analyzed in separate sections under each region. Cross cutting social factors The mother does not have the father s ID: The most common explanation for not registering the child immediately after birth was that the mother does not have a copy of the fathers ID. Many men are working on farms or in different towns. According to the DHS (2006) only one-quarter of children grow up with both their parents. 1 Many women in particular from the northern region find it important to register the child in the fathers name due to social and cultural practices, and therefore do not register the child, until the father is present. Some mothers are also aware of the possible benefits for the child, and patiently wait several years for the father to reappear. One mother of three, who the team spoke to, was determined that the children should benefit in the form of maintenance from the father, due to the fact that he has got a permanent job. She had at that point waited 3 years. Moreover, there is a widespread misconception that women cannot register children in their own surname. The father denies fatherhood or the father is unknown: Another common barrier to birth registration is that the father denies fatherhood or the father is unknown. The mothers, often with pressure from the family, will first try to see if they can find the father and convince him to take responsibility for the child. In some cultures it can be very emotionally painful for the mother to register the child in her own surname. Children growing up with grandparents or relatives: Many children of working parents are taken to the grandparents in remote villages in the northern parts of the country as the parents cannot afford to pay for a nanny. The children will stay with the grandparents until they are 2-3 years old, and will only be registered, when they return to their parents. In other cases the children are sent to live with their relatives in Windhoek, and the relatives do not have the documents of the parents. It can be difficult for the relatives to get hold of the documents, in some incidences the parents had died, or the caregivers do not have the money to travel to get the documents. In Namibia, 24% of all childrendo not live with either of their biologically parents despite the parents being alive. If orphaned children are included, the statistics shows that 36% of all children do not live with either of their biological parents. In the rural areas, the proportion of children living away from their biological parents is 44%, while the proportion in urban setting is 23%. 2 In the Khomas region 26,7 % of all children do not live with their parents. 3 In the 1 Demographic Health Service ( DHS) p Demographic Health Service ( DHS) p Demographic Health Service ( DHS) p. 256

6 P a g e 6 Omaheke region only 58% live with one or both biological parents. This means that 42 % of all children are staying with relatives. Many of these do not have any documents, and it can be difficult getting the documents from the parents. Maternal difficulties: 3 women explained to the teams that they had been very ill after giving birth, and their family therefore had taken them to their home village to recover. Another woman s baby had been severely underweight, and it was uncertain whether it would survive. Due to the fear of the child s life the mother could not get herself to register him/her. The mother is working on a farm or a lodge: A few mothers told the interviewers that they were working outside town, and rarely come to town. The children were all born at the Central hospital. In the Omaheke region over 60% of the labor force are working on commercial farms as laborers. No one to look after the baby: One mother told the interviewer that she did not have anybody to look after the child while going to Katutura Hospital to register. She did not want to take along the baby due to the long queues. The mother is in prison: A mother was sent to prison for 9 years shortly after she had given birth to her child. The father disappeared, and the child was staying with the sister of the father. The auntie applied several times for a birth certificate, but it was turned down every time on the basis that she was not the mother of the child. The child is today 9 years and has never been to school. Current Situation and Birth Registration Practices Khomas Region In the Khomas region parents can currently only register their babies at the Katutura State Hospital. Roughly children are born each year at the city s 4 main hospitals: Katutura State Hospital, Central Hospital, Medi City Rhino Park Hospital. The high number of births put high pressure on the office. Especially on Mondays and Thursday long queues are formed outside the office. In order to alleviate some of the pressure on the Katutura Hospital facilities, the Ministry is in the process of opening an office at the new maternity ward at the Central hospital. Plans of opening 2 sub-regional offices are also in the pipeline. According to table 1, 6929 babies were registered within their first year in 2008, and 8185 in This means approx. 1/5 of all children in the Khomas region did not get registered in time. The late registration statistics shows proof of this. According to table, in children were registered late, and 1802 in Late registration is a challenge for the Ministry, as many parents fail to produce the right documents when the child gets older. Many parents have for example has misplaced their health cards, which documents that the child was born in Namibia. Registering a child late also means that many children cannot access benefits right from birth. A common scenario is that the parents postpone registration to the child needs to go to school, but unfortunately dies before the child reach the school

7 P a g e 7 age. The child s new caretaker will experiences difficulties registering the child, especially if the parents documents are no where to be found. Consequently the child cannot get a social grant, which it is entitled to. From a state administration point of view, it also essential to know how many children are born very year for future is planning purposes. The new statistics from 2010, however, looks extraordinarily positive. From January August 2010 there has almost been registered the same amount of babies as in the whole year of In 2008, the monthly average of babies below 1 year being registered was 577,4, whereas in 2010 the monthly average is 828,5 babies. If this trend continues to the end of the year, approx children will be registered before they turn one, which means more than 95% of all the children born in the Khomas Region. Table 1: Birth Registration, children below 1 year Office * Khomas Regional office Katutura State Hospital TOTAL *January August 2010 Table 2: Late registration, children above 1 year Office * Khomas Regional office Katutura State Hospital TOTAL * January August 2010 Table 3: Total amount children registered (normal registration and late registration) Office * Khomas Regional office Katutura State Hospital TOTAL * January August 2010 Table 4: Average monthly birth registration rate at Katutura State Hospital Hospital facility Katutura State Hospital 557,4 608,5 828,5 Interviews with the parents at the Katutura State Hospital revealed that the majority of children were registered before they turned 6 weeks, only very few, however, were registered while still being in hospital. Children born at either Rhino Park Hospital or Medi City where all registered before they

8 P a g e 8 turned 6 days, since the medical aid requires the birth certificate in order to settle the hospital bills. The Social Security Commission requires a birth certificate, in order to pay out the second payment during maternity leave. This means that most people, who do not register their child shortly after giving birth, either work in the informal sector, or are unemployed. A large number of people belonging to these groups are socially and economically vulnerable. Cultural barriers Cultural barriers often seem to be strongly related to social barriers. Only a few mothers gave as an explanation that they were registering the child late due to traditional name giving traditions. Two mothers told the team that they had been waiting for the grandfather to arrive in Windhoek, as it was custom that the grandfather was giving the child a name. Both of them originated from North Central Namibia. A staff member originating from the north explained that name giving before birth only becomes an issue if the father has disappeared or is unknown. According the epitith tradition practiced in the north central regions, the mother and the child has to stay indoors for 5-30 days, until a family member from the father side of the family has arrived. The family will cut a piece of the hair of the child and introduce it to the world, by taking it outside for the first time. In the case there is no father, the family has to gather, and discuss how to handle the situation, which can be a long process. In some cases the father of the mother denies the mother to use the family name for the child. Administrative and procedural barriers As mentioned earlier, people particularly from lower income groups, often struggle to obtain birth certificates for their children due to internal administrative and financial procedures within the system. Documents lost: One scenario, which came up several times, was that the parents have lost their birth certificates and ID s, and that they cannot afford to go back to where their birth certificates were issued. Without documents they cannot register their children. The office was closed: A high number had failed to register the child while still being at hospital because the MHAI office was close, the day they were discharged from the hospital. Fridays, weekends and public holidays. Cannot afford the hospital bill: The Clerk at the Katutura hospital facility has been asked by MoHSS not to register births if the parents have not paid their hospital bill of N$30. The clerk asks for the receipt before she issues the birth certificate. No white hospital card: MHAI does not register the child if the parents do not have the white slip from the hospital. Parents need to go back to the hospital where the child was born. In many cases this is in the North and the parents cannot afford to go. If certificate is damaged or lost: If the certificate is lost or damaged, the public has to apply for a new at the Khomas Regional Office. The payment must be done at the HO. Many people cannot afford to travel forth and back.

9 P a g e 9 Financial constraints: Some mothers do not have the funds to travel to Home Affairs. According to a home base care worker, some mothers on ARV s find it unbearable to have to sit in a queue at Ministry of Home Affairs and Immigration, and often cannot afford to pay for the taxi money and food, while waiting. Current Situation and Birth Registration Practices The MHAI s Regional office is situated in Gobabis, and was until the beginning of 2010 the only point in the region where children could be registered. In February 2010 the Talismanus sub-regional office and the Aminus sub-regional office was opened, followed by a hospital based facility in March 2010 at Gobabis State Hospital. Around 1200 babies are born each year at the state hospital and approx children are born at the private clinic, and the state clinics in the rural areas. The late registration rate in the Omaheke region is still very high. There are more late registrations than registration of birth of children below 1 year old. According to the 2008 and 2009 figures, the regional office registered approx. 65 % of all babies under a 1 year in 2008, and 61% in This means that 4 of 10 children will be registered late, and some is likely not to be registered at all. Overall, the Regional office was in 2008 and 2009 registering more children than are being born every year due to two large mobile campaigns. From April August 2010 only 32 babies was registered at the hospital facility (see table 5). Most children are still being registered at the regional office. (See table 4) A visit to the maternity ward revealed that the mother had never heard about the hospital facilities, and none of them had brought their ID or the father ID along. The regional rates at sub-regional offices in Talismanus and Aminus are still very low, and there is more late registration than birth registrations. Table 5: Total number of children registered in Omaheke OMAHEKE REGION * Birth registration Late registrations Total *January August 2010 Table 6: Total number of children registered at Gobabis State Hospital OMAHEKE STATE HOSPITAL Male Female Total April 2010 Omaheke May 2010 Omaheke June 2010 Omaheke July 2010 Omaheke 4 5 9

10 P a g e 10 August 2010 Omaheke GRAND TOTAL Table 7 Gobabis Regional Office Omaheke region GOBABIS Birth registration Late Registration Month Year Region Office Male Female Male Female TOTAL January 2010 Omaheke Gobabis February 2010 Omaheke Gobabis March 2010 Omaheke Gobabis April 2010 Omaheke Gobabis May 2010 Omaheke Gobabis June 2010 Omaheke Gobabis July 2010 Omaheke Gobabis August 2010 Omaheke Gobabis TOTAL Table 8: Aminus sub-regional office Omaheke-2010 AMINUS Birth registration Late Registration Month Year Region Sub-office Male Female Male Female TOTAL April 2010 Omaheke Aminus May 2010 Omaheke Aminus June 2010 Omaheke Aminus July 2010 Omaheke Aminus August 2010 Omaheke Aminus TOTAL Table 9: Talismanus Sub-regional office Omaheke TALISMANUS Birth Registration Late Registration Month Year Region Sub-office Male Female Male Female TOTAL March 2010 Omaheke Talismanus April 2010 Omaheke Talismanus May 2010 Omaheke Talismanus June 2010 Omaheke Talismanus July 2010 Omaheke Talismanus August 2010 Omaheke Talismanus TOTAL

11 P a g e 11 Social barriers Severe poverty, alcoholism and unemployment seem to be the single biggest contribution to children not being registered in the Omaheke region. According to the Namibian Household and Expenditure survey from about 12.4% of all households in Omaheke are classified as extremely poor in that over 80% of their income is spent on food, whilst 28% are qualified as poor. This group is spending 60-80% of their income on food. The region has got the highest number of severely poor, just as the region has got the highest numbers of illiterate people in the country. The literate rate is only 64,4%. 4 According to the regional head of the regional office in Gobabis there is no local name culture, which block for registration immediately after birth. Most of the communities fully accept registration in the mother s surname. 3 additional social barriers were brought up, although it is likely these also plays a role in Windhoek. Negligence and alcohol abuse: Abuse of alcohol is high and many children are neglected by the parents. Parents do not acknowledge the importance of a birth certificate. Many of the parents do not have documents themselves. Street children: These children are particular vulnerable. In most cases no documents can be found, or there is great difficulties tracing their parents. Some of the parents are alive, but they are having severe alcohol problems and children will not recognize that they are their parents. If they are traced, police failed to take them to MHAI for registration. The age of the children are unknown, as they were abandoned at a very early age. Most of the street children are San boys. Not many girls live on the street. It is believed that the boys chase the girls away, as the girls are often favored by the locals and tourists when begging in the town centre. The girls are hanging around the location, assumed to be living of sex work. The only organization which caters for street children has not been approved by Ministry Gender Equality and Child Welfare (MGECW). The MHAI has so far decline to register the children without a social report from the MGECW. The children are often involved in criminal activities, and some of them are being locked up because there are no other alternatives. It is likely some are under age for receiving a prison sentence. Administrative and procedural factors Duplicates: Many people cannot afford to pay for a duplicate. Anxiety for registration process: Some community members expressed anxiety visiting MHAI, due to lack of language skills. They are afraid that officials will shout of them if they fail to understand the procedures and requirements. Poor partnership with MoHSS: The mothers are not informed about the services before giving birth; consequently they do not bring the documents. Very few babies are registered in the hospital facilities. This might also be linked to the fact that MHAI requires that both parents must be present, if they are unmarried and want the child to be registered in the father s surname. Many of the fathers work on farms, and they do not always have the possibilities of picking up the mothers from the hospital. 4 The Namibian Household Income and expenditure Survey, NHIES p. 16

12 P a g e 12 Summary findings The assessment re-established that it is predominately people of Namibia s lowest income groups, who fail to register their children timely. The fact is that the older the child gets the more complicated it gets to register the child, from an administrative point of view. The most common barriers in the Omaheke region and the Khomas region can be generalized and summarized to: The father work in another region: The mothers are not registering their children at the hospital-facilities because they do not have the fathers ID. Many men work in other towns. Predominantly, Windhoek, Oranjemund and Walvis Bay. The fathers are non-existence or deny fatherhood: Women from the North Central Regions are reluctant to register in their surnames, and there is a common misconception that a child cannot be registered if the father is absent. Children growing up with grandparents or relatives: Many children of working parents are taken to the grandparents in remote villages in the northern parts of the country as the parents cannot afford to pay for a nanny. The children will stay with the grandparents until they are 2-3 years old, and will only be registered, when they return to their parents. In other cases the children are sent to live with their relatives in Windhoek, and the relatives do not have the documents of the parents Lack of information and partnership with Ministry of Health and Social Services: Many parents are not informed about the services at the hospital, and for this reason fail to bring the right documents or choose a name for the child before birth. MHAI administrative and financial procedures: Parents with low income groups are most likely to fall victim to the system. They might not be able to pay for their hospital bill, or return to the hospital, in the event that the facility at the hospital is closed. The hospital facility is closed 3 days a week, Friday, Saturday and Sunday, and since most mother are discharged within 24 hours, there is a 42% chance that the parents have to return to the hospital. Given that there is only one registration point in the whole of the Khomas region, the queues are often low. Single mother with small babies find it mentally and physically constraining to sit 1-2 hours waiting to register the child, and it likely to postpone it. Recommendations The Ministry of Home Affairs and Immigration has taken significant steps towards improving accessibility to birth registration in the past 3 years, and is currently registering more children annually than children are being born. Changing the present registration pattern is the Ministry s biggest challenge along with reaching parents in the rural areas. Therefore it is crucial that the MHAI continuously explores new innovative avenues to reach these groups. Please find below the recommendation to change the current registration patterns: Establishing a solid partnership with ante-natal staff and post-natal at the clinics and maternity wards is alpha omega for universal birth registration. If the parents are well informed about the requirements and service points, and continuously encouraged to register their

13 P a g e 13 unborn baby at the hospital immediately after birth, many of the barriers can be eliminated. E.g. if the child is registered right after birth, grannies and relatives will not longer struggle to obtain a birth certificate for the child. Reviewing the structure and administrative systems and procedures: Roughly babies are born in Windhoek every year. Yet there is only one registration point. In comparison, Otjozondjupa has got 7 birth registration points, despite a much lower birth rate. Population numbers and the structure do not correlate. Having the busiest registration points open on Friday and Saturday would improve the access to the services. Meeting the community where they live: To eliminate the current backlog the Ministry should be more pro-active in meeting the people where they live. It can be done by setting up mobile registration points in the poorer parts of Windhoek, and accompany health outreach to the farms. Information Campaign: A media campaign on birth registration is long overdue. In Omaheke region a lot of parents are still not aware of the services at the hospital. In order to reach the more vulnerable groups, alternative and local distribution network should be identified. Example, set up an agreement with the farmers associations. The farmers are often supporting farm workers with paper work. In urban areas, information could be distributed through soup kitchens and so fort. Strengthening partnership with Ministry of Gender Equality and Child Welfare (MGECW): Set up an agreement on registration of OVC. Example, if MHAI staff comes across an orphaned child, who does not have any documents, they should contact MGECW for a social assessment of the child. Evaluation report: Compile an evaluation report, including all regions, in order to determinate if a larger report on barriers to birth registration is needed. Proposed next steps Set up written agreement with the MOHSS management on how to integrate birth registration into ante-natal care services, post-natal care service and health outreach, based all the suggestions from the regions; Oversee the implementation of the integration of birth registration into health services; Set up a written agreement with MGECW on registration of OVC. Provide health care staff with information on birth registration, pamphlets, posters, laminated table covers etc. Formulate a media strategy: Send out press releases, go on national TV and radio, contact alternative distribution networks; Take a pro-active approach towards registering unregistered children in poor areas. Encourage them to request the Ministry to visit their community to register unregistered children; Speed up the opening of new sub-regional offices.