Influence of Community-Led Notification Systems on Promoting Universal Birth and Death Registration in Elgeyo Marakwet County, Kenya
Keywords:
community-led notification systems,Universal birth, KenyaAbstract
Timely notification of births and deaths is the first link in the civil registration chain, yet its contribution to completed registration is rarely tested separately from other interventions. In Elgeyo Marakwet County, Kenya, birth registration coverage is approximately 62 percent and death registration about 25 percent, and community-led notification mechanisms have been introduced to close the gap. This study examined the influence of community-led notification systems, comprising community notification centres, volunteer notification agents, reporting hotlines and door-to-door notification services, on universal birth and death registration in the county, guided by the Diffusion of Innovations Theory, the Health Belief Model and Community Participation Theory. It adopted a convergent parallel mixed-methods design. Quantitative data were collected from 392 household heads (a 98.2 percent response rate) in Keiyo North and Keiyo South sub-counties, selected through multistage sampling, and qualitative data from nine key informant interviews (of 12 targeted) with civil registration officers, Community Health Promoters and assistant chiefs. Quantitative data were analyzed using descriptive statistics, Pearson correlation, and simple and multiple linear regression; qualitative data were analyzed thematically. Respondents held positive perceptions of notification systems (M = 4.12, SD = 0.885), rating door-to-door services highest (M = 4.26) and reporting hotlines lowest (M = 3.94). Notification systems correlated positively and significantly with universal registration (r = .240, p < .01) and were a significant predictor when modelled alone (β = .240, p < .001, R² = .058), but lost independent significance once the other three community-led interventions were controlled for (β = -.009, p = .872). Interview themes showed that Community Health Promoters were the most consistent notifiers, that poor roads, weak network coverage and unpaid volunteer work limited effectiveness, and that home deaths were notified far less reliably than births. The study concludes that notification systems contribute to registration mainly alongside other interventions, and that their value is currently constrained by infrastructure and volunteer support. It recommends investing in sub-location notification points, transport and airtime support for notifiers, and embedding notification within an integrated county registration strategy.
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