Summer in the Field: Why People Don’t Register Deaths in Ghana
Funerals are big events in Ghana, very extravagant and expensive, with people often borrowing heavily to carry out elaborate celebrations, planning them for months, sometimes years. Careful thought is given to ensuring colorful billboards announcing the funeral arrangements, drinks, food, music and dance, elaborate caskets, inviting a large guest list, and a thorough service at the church or mosque.
Despite this fastidious planning, Ghanaians often skip an important aspect of death and burial: getting the paperwork done.
Most Ghanaians do not register a death with the state or procure a death certificate, as is common in other sub-Saharan African countries. This has major implications for the effectiveness of government policy. Without critical information on who is dying, when, why and where, the government cannot plan, allocate or target resources effectively. They cannot effectively tax its people or design health and social protection policies. This phenomenon is not peculiar to Ghana, most African countries have incomplete death data.
This information deficit became even more salient amid the COVID-19 pandemic, with governments not knowing where best to target resources or money. In Ghana, like a lot of other African countries, people typically die in their homes, not in hospitals, either because they can’t reach a medical facility or because people prefer to be at home with their families.
To date, there has been limited investigation into the factors determining low death registrations in developing countries. As part of my 2024 Summer in the Field Fellowship, I traveled to Accra and Tamale in Northern Ghana to interview various stakeholders, registrars at the registration offices, mortuary men, sextons at burial grounds, village chiefs and imams, to understand the demand side and supply side constraints surrounding death registrations.
The field interviews suggest that a large variation in registrations by place of death, gender, religion, region and income, among other characteristics. For instance, female deaths, deaths that occur in hospitals, child deaths and deaths associated with taboo causes are less likely to be registered.
Another interesting dimension of death registration involves religious and cultural norms and practices.
In Ghana, Muslims are less likely to register deaths than Christians. On speaking to Imams and people from the community, I found that this emerged from the immediacy of burial. Muslims bury their loved ones within a day of passing; procedural requirements like needing a medical cause of death certificate to register a death with the government are at odds with this practice. Many prefer not to probe into the cause of death or cause the soul any more pain or harm by requesting invasive procedures, like an autopsy. This highlights an important failing of uniform civil codes and policies that exclude entire communities from essential services.
Another important barrier is the requirement of documentation to register a death, such as a medical cause of death form furnished by doctors. While doctors are legally required to provide these forms upon request at no cost, the reality is quite different. Most doctors refuse to sign these forms, and often loved ones must wait very long, and oftentimes pay a bribe to procure it. This adds additional costs to the death registration process, financial and otherwise, that discourages individuals from following through with the process. Policies that appear at face value to be free can, in reality, cost citizens dearly.
There are also issues around incomplete information and information asymmetries. Many people don’t have enough information on how the process works, what documentation is required and that it is free to register within 10 days of the person’s passing. It is also evident that people are not thinking about future benefits from registering a death. Death certificates are critical for individuals, granting rights to a deceased’s estate, and access to social benefits such as insurance and pensions.
If Ghana is to increase death registration rates, it needs to address some of these demand side issues and set a norm of registering deaths amongst its people, given that the state is very limited in capacity and would be unable to reasonably enforce the policy in all cases. Registration officers are often traveling long distances and are overworked, overstretched and with understaffed offices trying to reach remote communities. Some of them are combing through newspaper obituaries to try and identify those who have passed to approach their families for registration. However, the bureaucrats at the births and deaths registry are fairly committed to increasing death registration rates after having successfully improved birth registration rates. The challenge is to devise a policy innovation that is inexpensive and easily scalable, given the lack of resources at their disposal.
After an incredibly successful field visit where I learnt a lot about the realities and barriers around death registrations, I am now working on liaising with the births and deaths registry in Ghana to collect survey data to further understand barriers by different stakeholders, as well as pilot some interventions that could be targeted at improving registrations.
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Learn more about the Summer in the Field Fellowship Program.