From Birth to Identity: Birth Registration in Health Services in Guinea-Bissau

The children are restless, full of energy, and want to touch everything in the small birth registration office of the Maternity and Child Care Center in Bissau. They don’t know it, but today is an important day for them. Today, four-year-old Mamadu Balde and his one-year-old sister, Adama Balde, will receive their first document — the birth certificate — and officially become citizens of Guinea-Bissau.

“The birth certificate describes the story of our arrival in the world,” explains Victor da Silva, the Head of the first Civil Registry Office established in the capital, Bissau, late in the 50s. This “document tells us who our parents are, where and when we were born, and this information will accompany us throughout our lives, until we die,” he adds. “Our children, grandchildren, and great-grandchildren will also need this information.”

Guinea-Bissau is a small West African country of around 2 million people. Still, according to the Multiple Indicator Cluster Survey 2019, only about 46% of children under five years old have their births registered. To support the Government's efforts to improve Civil Registration and Vital Statistics, UNICEF created the Towards Universal Birth Registration and Legal Identity project, financed by the Italian Agency for Cooperation and Development. The project relies on interoperability, decentralization, and digitalization to bring civil registration  services closer to communities. At the same time, the project is supporting the new civil registry digital system (SIREC, acronym in Portuguese).

That is why Mamadu and Adama are here today. Their parents, Tcherno Balde and Joia Sambe, often come to the Maternity and Child Care Center for medical appointments and to vaccinate their children. Now, after vaccinating their little girl, they decided to register both children.

The registry office is located inside the center, in a small, airy room. While the kids play, the parents talk with Abi da Silva and sign documents. Abi is a nurse and nutritionist, but she has received training to register children at the Maternity and Child Care Center, using a digital platform on a tablet and a printer, all given by the project. “The platform is easy to use,” she says. This week, she is responsible for birth registration, but next week she will return to her usual duties as a nurse. “Each of us works in this registry office for a week, and then we rotate,” Abi explains.

The integration of birth registration into health services, along with the training provided to health workers, the computers, tablets and motorcycles, has been a game-changer in Guinea-Bissau. In the regions of Bissau, Tombali, and Quinara, children are now being registered at birth in hospitals and health centers, or later when they come for vaccinations or medical appointments, by health staff. Since December 2024, nurses, social workers, and even midwives have been authorized to register births for children under one year old.

“With UNICEF, we realized we have to register children in hospitals” and use the health services, which have more human resources than justice services, to reach younger generations, explains Victor. He is now at the National Hospital Simão Mendes, on one of his regular supervision visits, to ensure that civil registry services are functioning properly in health centers.

Here, Victor meets two-month-old Erica de Oliveira Viriato, daughter of Banuma de Oliveira and Madi Viriato. The girl was brought to the national hospital after being sick for the last two days. After being seen by a doctor and receiving treatment, she is now being registered by Cady da Gama, a hospital social worker. Cady says most parents register their children when they come for vaccination appointments. At this hospital, she registers around eight children per day.

Erica was born here, and her mother was informed about the registration service at that time. However, she decided to wait and register her daughter later. Victor da Silva explains that there are historical and cultural barriers that influence why some parents still delay registration. During colonization, only a few people had the right to be considered citizens, and civil registration was associated with the payment of a tax. The project is addressing these beliefs by involving traditional and community leaders in advocacy efforts and community mobilization, especially in rural areas. “The imams, the rulers of tabankas, the youth, and opinion leaders help us change people’s mindset”, explains Victor.

Another barrier is the centralization of registry services, which forces families to travel long distances to reach them. With digital registration now available in hospitals and health centers in three regions - Bissau, Tombali, and Quinara - and the integration of birth registration into nationwide vaccination campaigns, access to services has improved significantly.

Slowly but surely, results are becoming visible. In just nine months, from October 2024 to June 2025, thanks to interoperability between civil registration and the health sector, more than 20,000 children aged 0–7 years were chargeless registered and received their birth certificate, including 5,886 before their first birthday.

Back at the Maternity and Child Care Center, 11-month-old Samara awaits her turn. Her mother, Cadija Ndomba, is happy. Samara was born in another hospital closer to home, but because Cadija did her prenatal care here, she knew she could register her child at this center. She dressed little Samara in a pretty dress for the occasion because today, her daughter will officially have a name.