Improving the timeliness of birth registration in Fiji through a financial incentive

Abstract Background: Fiji is a Pacific Island nation of 884,887 (2017 census), with the predominant ethnic groups indigenous Fijians (iTaukei) (62%) and Fijians of Indian descent (31%). In Fiji, birth registration is considered on-time if completed within one year of a child’s birth. From August 2018 to July 2020, the government implemented a financial incentive tied to on-time birth registration called the Parental Assistance Payment Program (PAPP). This study reports on the effect of the PAPP on the timeliness of birth registration in Fiji. Methods: Unit record birth registration data (n=117,842) for children born during 2016-22 were obtained from the Ministry of Justice. Mean birth-to-registration intervals (days between date-of-birth and date-of-registration) and the likelihood of on-time birth registration were analysed before the PAPP (January 2016–July 2018) compared to during the PAPP (August 2018-July 2020), by sex and ethnicity of the child, and by maternal age and marital status. Results: Whilst the PAPP was available, the mean birth-to-registration interval declined sharply by 81%, from 665 days (95%CI: 658-671) to 124 days (121-127). The largest declines were among i-Taukei children (803 to 139 days, 83%) compared to non-iTaukei (283 to 76 days, 73%); mothers aged 10-19 years (880 to 134 days, 85%) compared to ≥20 years (653 to 123 days, 81%); and single mothers (983 to 145 days, 85%) compared to married mothers (570 to 115 days, 80%). On-time birth registration increased from 57% to 93%, and the adjusted odds ratio showed that children born during the PAPP were 5.2 times more likely to have their birth registered on-time compared to children born before the PAPP (p<.0001). When the PAPP was discontinued in August 2020, the birth-to-registration interval increased sharply in all population groups. Conclusions: During the two-year period the PAPP was available, it was highly effective at improving the timeliness of birth registration, particularly among iTaukei children, young mothers, and single mothers. After the PAPP was discontinued, the timeliness of birth registration deteriorated sharply. Longer post-PAPP follow-up time (≠5 years) is required to determine whether the timeliness of birth registration has deteriorated to levels similar to those during the pre-PAPP period.