{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T07:24:51Z","timestamp":1787037891745,"version":"build-2736575974"},"reference-count":77,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The health system has been identified as a key lever for increasing access to birth registration (BR) directly after birth. BR is critical for upholding human rights and accessing essential services, yet many low- and middle-income countries struggle with low BR rates. In this realist synthesis, we reviewed literature on two separate interventions that are designed to increase access to BR services. This included (i) embedding or appointing an official to register births in health facilities and (ii) incorporating education on BR in routine perinatal care programmes. This study aimed to support the knowledge base on how these interventions work, why, and for whom, within health facility contexts. We followed the RAMESES I publication guidelines for realist syntheses. Iterative searches were carried out in PubMed, Scopus, and Web of Science. The search also included grey literature, policy documents, and insights from a key informant in South Africa. We adopted an iterative cycle of searches guided by review team exchanges, stakeholders\u2019 insights, and sequential snowballing searches for theory and background information. We developed two initial programme theories, presented as ICAMO configurations, that were then refined against empirical evidence from 17 included studies, with publication dates ranging from 1992 to 2021. Our review findings highlight that the interventions improved BR rates by lowering logistical barriers, raising awareness, and supporting BR staff, (i.e. personnel responsible for conducting BR within health facilities). Literature from low- and middle-income countries suggests that the effectiveness of facility-level BR interventions is often affected by access to care, travel distances, and transportation costs, as well as by the availability of resources, BR infrastructure, and staff motivation within healthcare facilities. These factors may, in turn, affect BR demand, parents\u2019 self-efficacy, and the extent to which BR initiatives align with parents\u2019 real-life contexts.<\/jats:p>","DOI":"10.1093\/heapol\/czag078","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T11:18:20Z","timestamp":1781695100000},"page":"1280-1306","source":"Crossref","is-referenced-by-count":0,"title":["Health facilities as a lever for birth registration in low- and middle-income countries: a realist review"],"prefix":"10.1093","volume":"41","author":[{"given":"Lisanne","family":"Wolsink","sequence":"first","affiliation":[{"name":"Health Campus, Department of Public Health and Primary Care, Leiden University Medical Center , Spui 5, the Hague 2511 BL ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0115-682X","authenticated-orcid":false,"given":"Zakaria","family":"Belrhiti","sequence":"additional","affiliation":[{"name":"International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health, (UM6SS) , Anfa City, Commune Hay Hassani 82 403, Casablanca 20230 ,","place":["Morocco"]},{"name":"Mohammed VI Center for Research and Innovation , Laboratory of Public Health and Management, 01, Boulevard Mohamed Al Jazouli, Madinat Al Irfane, Hay Riad, Rabat BP: 10112 ,","place":["Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1566-8228","authenticated-orcid":false,"given":"Wiedaad","family":"Slemming","sequence":"additional","affiliation":[{"name":"Children\u2019s Institute, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town , Sawkins Road, Rondebosch, Cape Town 7700 ,","place":["South Africa"]},{"name":"Division of Community Paediatrics, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg 2000 ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1243-858X","authenticated-orcid":false,"given":"Matty","family":"Crone","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Research Institutes CAPHRI\/NUTRIM, Maastricht University , Minderbroedersberg, 4-6, Maastricht 6211 LK ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3831-6249","authenticated-orcid":false,"given":"Marsha","family":"Orgill","sequence":"additional","affiliation":[{"name":"Children\u2019s Institute, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town , Sawkins Road, Rondebosch, Cape Town 7700 ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"2026081802320383900_czag078-B1","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.1016\/S0140-6736(15)60170-2","article-title":"Towards universal civil registration and vital statistics systems: the time is now","volume":"386","author":"Abou Zahr","year":"2015","journal-title":"Lancet"},{"key":"2026081802320383900_czag078-B2","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/s13104-015-1026-y","article-title":"Understanding whose births get registered: a cross sectional study in Bauchi and Cross River states, Nigeria","volume":"8","author":"Adi","year":"2015","journal-title":"BMC Res Notes"},{"key":"2026081802320383900_czag078-B3","volume-title":"African Charter on the Rights and Welfare of the Child","author":"African Union","year":"1990"},{"key":"2026081802320383900_czag078-B4","doi-asserted-by":"publisher","first-page":"66","DOI":"10.5897\/JASD2013.0243","article-title":"Reasons for low birth registration in Sudan","volume":"7","author":"Ahmed","year":"2015","journal-title":"J Afric Stud Develop"},{"key":"2026081802320383900_czag078-B5","author":"Beko"},{"key":"2026081802320383900_czag078-B6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0168405","article-title":"Using the Three Delays Model to Examine Civil Registration Barriers in Indonesia","volume":"11","author":"Bennouna","year":"2016","journal-title":"PLoS One"},{"key":"2026081802320383900_czag078-B7","first-page":"1","article-title":"A medical birth registry at Kilimanjaro Christian Medical Centre","volume":"4","author":"Bergsj\u00f8","year":"2007","journal-title":"East Afr J Public Health"},{"key":"2026081802320383900_czag078-B8","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1186\/s12939-017-0635-6","article-title":"Who and where are the uncounted children? 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