Nationally, there are two main entities involved in the CRVS process in the Federal States of Micronesia. The Department of Health and Social Affairs (DHSA) is in charge of coordination and gathering of different data sources. The National Statistical Office is responsible for the publication of vital statistics. But considering the federal nature of the country, each of the four states (Yap, Pohnpei, Chuuk, Kosrae) have local equivalents to those two institutions, which are in charge of carrying the actual data gathering and statistics production. In addition, each state’s Supreme Court is responsible for civil registration activities, providing birth and death registrations and certificates.

In addition to agency collaboration, the geography of the country is also a major challenge, considering some regions are constituted of very sparsely populated islands, with very little infrastructure or personnel for health services. Birth registration completeness is highly dependent on location. The national overall birth registration after one-year completeness rate estimates of approximately 80%, but a same rate at approximately only 65 % in Yap, when it is 85-90% in Pohnpei, and virtually complete in Kosrae, a single island state. The same phenomenon can be observed for death registration, also almost complete in Kosrae, but of only 80% in Pohnpei and 70% in Yap. All those issues make the collaboration even more critical, which has been the objective of some recent reforms.