Presentation on theme: "Health Statistics Reporting in Maldives"— Presentation transcript:
1Health Statistics Reporting in Maldives Ministry of Health & GenderRepublic of MaldivesHealth Statistics Reporting in MaldivesBy: Ms.Mariyam Mohamed & Ms.Ummeedha Abdul Razzag
2I: Civil Registration and Vital Statistics (CRVS) system in Maldives Maldives – An overviewStructure of Health SystemContents of the Annual Health Report / Maldives Health StatisticsData compilation and AnalysisFormat of Presentation / DisseminationAreas for ImprovementIn this presentation we will be highlighting the following areas
3MALDIVES – AN OVERVIEW Total of 1192 islands 187 inhabited islandsPopulation-298,968 (Census 2006) (2014)Infant Mortality Rate – 9 per 1000 live births 2012 (The Maldives Health Statistics draft )Maternal Mortality Ratio- 13 per 100,000 live births (The Maldives Health Statistics 2014 draft )Under Five Mortality Rate - 11 per 1000 live births (The Maldives Health Statistics 2014 draft )Life expectancy at birth:Male: 73.0 (2012)Female: (2012)(The Statistical Yearbook of Maldives, 2014)
4Health System of Maldives CCHDC has been changed to HPA
5STRUCTURE OF HEALTH SYSTEM (previous) 1CENTRALDepartment ofPublic HealthMedical ServicesMaldives Food andDrug AuthorityIndira GandhiMemorial HospitalNational ThalassaemiaCentreRegional HospitalsAtoll HospitalsHealth Posts & Family Health SectionsNational HealthLaboratoryHealth CentresMINISTRY OF HEALTH & GENDER2REGIONAL3ATOLL4SUB-ATOLL5ISLAND
6Birth Form / Death form (Triplicate copy forms) Figure 1: VRS FLOW DIAGRAMBirth / Death OccursBirth Form / Death form (Triplicate copy forms)White CopyYellow CopyPink CopyParent/ GuardianDepartment of National Registration (DNR)Island administration responsible for death registration/ Male’ MunicipalityIsland Councils /Atoll Council/ DNRFrom 2003, a triplicate copying system of reporting births and deaths through birth form and death certificate has been operational. The original copy of the form goes to the parent or guardian, second copy is passed to the island administrations (to Municipality in case of Male’). The third copy is sent to DNR, which is used to input data in the VRS database.
7Vital Registration System (VRS) Occurrence of deathOccurrence of a birthFill in the death form (death certificate)Fill in the birth formTriplicate copying of the formsIsland Office or Councils/ Male’ City CouncilParent / GuardianIf a birth ocuured in male the capital city it shoud be informd to male city councilDepartment of National Registration (DNR)
8VRS - Birth and death registration/ recording processes Health facilitiesIsland CouncilsAtoll CouncilsPhoto copyRegistry of all births/ deathsRegistry of all births/ deaths in the islandRegistry of all births/ deaths in the atollMinistry of Health & GenderDepartment of National Registration (DNR)This is a detailed of the prv oneRecords of all registered birthsDatabase of all births and deaths in the countryRecords of all deaths
9Dept. National Registration VRS - Reporting flow of birth and death dataDeathHospitalsHealth Centres(TBAs)FoolhumasIsland OfficesBirthFill in death formFill in the birth formPhoto copyIsland CouncilsParent / guardianMale’Male’Dept. National RegistrationAtoll CouncilsMale’Male’ City Council
10Contents of the Annual Health Report / Health Statistics NatalityMortalityMorbidity / Health ServicesHuman ResourcesHealth Care FinanceOthersMDG Indicators –incorporated within sectionsNHA – very limited baseline dataIn Maldives the health reports were published annually up until year However, at present we have the Maldives Health Statistics with only the statistical tables.In this presentation we will be focussing on Maldives Health Statistics.Looking at the contents of our health statistics there are 6 main categories.In the Natality Category, we have indicators such as Crude Birth Rate, and detailed information such as the Number of Live births, live and still births by place of occurrence, percentage of births by mode of delivery, deliveries by type of health professional.In the Mortality Section we have the basic mortality indicators such as the Crude Death Rate, IMR, U5MR,NMR MMR, Still Birth Rate, Age specific mortality rate…etc….In the morbidity and health services section, we have information such as the prevalence and incidence of certain diseases such as the TB, Leprosy, diarrhoea,…. Also we have information on HIV status, vaccine coverage …reported number of dengue cases etc…The Human resource section of the Health Statistics has information on the number of health care professionals by locality and distribution of medical staff in atolls and in Male’IN the Health Care Finance Section we have information on the government budget on health sector and government health expenditure.Lastly we have an OTHERS category which includes information on the Contraceptive PR, Drug abuse cases and imports of tobaccoAS CAN BE SEEN SOME OF THE MDG INDICATORS ARE INCLUDED IN THE DIFFERENT SECTIONS OF THE HEALTH STATISTICS… IT HAS TO BE NOTED THAT OUR NATIONAL HEALTH ACCOUNT SYSTEM REQUIRES IMPROVEMENT AND THERE IS A LIMITATION TO THE BASELINE DATA FOR NHA.SINCE THIS IS OUR FIRST HEALTH STATISTICS BOOK SOLELY FOCUSSING ON STATISTICS WE THINK THAT THERE WILL BE REVISIONS AND MUCH IMPROVEMENTS FOR THE NEXT PUBLICATION,
11Data compilation and Analysis Data collected at :Peripheral Health Care facilitiesHospitals / Health Centres / Health PostsData compiled :Ministry of Health & Gender – Planning and International Health Section/Health Protection Agency/Regional HospitalsData AnalysisPreviously Annual Health Reports publishedCurrently Maldives Health Statistics publishedHealth Reports to be published every five years – detailed analysis of trendsDATA is collected for statistics through all levels. In the peripheral atoll level, data is collected in all health care facilities, Hospitals, Health Centres and Health Posts…DATA is COMPILED at the central and regional level. At the central level data compilation is mainly done the Health Information and Research Section of the Ministry of Health & GenderData is also compiled from the central level at the HPA and DMS. At peripheral level, ifnormation flows from the island level to regional hospitals for data compilation…Data Analysis is very limited as currently the MoH publishes just the statistical tables with a small executive summary for the Maldives Health Statistics. Detailed analysis of the trends are to be in the Health Report which will be published every 5 years in future. This would allow us sufficient time to see the trends and analyse comprehensively
12Topics and themes covered by VS Vital Statistics:Crude Birth Rate / Crude Death Rate / Infant mortality rate/ Neonatal Mortality Rate /Under5 mortality rate/ Maternal mortality rate /still birth rate/teenage pregnancies/mode of delivery/ cause od death / Age specific Mortality rate/etc are calculatedAnnual statistics published with gender disaggregationStats are taken by locality /island /atoll wise and gender disaggreagtedVRS is the main source of vital stats.Since VRS is complete ,Census and other surveys not used to collect vital stats ,however Census is conducted in every 5yrsOther than health stat book we analise data for the UN demographic year book and SYB by dnp
13Format of Presentation / Dissemination Maldives Health Report & Maldives Health StatisticsPublished (last one published in 2012)Printed in hard copyElectronic Form availableOn CDOn WebsiteUsed for policy making and for other purposes including for use by government and students.Both Maldives Health Statistics and Maldives Health Report is published and printed in hard copy. The electronic form is also available on CD and on the website
14Areas for Improvement Improved Data Collection Timely InformationStrengthened Reporting SystemStandards developedCapacity BuildingAt central levelAt Regional / Atoll LevelThere is a lot to be improved … we need to improve the data collection at the peripheral level in a more timely manner.Reporting system to the data compilation points need to be strengthened….Furthermore we need to build the capacity at different levels to have a quality statistics in Maldives.
15II: Changes / Reforms in CRVS in the last decade Major changes / reforms in the CRVS in Maldives during the last decadeFunctioning of CRVSCoordination in CRVSTopics and themes covered by Vital StatisticsQuality assessment and assurance in Vital Statistics
16Coordination in CRVS 100% coverage ICD coding1992 legislation still continues in birth registrationThe system will catch all the entries and get access toDNR / MoH&GOnline system is hosted by NCITPresent change VRS data entry work moved to DNR in June 2011Online system functioning only in central level
17Quality assessment and assurance in VS ICD training has given to Drs in the IGMH and coders have been trained in different regions (working in different hosps)Cause of death validation studyVRS assessmentVRS completeness studyRegular checking of data in the forms
18Functioning of CRVS Triplet copies introduced in 2003 - Copies of the original forms to central level for recordsOnline system introduced in late 2009ICD coding to 4 digits introduced in 2004Birth and death forms are shared with all island facilities
19The geographical nature of the Maldives presents difficulty in transportation and also causes delays in timely exchange of information. However, over the years the development in telecommunication has brought about positive changes to the problem but still the problem of timely exchange of information does exist.
20As early as 1960s births and have been reported to the Ministry of Health through a system of registration and this can be said to be the first records in a formalized manner.The previous death forms and birth forms did not flow from the atolls to Male’, rather a birth and death list was compiled from atolls and sent to MoHG.
21Legislation pertaining to registration of births and deaths were passed and enacted in the country in The legislation entitled “Registration of Births, Birth Certification and Death Certification”, legislation number 7/92 was a turning point in strengthening the birth and death registration in the country.Since its enforcement various efforts were made to improve and facilitate the process. the role of registration was passed later to Male’ City Councils and Island Concils in the atolls.
22Establishment of a systematic reporting system with triplet copy method which ensures that a copy is kept at: 1) local registration facility (Male’ municipality and island offices 2) patient or relative and 3) Department of National Registration. It is encouraged that a photocopy of the forms are kept at the health facility.Development of a unique serial number for each reporting form (Birth and Death) which enables tracking the reporting form and allows for follow up.Various training workshops and awareness programmes have been conducted in the islands to familiarize with the procedure of reporting vital events.
23Various training workshops and awareness programmes have been conducted in the islands to familiarize with the procedure of reporting vital events.Procedure Manuals have been distributed to all islands and health facilities.Each and every field of the birth and death records are cross checked from the database with the manual reporting form.Establishment of Online Birth and Death system.
24Data processing and records maintenance at DNR All the yellow copies of births and death forms received at DNR is entered to the computerized system.Cross checking is done to ensure the correctness of information and attempts are made to obtain any missing information on the formsAt the end of the year all the information entered to the system is checked against the yellow hard copy of the forms and validated.
25There is usually a delay in getting the forms from the atolls mainly due to lack of a monitoring. Even if staff follow up and call to request to send the forms, forms will be submitted towards the end of the year which may possible to due difficulty in transportation and sending of forms.
26Improvement of the years Since 1999 there has been a lot of work done to improve the national vital registration system of Maldives. Some of the actions that have been taken are:Establishment of a systematic reporting system with triplet copy method which ensures that a copy is kept at: 1) local registration facility (Male’ municipality and island offices 2) patient or relative and 3) Ministry of Health & Family. It is encouraged that a photocopy of the forms are kept at the health facility.Development of a unique serial number for each reporting form (Birth and Death) which enables tracking the reporting form and allows for follow up.Various training workshops and awareness programmes have been conducted in the islands to familiarize with the procedure of reporting vital events.
27Improvement of the years Procedure Manuals have been distributed to all islands and health facilities.Each and every field of the birth and death records are cross checked from the database with the manual reporting form.Establishment of Online Birth and Death system.