Hospital Based Mortality Reporting System at the MOPH Workshop on the Operation of Civil Registration, Vital Statistics and Identity Management Systems and the Production of Vital Statistics Reports for the Eastern Mediterranean Region Countries (Group2) Tunisia, March 26-30, 2018 Hilda Harb – MPH - 11/12/2018

Selected Indicators VITAL STATISTICS - 2016 POPULATION ESTIMATE PER 1,000 CITIZENS 4,356 CRUDE BIRTH RATE PER 1,000 POPULATION 20.4 CRUDE DEATH RATE PER 1,000 POPULATION 5.7 NEONATAL MORTALITY RATE PER 1,000 LB 4.8 MATERNAL MORTALITY RATIO PER 100,000 LB 21 INFANT MORTALITY RATE PER 1,000 LB 6.4 UNDER-5 MORTALITY RATE PER 1,000 LB 8.5 LIFE EXPECTANCY AT BIRTH (YEARS) 81.24 (2012) Hilda Harb – MPH - 11/12/2018

Selected Indicators (cont’d) HEALTH EXPENDITURE - 2012 TOTAL HEALTH EXPENDITURE (THE) AS %GDP 7.2 % PER CAPITA (THE) 750 USD OOP HEALTH EXPENDITURE AS % THE 37.3% Hilda Harb – MPH - 11/12/2018

Introduction The Department of Vital and Health Statistics at the Ministry Of Public Health (MOPH) is responsible for gathering all health information data available in the country including civil registration (Namely Birth and Death) from the Ministry of Interior and Municipalities (MOIM). Hilda Harb – MPH - 11/12/2018

Introduction (cont’d) We have fragmented sources of information on vital statistics: -From Ministry of Interior (manual data) Name lists provided to MOPH (automated at MOPH) Aggregate data provided to CAS (automated at CAS) -From Ministry of Public Health (Through Hospital online systems) -From surveys Hilda Harb – MPH - 11/12/2018

MOPH Reporting systems Hilda Harb – MPH - 11/12/2018

MOPH Reporting systems 1- Name lists of birth and death II- Hospital based vital data reporting systems III- Beirut governorate certificates of death (pilot project) Hilda Harb – MPH - 11/12/2018

I- Name lists of birth and death Ministry of Interior and Municipalities MOIM Information on Births and Deaths is gathered at the district level and reported to the MOPH central offices since 2009. Hilda Harb – MPH - 11/12/2018

I- Name lists of birth and death (cont’d) Variables collected: Place of Registration Full Name Mother’s Name Gender Date of Birth Date of Death Variables available on the form but not filled: Place of Death Cause of Death Place of residence Hilda Harb – MPH - 11/12/2018

I- Name lists of birth Hilda Harb – MPH - 11/12/2018

I- Name lists of death Hilda Harb – MPH - 11/12/2018

I- Birth and death - The summary form Hilda Harb – MPH - 11/12/2018

I- Name lists of birth and death (cnt’d) 88,996 Births and 24,617 Deaths were registered at MOIM in 2016 of which 20,081 also occurred in 2016. 2017 is yet to be completed (usually by end March every year). Online reporting from districts started during 2017. Hilda Harb – MPH - 11/12/2018

I- Birth and death - The online form Hilda Harb – MPH - 11/12/2018

I- Birth and death - The online form Hilda Harb – MPH - 11/12/2018

I- Birth and death - The extracted birth report Hilda Harb – MPH - 11/12/2018

I- Birth and death - The extracted death report Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems Currently, there are three reporting systems on vital data between MOPH and hospitals: Maternal Neonatal Mortality Notification System Birth Data records Reporting System on Causes of Death (2017) Completely automated online reporting on cause of death by end of 2018 Vital Data Observatory (2011) Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems (cnt’d) Maternal Neonatal Mortality Notification  Hospitals report to the MOPH the following variables on a monthly basis: Number of Deliveries (NVD, CS) Number of Newborns Number of Live Births (less than 2.5Kg, 2.5-4kg, more than 4kg) Number of Birth Defects (since Mid 2012) Number of Abortions, IUFD and Stillbirths Number of Neonatal Deaths with cause Number of Maternal Deaths with cause All available by district and hospital since 2011, and by Nationality since 2015. Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems (cnt’d) Vital Data Observatory – Monthly report Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems (cnt’d) Vital Data Observatory – Neonatal Death Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems (cnt’d) Vital Data Observatory – Maternal Death Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems (cnt’d) Vital Data Observatory – Birth Data records Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems (cnt’d) As a development of the reporting agreement between the MOPH and the hospitals, we launched at the beginning of 2017 the reporting system on Causes of Death. The hospitals are reporting to the statistics department anonymously and on a monthly basis all deaths that are registered in their premises including those DOAs, at the morgue or at home. Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems (cnt’d) Hospital based Mortality reporting System (HMS) Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems (cnt’d) Hospital based Mortality reporting System (HMS) - The extracted report Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems (cnt’d) Variables include Nationality, mode of death, place of death, and 4 CODs in codes and description. Tools used: Software specially developed by WHO IRIS for selection of UCOD ANACONDA for quality checks (to be used this year) (Deaths occurring and registered in 2016: 20,081 (6.43% Expected outside)---18,000-19,000. Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems (cnt’d) Software specially developed by WHO based on the actual and the recommended form of the certificate of death. IRIS for selection of UCOD: Iris is an automatic system for coding multiple causes of death and for the selection of the underlying cause of death. ANACONDA for quality checks and completeness: ANACONDA is a tool for checking the quality of mortality and COD data Acronym for: Analysis of causes of national death for action Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems (cnt’d) Till end 2017, around 18,053 death records were reported. 37 hospitals covered around 60% of total deaths. Hilda Harb – MPH - 11/12/2018

III- Beirut governorate certificates of death Copies of certificates of death are sent since 2014 to the MOPH on a monthly basis. Data are entered on a specialized software which was prepared by WHO based on the actual certificate form. 4,456 certificates are already entered Hilda Harb – MPH - 11/12/2018

III- Beirut governorate certificates of death After the information is automated the certificates are scanned and then shredded Hilda Harb – MPH - 11/12/2018

Results...so far Hilda Harb – MPH - 11/12/2018

Output from the Name lists of Birth and Death https://www.moph.gov.lb/DynamicPages/download_file/2282 Hilda Harb – MPH - 11/12/2018

Preliminary results - Hospital based cause of death reporting system PLACE OF DEATH 2017 Data available at District level. Hilda Harb – MPH - 11/12/2018

Preliminary results - Hospital based cause of death reporting system Manner of Death 2017 Hilda Harb – MPH - 11/12/2018

Preliminary results - Hospital based cause of death reporting system In progress - Place of death by district of residence In progress - Underlying cause of death by ICD-10 chapter In progress - Underlying cause of death by gender and age group Leading causes of death by age and gender Hilda Harb – MPH - 11/12/2018

Future steps Hilda Harb – MPH - 11/12/2018

Future steps I- Name lists of Birth and Death Generating automatically a series of specific reports by location, age groups, gender, etc. Continue on collaborating with the Ministry of Interior and Municipalities on automating the civil registration and vital data. Hilda Harb – MPH - 11/12/2018

II- Hospital based vital data reporting systems Future steps (cont’d) II- Hospital based vital data reporting systems Training Medical Doctors on the proper certification of deaths Refresher training of focal points at hospitals Revise the system for quality and completeness Merging the existing systems into one hospital based reporting system for the MOPH (VDO and HMS) Hilda Harb – MPH - 11/12/2018

Future steps (cont’d) Pending issues: III- Beirut governorate certificates of death Pending issues: Plan A (continue and expand to all governorates) Plan B (MOIM takes over and uses the developed software) Amendment of the COD form in collaboration with MOIM. Hilda Harb – MPH - 11/12/2018

“It is through connecting all the pieces of the puzzle that the picture becomes complete” Thank You Hilda Harb – MPH - 11/12/2018