1. 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

2. 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

3. Selected Indicators (cont’d)
HEALTH EXPENDITURE
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

4. 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

5. 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

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

7. 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

8. 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

9. 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

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

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

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

13. 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
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

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

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

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

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

18. 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

19. 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

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

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

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

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

24. 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 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

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

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

27. 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

28. 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

29. 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

30. 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

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

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

33. Output from the Name lists of Birth and Death
Hilda Harb – MPH - 11/12/2018

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

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

36. 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

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

38. 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

39. 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

40. 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

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