1. Health Statistics Reporting in Maldives
Ministry of Health & Gender
Republic of Maldives
Health Statistics Reporting in Maldives
By: Ms.Mariyam Mohamed & Ms.Ummeedha Abdul Razzag

2. I: Civil Registration and Vital Statistics (CRVS) system in Maldives
Maldives – An overview
Structure of Health System
Contents of the Annual Health Report / Maldives Health Statistics
Data compilation and Analysis
Format of Presentation / Dissemination
Areas for Improvement
In this presentation we will be highlighting the following areas

3. MALDIVES – AN OVERVIEW Total of 1192 islands
187 inhabited islands
Population-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)

4. Health System of Maldives
CCHDC has been changed to HPA

5. STRUCTURE OF HEALTH SYSTEM (previous)1
CENTRAL
Department of
Public Health
Medical Services
Maldives Food and
Drug Authority
Indira Gandhi
Memorial Hospital
National Thalassaemia
Centre
Regional Hospitals
Atoll Hospitals
Health Posts & Family Health Sections
National Health
Laboratory
Health Centres
MINISTRY OF HEALTH & GENDER 2
REGIONAL 3
ATOLL 4
SUB-ATOLL 5
ISLAND

6. Birth Form / Death form (Triplicate copy forms)
Figure 1: VRS FLOW DIAGRAM
Birth / Death Occurs
Birth Form / Death form (Triplicate copy forms)
White Copy
Yellow Copy
Pink Copy
Parent/ Guardian
Department of National Registration (DNR)
Island administration responsible for death registration/ Male’ Municipality
Island Councils /Atoll Council/ DNR
From 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.

7. Vital Registration System (VRS)
Occurrence of death
Occurrence of a birth
Fill in the death form (death certificate)
Fill in the birth form
Triplicate copying of the forms
Island Office or Councils/ Male’ City Council
Parent / Guardian
If a birth ocuured in male the capital city it shoud be informd to male city council
Department of National Registration (DNR)

8. VRS - Birth and death registration/ recording processes
Health facilities
Island Councils
Atoll Councils
Photo copy
Registry of all births/ deaths
Registry of all births/ deaths in the island
Registry of all births/ deaths in the atoll
Ministry of Health & Gender
Department of National Registration (DNR)
This is a detailed of the prv one
Records of all registered births
Database of all births and deaths in the country
Records of all deaths

9. Dept. National Registration
VRS - Reporting flow of birth and death data
Death
Hospitals
Health Centres
(TBAs)Foolhumas
Island Offices
Birth
Fill in death form
Fill in the birth form
Photo copy
Island Councils
Parent / guardian
Male’
Male’
Dept. National Registration
Atoll Councils
Male’
Male’ City Council

10. Contents of the Annual Health Report / Health Statistics
Natality
Mortality
Morbidity / Health Services
Human Resources
Health Care Finance
Others
MDG Indicators –incorporated within sections
NHA – very limited baseline data
In 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 tobacco
AS 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 ,

11. Data compilation and Analysis
Data collected at :
Peripheral Health Care facilities
Hospitals / Health Centres / Health Posts
Data compiled :
Ministry of Health & Gender – Planning and International Health Section/Health Protection Agency/Regional Hospitals
Data Analysis
Previously Annual Health Reports published
Currently Maldives Health Statistics published
Health Reports to be published every five years – detailed analysis of trends
DATA 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 & Gender
Data 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

12. Topics 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 calculated
Annual statistics published with gender disaggregation
Stats are taken by locality /island /atoll wise and gender disaggreagted
VRS 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 5yrs
Other than health stat book we analise data for the UN demographic year book and SYB by dnp

13. Format of Presentation / Dissemination
Maldives Health Report & Maldives Health Statistics
Published (last one published in 2012)
Printed in hard copy
Electronic Form available
On CD
On Website
Used 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

14. Areas for Improvement Improved Data Collection
Timely Information
Strengthened Reporting System
Standards developed
Capacity Building
At central level
At Regional / Atoll Level
There 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.

15. II: Changes / Reforms in CRVS in the last decade
Major changes / reforms in the CRVS in Maldives during the last decade
Functioning of CRVS
Coordination in CRVS
Topics and themes covered by Vital Statistics
Quality assessment and assurance in Vital Statistics

16. Coordination in CRVS 100% coverage
ICD coding
1992 legislation still continues in birth registration
The system will catch all the entries and get access to
DNR / MoH&G
Online system is hosted by NCIT
Present change VRS data entry work moved to DNR in June 2011
Online system functioning only in central level

17. Quality 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 study
VRS assessment
VRS completeness study
Regular checking of data in the forms

18. Functioning of CRVS Triplet copies introduced in 2003
- Copies of the original forms to central level for records
Online system introduced in late 2009
ICD coding to 4 digits introduced in 2004
Birth and death forms are shared with all island facilities

19. The 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.

20. As 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.

21. Legislation 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.

22. 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) 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.

23. Various 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.

24. Data 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 forms
At the end of the year all the information entered to the system is checked against the yellow hard copy of the forms and validated .

25. There 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.

26. Improvement 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.

27. Improvement 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.

28. Thank you!