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

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

MALDIVES – AN OVERVIEW • Total of 1192 islands • 187 inhabited islands • Population-298,968(Census 2006) 341848 (2014) • Infant Mortality Rate – 9 per 1000 live births 2012 (The Maldives Health Statistics 2014 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: 74.8 (2012) (The Statistical Yearbook of Maldives, 2014)

Health System of Maldives

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

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

Occurrence of a birth Occurrence of death 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 Department of National Registration (DNR)

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 Department of National Registration (DNR) Ministry of Health & Gender Records of all registered births Database of all births and deaths in the country Records of all deaths

Birth Hospitals Health Centres (TBAs)Foolhumas Island Offices Death 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

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

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

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

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 • www.health.gov.mv • Used for policy making and for other purposes including for use by government and students.

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

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

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

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

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

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.

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.

Legislation pertaining to registration of births and deaths were passed and enacted in the country in 1993. 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 Concilsin the atolls.

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.

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.

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 .

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.

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.

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.

Thank you!

Health Statistics Reporting in Maldives