X.
Planning and Evaluation Services
A.
Present Status
The present Vital Statistics Office is housed in the Medical Records Section
of the Majuro Hospital.
There are only two employees.
The office is in charge of
collecting all birth, death, fetal death, and health services utilization data in
the Marshall Islands.
(Examples of the forms used at present are in Appendix N).
The office sends out forms to the health aides (who are supposed to register
births and deaths) and picks them up periodically when "field ships" make the
tour of the islands.
The health aides fill in the needed data in handwriting on
the forms, either in English or Marshallese, and then send them back to the main
office where a final original birth or death form is typed out from the rough
handwritten one.
Generally the health assistant lists only signs and symptoms
for "cause of death" on their form.
A medical officer in Majuro interprets the
signs and symptoms and attributes a “cause of death" (cause of death is seldom
determined by autopsy).
After an “original” death or birth certificate is typed
out copies are sent to the courthouse and until recently to Saipan where ail
tabulations and analysis of data has been done.
Unfortunately, many vital events
(particularly deaths) go unreported, and many forms are lost in transit from the
outer islands to the central office.
.
the
Basic health utilization data comes from the "Sick call" forms filled out by
health
assistants
(see Worksheet for
Dispensary Reports in Appendix).
Sick
Call
forms
and
the
Monthly
Unfortunately, not much information is availale
from these forms and many of them get lost as well.
Immunization data is recorded
on a patient-retained card (usually held by the mother of the child).
Recently
the staff in Majuro have introduced in the outer island clinics the use of a
larger more complete personal/family medical form (see example in Appendix N).
Not all clinics are using it yet,
furthermore accuracy and completeness varies
considerably among the health assistants.
This latter form remains at the clinic
and is not sent in like the sick call form.
Initially it was hoped the health
supervisory personnel traveling on the "field ship" tours would retrieve relevant
health data from the clinic based form.
Unfortunately,
tours to the outer
islands have been very sporadic and usually the short time spent on each atoll is
used up conducting inmunization clinics and other activities, leaving little or
no
time
to
evaluate
or
retrieve
data from the
clinic records.
(The Majuro
Hospital medical record system is discussed under a separate section).