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).