S/ .Q summarize, the present vital and Lealth service data collection sytem in Majuro has been functioning primarily as Territory offices based in Saipan. a clerical service for Its staffing (two people) and the level of training of the personnel mitigate doing more than clerical work. resulting are many: the Trust The problems quality and accuracy of data are low, particularly that gathered by the health assistants. Sporadic and inefficient mail and transport services has led to a high occurrence of lost forms and missing data. Many deaths are not recorded (particularly of old people on the outer islands). Data on cause of death and health service utilization by cause is also unreliable or missing. Birth registration data is complicated by a common local custom of people changing their first names several times during their lifetimes (this is more common during childhood years). As a result, one person may have several records on himself all under different names. Utilization of the health service data collected as feedback into the health system for management or health status existent. the evaluation purposes is all but non- Now that the Marshall Islands are becoming a Freely Associated State, Saipan connection analysis/planning/evaluation is being function phased without a out, leaving the designated home. The Marshallese Health Services is the logical one to pick it up but it lacks the personnel with appropriate expertise. ability of the health Thus, a very critical breakdown in the system to monitor change and plan for the future is occurring. B. Recommendations The Secretary of Health Services and the head of the Vital Statistics Office on Majuro believe that the development of capability must be established soon on Majuro. an inhouse planning/evaluation It must be able to assume the role previously performed by the TT Health Systems Agency in Saipan. The medical and other vital statistics forms designed by TT are quite good and probably will suffice for now (some revision or addition of items to the forms is all] that is needed). What is more serious is the transport, communications, and supervisory breakdowns which have caused the system as originally designed to not meet its objectives of providing timely and accurate data upon which to measure change. 1. Administrative It is recommended that the Planning/Evaluation Unit assume the role now performed by Saipan of preparing five-year health plans and annual implementation plans. There is a general dislike by the Marshallese for plans developed by