X. Planning and Evaluation Services A. Present Status The present Vital Statistics Office is housed in the Medical Récords Section of the Majuro Hospital. There are only two employees. The office iB in charge of collecting all birth, death, feta! death, and health services utilipfation data in the Marshall Islands. (Examples of the forms used at present are i Appendix N). The office sends out forms to the health aides (who are suppose! 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 ba to the main office where a final original birth or death form is typed out om the rough handwritten one. and symptoms Generally the health assistant lists only sign for “cause of death" on their form. A medical officer in Majuro #terprets 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 Saigan where all 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 health assistants (see Worksheet for Dispensary Reports in Appendix). Sick Call forms and] illed out by the Monthly Unfortunately, not much informatign is availale from these forms and many of them get lost as well. Immunization da a is recorded on a patient-retained card (usually held by the mother of the chilH). the staff in Majuro have introduced in the outer island clinics Recently fthe use of a larger more complete personal/family medical form (see example inj Appendix N). Not all clinics are using it yet, furthermore accuracy and comp] considerably among the health assistants. eness varies This latter form remains fat the clinic and is not sent in like the sick call form. Initially it was hopfd the health Supervisory personnel traveling on the "field ship" tours would retrfleve relevant health data from the clinic based form. Unfortunately, tours fo the outer islands have been very sporadic and usually the short time spent onfeach atoll is _used up conducting immunization 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 sectipn).