.O Summarize, the present vital and fiealth service data collect on sytem in Majuro has been functioning primarily as a clerical G . ot Territory offices based in Saipan. service fo Its staffing (two people) and he level of training of the personnel mitigate doing more than clerical work. ‘resulting are many: the Trust he problems quality and accuracy of data are low, parti ularly that gathered by the health assistants. Sporadic and inefficient mail ahd 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 u reliable or missing. Birth registration data is complicated by a common loc 1 custom of people changing their first names several times during their lifeti es (this is more common during childhood years). ave several As a result, one person may records on himself all under different names. Utilization of the health service data collected as feedback in system for management or health status evaluation purposes existent. the a 1 is but non- Now that the Marshall Islands are becoming a Freely Assoc jated State, Saipan connection analysis/planning/evaluation ty the health is being function phased without a le ving out, designated me. Marshallese Health Services is the logical one to pick it up but personnel with appropriate expertise. the The t lacks the Thus, a very critical brea down in the ability of the health system to monitor change and plan for t future jis occurring. B. on Recommendations The Secretary of Health Services and the head of the Vital Stat tics Office Majuro /evaluation believe that the development of capability must be established soon on Majuro. an inhouse planni It must be able to as ume the role previously performed by the TT Health Systems Agency in Saipan. Th medical and other vital statistics forms designed by TT are quite good and obably will suffice for now (some revision or addition of items to the forms i all that is needed). What is more serious is the transport, communications, an supervisory breakdowns which have caused the system as originally designed to ot meet its objectives of providing timely and accurate data upon which to mea re change. 1. Administrative It is recommended that the Planning/Evaluation Unit assume fhe 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 Ideveloped by