Ministry
ofHealth
Health& Gender
Ministry of
Republic of Maldives
Republic
By: Ms.Mariyam Mohamed & Ms.Ummeedha
Abdul Razzag
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
I: Civil Registration and Vital Statistics (CRVS) system in Maldives
1.
Maldives – An overview
2.
Structure of Health System
3.
Contents of the Annual Health Report
/ Maldives Health Statistics
4. Data compilation and Analysis
5.
Format of Presentation /
Dissemination
6. Areas for Improvement
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
MALDIVES – AN OVERVIEW
 Total of 1192 islands
 187 inhabited islands
 Population-298,968 (Census 2006) 341848 (2014)
 Infant Mortality Rate – 9 per 1000 live
births 2012 (The Maldives Health Statistics 2014 draft )
 Maternal Mortality Ratio- 13 per 100,000
live births (The Maldives Health Statistics 2014 draft )
 Under Five Mortality Rate - 11 per 1000 live
births (The Maldives Health Statistics 2014 draft )
 Life expectancy at birth:
 Male: 73.0 (2012)
 Female: 74.8 (2012)
(The Statistical Yearbook of Maldives, 2014)
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Health System of Maldives
Annex 1: Health system – 2010-2015
Ministry of Health (National health policy and health
development planning; regulator of health services; health
services delivery, nationally coordinate blood transfusion
services d Emergency Medical Services)
Maldives
Medical
council;
Maldives
Nursing
Council;
Maldives
Board of
Health
Sciences
Maldives
Food and
Drug
Authority
(regulation
of medicines
& medical
devices;
food safety
& control
system;
national
health
laboratory )
National
Social
Protection
Agency
(social
health
insurance;
welfare &
disease
specific
trust funds)
Centre for
Community
Health and
Disease
Control
(national
public health
programmes;
disease
control &
surveillance;
community
based health
promotion
and public
health
enforcement
)
Specialize
d medical
institutes
Reporting
Primary
care health
centres
National
Drug
Agency
Secondary
care
hospitals
(Drug
prevention
and
rehabilitati
on)
Regulation
Tertiary
care
hospitals;
Private Health Service
Providers (private hospitals;
polyclinics; diagnostic services;
pharmacies)
Collaboration
Atoll and Island Councils
(Health service operational policy; health promotion &
enforcement of public health functions)
Academic
institutions
Maldives
Red
Crescent
NGOs /CBOs and
professional
associations
(health promotion
and community
based services)
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
STRUCTURE OF HEALTH SYSTEM (previous)
MINISTRY OF HEALTH & GENDER
Department of
Public Health
Department of
Medical Services
National Thalassaemia
Centre
Maldives Food and
Drug Authority
CENTRAL
1
Indira Gandhi
Memorial Hospital
National Health
Laboratory
REGIONAL
2
Atoll Hospitals
ATOLL
3
Health Centres
SUB-ATOLL
4
ISLAND
5
Regional Hospitals
Health Posts & Family Health Sections
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Figure 1: VRS FLOW DIAGRAM
Birth / Death Occurs
Birth Form / Death form
(Triplicate copy forms)
White Copy
Parent/
Guardian
Yellow Copy
Department of
National
Registration
(DNR)
Pink Copy
Island
administration
responsible for
death registration/
Male’ Municipality
Island Councils /Atoll
Council/ DNR
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Occurrence of death
Fill in the death form
Occurrence of a birth
Fill in the birth form
Parent / Guardian
Triplicate copying of the forms
Department of
National Registration
(DNR)
Island Office or Councils/
Male’ City Council
(death certificate)
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Health facilities
Atoll Councils
Photo
copy
Island Councils
Registry of all
births/ deaths
Registry of all births/
deaths in the island
Ministry of Health & Gender
Database of all births and
deaths in the country
Registry of all births/
deaths in the atoll
Department of National
Registration (DNR)
Records of all registered
births
Records of all deaths
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Birth
Fill in the birth form
Photo
copy
Parent /
guardian
Fill in death form
Hospitals
Health Centres
(TBAs)Foolhumas
Island Offices
Island
Councils
Death
Dept. National Registration
Atoll Councils
Male’
Male’ City Council
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Contents of the Annual Health Report
/ Health Statistics
 Natality
 Mortality
 Morbidity / Health Services
 Human Resources
 Health Care Finance
 Others
 MDG Indicators –incorporated within sections
 NHA – very limited baseline data
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Data compilation and Analysis
 Data collected at :
 Peripheral Health Care facilities
 Hospitals / Health Centres / Health Posts
 Data compiled :
 Ministry of Health & Gender – Planning and
International Health Section/Health Protection
Agency/Regional Hospitals
 Data Analysis
 Previously Annual Health Reports published
 Currently Maldives Health Statistics published
 Health Reports to be published every five years –
detailed analysis of trends
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Topics and themes covered by VS
Vital Statistics:
 Crude Birth Rate / Crude Death Rate / Infant mortality




rate/ Neonatal Mortality Rate /Under5 mortality rate/
Maternal mortality rate /still birth rate/teenage
pregnancies/mode of delivery/ cause od death / Age
specific Mortality rate/etc are calculated
Annual statistics published with gender disaggregation
Stats are taken by locality /island /atoll wise and gender
disaggreagted
VRS is the main source of vital stats.
Since VRS is complete ,Census and other surveys not used
to collect vital stats ,however Census is conducted in every 5yrs
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Format of Presentation /
Dissemination
 Maldives Health Report & Maldives Health Statistics
 Published (last one published in 2012)
 Printed in hard copy
 Electronic Form available


On CD
On Website
 www.health.gov.mv
 Used for policy making and for other purposes including
for use by government and students.
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Areas for Improvement
 Improved Data Collection
 Timely Information
 Strengthened Reporting System
 Standards developed
 Capacity Building
 At central level
 At Regional / Atoll Level
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
II: Changes / Reforms in CRVS in the last decade
Major changes / reforms in the CRVS in Maldives during the last decade
1.
Functioning of CRVS
2.
Coordination in CRVS
3.
Topics and themes covered by Vital Statistics
4.
Quality assessment and assurance in Vital Statistics
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Coordination in CRVS
 100% coverage
 ICD coding
 1992 legislation still continues in birth registration
 The system will catch all the entries and get access to
 DNR / MoH&G
 Online system is hosted by NCIT
 Present change VRS data entry work moved to DNR in June
2011
 Online system functioning only in central level
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Quality assessment and assurance in VS
 ICD training has given to Drs in the IGMH and coders
have been trained in different regions (working in
different hosps)
 Cause of death validation study
 VRS assessment
 VRS completeness study
 Regular checking of data in the forms
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Functioning of CRVS
 Triplet copies introduced in 2003
- Copies of the original forms to central level for
records
 Online system introduced in late 2009
 ICD coding to 4 digits introduced in 2004
 Birth and death forms are shared with all island
facilities
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
The geographical nature of the Maldives
presents difficulty in transportation and also
causes delays in timely exchange of
information. However, over the years the
development in telecommunication has
brought about positive changes to the
problem but still the problem of timely
exchange of information does exist.
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
 As early as 1960s births and have been
reported to the Ministry of Health through a
system of registration and this can be said to
be the first records in a formalized manner.
 The previous death forms and birth forms
did not flow from the atolls to Male’, rather a
birth and death list was compiled from atolls
and sent to MoHG.
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
 Legislation pertaining to registration of births and deaths
were passed and enacted in the country in 1993. The
legislation entitled “Registration of Births, Birth
Certification and Death Certification”, legislation number
7/92 was a turning point in strengthening the birth and
death registration in the country.
 Since its enforcement various efforts were made to improve
and facilitate the process. the role of registration was
passed later to Male’ City Councils and Island Concils in
the atolls.
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
• Establishment of a systematic reporting system with triplet copy
method which ensures that a copy is kept at: 1) local registration
facility (Male’ municipality and island offices 2) patient or relative and
3) Department of National Registration. It is encouraged that a
photocopy of the forms are kept at the health facility.
• Development of a unique serial number for each reporting form (Birth
and Death) which enables tracking the reporting form and allows for
follow up.
• Various training workshops and awareness programmes have been
conducted in the islands to familiarize with the procedure of reporting
vital events.
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
• Various training workshops and awareness
programmes have been conducted in the islands to
familiarize with the procedure of reporting vital
events.
 Procedure Manuals have been distributed to all islands
and health facilities.
 Each and every field of the birth and death records are
cross checked from the database with the manual
reporting form.
 Establishment of Online Birth and Death system.
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Data processing and records maintenance at DNR
All the yellow copies of births and death forms
received at DNR is entered to the computerized
system.
Cross checking is done to ensure the correctness of
information and attempts are made to obtain any
missing information on the forms
At the end of the year all the information entered to
the system is checked against the yellow hard copy
of the forms and validated
.
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
There is usually a delay in getting the forms from
the atolls mainly due to lack of a monitoring. Even if
staff follow up and call to request to send the forms,
forms will be submitted towards the end of the year
which may possible to due difficulty in
transportation and sending of forms.
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Improvement of the years
Since 1999 there has been a lot of work done to improve the national vital
registration system of Maldives. Some of the actions that have been taken
are:
 Establishment of a systematic reporting system with triplet copy
method which ensures that a copy is kept at: 1) local registration
facility (Male’ municipality and island offices 2) patient or relative and
3) Ministry of Health & Family. It is encouraged that a photocopy of the
forms are kept at the health facility.
 Development of a unique serial number for each reporting form (Birth
and Death) which enables tracking the reporting form and allows for
follow up.
 Various training workshops and awareness programmes have been
conducted in the islands to familiarize with the procedure of reporting
vital events.
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
Improvement of the years
 Procedure Manuals have been distributed to all islands
and health facilities.
 Each and every field of the birth and death records are
cross checked from the database with the manual
reporting form.
 Establishment of Online Birth and Death system.
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH
MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH MINISTRY OF HEALTH