DATA EVALUATION AND METHODS RESEARCH

Vital RegistrationSystemsin

FiveDevelopingCountries:

Honduras,Mexico,Philippines,

Thailand, and Jamaica

This report was prepared under the direction of the World Health

Organization through a contract with the Vital Statistics Improvement (vISTIM) project of the Office of International Statistics,

Nationid Center for Health Statistics (Contract No. BRA

230-76-0293).

The Vital Statistics Improvement project is funded by the Agency

for International Development through a Resources Support Service

Agreement with the National Center for Health Statistics.

DHHS Publication No. (PHS) 81-1353

Series 2

Number 79

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

Hyattsville, Md. October 1980
Library of CongressCataloging in Publication Data

I

Main entry under title:

Vital Registration systems in five developing countries.

(Vital and health statistics : Series 2, Data evaluation and methods research ; no. 79)

(DHHS publication; no. (PHS) 81-1353)

1. Underdeveloped areas–Registers of births, etc. 2. Underdeveloped areas–

Statistics, Vital. 3. Underdeveloped areas-Statistics, Medical. 4. Underdeveloped

areas-Public health-Statistical services. I. Series: United States National Center for

Health Statistics. Vital and health statistics : Series 2, Data evaluation and methods

research ; no. 79. II. Series: United States. Dept. of Health and Human Services. DHHS

publication ; no. (PHS) 81-1353,

RA409.U45 no. 79 [HA38.A1] 312’.07’23s [350’,81]

79-16799

For sale by the Superintendent of Documents, U.S. Government Printing Otlice,Washington, D.C. 20402
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. PRICE, Director

ROBERT A. ISRAEL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Director for Analysis

GAIL F. FISHER, Ph.D., Associate Director for the Cooperative Health Statistics System

ROBERT A. ISRAEL, Acting Associate Director for Data Systems

ALVAN O. ZARATE, Ph.D., Acting Associate Director for International Statistics

ROBERT C. HUBER, Associate Director for Management

MONROE G. SIRKEN, Ph.D., Associate Director for Mathematical Statistics

PETER L. HURLEY, Associate Director for Operations

JAMES M. ROBEY, Ph.D., Associate Director for Pro~am Development

GEORGE A. SCHNACK, Associate Director for Research

ALICE HAYWOOD, Information Officer

OFFICE OF INTERNATIONAL STATISTICS

ALVAN O. ZARATE, Ph.D., Acting Director

Vital and Health Statistics-Series 2-No. 79

DHHS Publication No. (PHS) 81-1353

Library of Congress Catalog Card Number 79-16799
PREFACE

In 1976, the National Center for Health

Statistics (NCHS) entered into an agreement

with the Agency for International Development

(AID) to conduct a project directed to improving civil registration and vital statistics in selected AID-assisted countries. The project,

known as the Vital Statistics Improvement

(VISTIM) project, is under the direction of the

Office of International Statistics of the NCHS.

VISTIM seeks to improve the registration of

births and deaths, and the resulting vital statistics, so that the data may be used for demographic analysis, population growth monitoring,

health planning, family planning, and economic

program planning and evaluation.

As a first step in the development of the

VISTIM project, it was decided that studies

should be undertaken to define the problems of

several countries, as a preliminary to possible development of specific assistance projects in those

countries, and to gain an understanding of basic

problems that might be generic to civil registration in the developing world. Accordingly,

studies of the civd registration and vitzd statistics

systems of five developing countries were contracted with the Health Statistics Division of the

World Health Organization (WHO) in Geneva.

Countries w;re selected on the basis of

following criteria:

1. The registration of births must be

tween 50 and 90 percent complete,

2. There should be some expectation

the system can be improved.

the

be-

;hat

3. The government of

studied must have an

gram.

the country to be

interest in the proOn the basis of these criteria, and by mutual

agreement of VISTIM, AID, and WHO; the five

countries included in this report were selected

for study.

The studies were conducted by teams of experts assembled by the Health Statistics Division

of WHO. In order to obtain as clear a picture as

possible of the present civil registration and vitaI

statistics system, the teams interviewed a large

number of government officials at the national

and at the several local levels (depending on the

intemzd structure of the country being investigated). The team had discussions with university

and hospital authorities and population officers.

Storage facilities for records were viewed. In

addition to the five country reports, Bernard

Benjamin, professor of actuarial sciences of the

City of London University, has prepared a comparative report identifying ~lommon problems.

Although the major interest of the three

agencies involved in these studies is the production of improved data, the legal ramifications of

deficient registration systems should not be minimized. Civil registration provides the legal basis

for proof of age, citizenship, and paternity, and

the documents are generally needed for school

entry, employment, entry into the military or

civil service, passports, social security, and

property inheritance. Because the need for these

documents occurs at various points over the lifetime of an individual, deficiencies in the present

have implications for the individual and the

country for some 70 or 80 years into the future.

...

Ill
CONTENTS

Preface ...... ................................................................................................................................................

...

111

Chapter I. Vitaf and Health Statistics in Hondum ............................................................ .............. 1

Chapter II. The Health and Vital Statistics Systems of Mexico ......................................................... 31

Chapter III. Civil Registration and the Collection of Vkd Statistics in the Philippines ...................... 55

Chapter IV. Analysis of Vital Statistics Services in Thailand .............................................................. 87

Chapter V. Vitaf Registration and the Waf Statistics Systems in Jamaica ........................................ 113

Chapter VI. Vital Registration Systems in Five Developing Countries:

Honduras, Mexico, Phtippines, Thailand, and Jamaica-A Comparative Study ............ 147

v
ChapterI

Vital and HealthStatistics

Systemsin Honduras

Dr. Hans A. Bruch and luis Marchant Caviers

World Health Organization Study Mission to Honduras

March 6-27, 1977
CONTENTS

Introduction .............................................................................................................................................

General Infomation ............................................................................................................................ ;

1972 Demographic Sumey ................................................................................................................... 5

1970-73 Improvement of Vital Statistics Project ................................................................................. 6

Health Guardians ................................................................................................................................. 6

No National Authority ........................................................................................................................ 6

Organization of the Vital and Health Statistics Systems ............................................................................ 7

National Level ..................................................................................................................................... 7

LoCid hVcl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................... 8

Mechanisms of Registration and Certification of Vital Events................................................................... 9

Bkths ...................o..............................o....................oo........o....................o..............................o............. 9

Deaths ................................................................................................................................................. 13

The Health Statistics System ..................................................................................................................... 16

Objectives ............................................................................................................................................ 16

Functions ............................................................................................................................................ 16

Types of Data ...................................................................................................................................... 17

Organization and Stmcturc .................................................................................................................. 18

Manpower Qutifimtions ..................................................................................................................... 18

Utilization ................................................................................................................................................. 18

Evaluation ................................................................................................................................................. 18

Limitations and Defects ....................................................................................................................... 18

Education and Training Programs ............................................................................................................. 20

Statistics Courses at the School of Medcinc ........................................................................................ 20

Courses on Medical Records and Statistics for Auxiliary Pe~onnel ..................................................... 21

Isecommendations .................................................................................................................................... 22

Appendix: Forms ..................................................................................................................................... 24

LIST OF FIGURES

I-1. The civil registration of births in Hondums ........................................................................................ 11

1-2. The civil registration of deaths in Honduras ....................................................................................... 15

3
CHAPTER I

VITAL AND HEALTH STATISTICS SYSTEMS IN HONDURAS

Dr. Hans A. Bruch and Luis Marchant Caviers

INTRODUCTION

General Information

Honduras, located in Central Americaj is

bordered by the Caribbean Sea on the north,

Nicaragua on the south, El Salvador, the Pacific

Ocean, and Guatemala on the west. The total

area is about 42,300 square miles. Two major

mountain ranges bisect Honduras northwest to

southeast, with tropical lowlands along both

coastal areas. Extensive fertile valleys and

plateaus lie between the mountain branches. The

climate ranges from temperate in the mountainous interior to tropical in the lowlands. The

dry season extends from November to May and

seriously affects the southern, western, and

interior areas of the country.

For administrative purposes Honduras is divided into 18 Departments. The chief officiaI of

each Department is a Governor who is appointed

by the President.

Honduras has few modern transportation

and communication facilities. There are ordy

about 250 miles of paved roads. The two fruit

companies own an additional 800 miles that are

confined to the north coastal banana region and

provide some passenger transport facilities. Railways are concentrated in the banana-producing

regions and serve the interests of that trade.

Air transportation is of .weat importance

within Honduras and is frequently the normal

means of conveyance for passengers and freight..

Communication services, with the exception of

the telegraph, are confined almost entirely to

the major cities.

i

The population of Honduras is about

3,100,000 (1979 estimate). Tegucigalpa (with its

sister city of Cornayaguela) is the largest city in

Honduras with over 1/4million inhabitants. San

Pedro Sula, principal city in the northern corn- ‘

mercial heartland, has over 130,000 people.

About 90 percent of the Honduran population is a mixture of Caucasian and Indian. SmaIl

minorities of Caucasians, Indians, and Blacks live

there. Spanish is the predominant language, although some English is spoken on the Bay Islands (in the Caribbean Sea) and along the

northern coast. The literacy rate is estimated to

be about 50 percent.

The vital statistics system in Honduras has

serious shortcomings that begin at the data collection level. More than 40 percent of aIl deaths

are never registered; fetal deaths are not registered at all. Only 13 percent of the deaths that

are registered are certified by a physician. Because most births occur at home (only 22 percent occur in maternity establishments), live

births are under-registered by 10-12 percent.

In light of these deficiencies, any type of

analysis to measure health conditions or changes

that occur becomes a fruitless undertaking.

1972 Demographic Survey

This situation was of such concern to the

Government that it sponsored a demographic

survey to measure the degree of under-registration and to estimate more precisely rates of

birth and death. This survey was performed by

the General Statistics and Census Office assisted

5
by the Latin American Demographic Center

(CELADE) and the Ministry of Public Health.

There has been no exhaustive analysis of this

survey to determine the causes and areas of

under-registration and to propose solutions. No

activities have been undertaken with a view to

improve coverage.

A new survey is being considered.

1970-73 Improvement of Vital

Statistics Project

The General Board of Statistics and Censuses, with consultative help from the United

Nations Latin American Demographic Centre

and financing from the Central Bank of Honduras, the Higher Economic Planning Council,

and the United Nations Fund for Population

Activities (UNFPA) carried out a national demographic survey of Honduras (EDENH). The main

aim of this survey was to obtain a set of reliable

demographic indexes that would enable evaluation of the situation with regard to the death

rate. fertilitv rate, miu-ria~erate. and mimation

in Hondur&. Results

reporting:

Vital statistics

Births .......................

Deaths ......................

Infant deaths ............

Deaths among babies

less than 1 day old..

&licate much underPercent Percent

reported not

reported

89.4 10.6

56.3 43.7

31.2 68.8

2.5 97.5

This Project for the Improvement of Vital

Statistics, carried out between January and December 1973, included:

1.

2.

3.

Program on the organization and functioning of a national vital statistics system.

National program for medical certification of causes of death.

Educational programs for municipal authorities, auxiliary mayors, hospital statisticians, medical records personnel, and

final-year students in medical schools.

4.

5.

Drafting of a preliminary bill on civil

registration.

Draft decree establishing a national vital

and health statistics com-mittee.

This project did not succeed in improving

vital event coverage. Under-registration continued at the same level. For a short time, there

was an improvement in the information content

and fewer data were omitted. Today, in the absence of supervision or control, these problems

have again become serious.

Health Guardians

The Ministry of Public Health, recognizing

the role played by data collection in identifying

major health problems, now has “health guardians” at a few rural health centers collecting data

on births and deaths. This serves the purposes of

health programs, but not of civil registration.

Furthermore, this program does not reach all

areas of Honduras nor does it work at full efficiency where it has been established.

Some of these community volunteers,

trained to deliver primary health care, are receiving additional training in recording the births

and deaths that take place in their villages, hamlets, or towns. Although there are only 300

health guardians at present (1977), more than

10,000 are proposed.

Plans for bringing information collected at

the rural health centers to regional and national

levels exist. It will be important for the activities

of the health guardians (rural) to be coordinated

with the data collection activities of the cities to

form one system that will add up to a national

system of civil registration. At the moment,

both sets of data are incomplete and uncoordinated.

No National Authority

No national authority responsible to direct,

organize, supervise, or advise on the activities of

civil registration was found. Every municipality

behaves independently, interpreting the laws

governing vital registration and statistics in its

own fashion. Every municipzdity has to provide

the necessary material within the limits of its

own budget. No uniform registers, no uniform

entries, and no uniform information exist.

6
As to quality, no effort to setup any system

of investigation or followup to supplement the

incomplete data received on births and deaths

was present. It is estimated that about one-third

of the forms submitted omit some items of information (age of mother, children born previously, type of care during childbirth, etc.).

Present legislation is inadequate for launching a good vital statistics program. In many instances, those laws in force are not obeyed.

To evaluate the health situation in Honduras, to measure the efficiency with which

health resources are being used, and to judge the

effectiveness of the health and nutrition programs (e.g., the impact of these programs on

health conditions in the regions and the country

as a whole), basic data on vital and health statistics are required. At the moment no reliable and

useful data are available and it is merely the results of the 1972 demographic survey that are

being used. The Higher Economic Planning

Council collaborated with and partly financed

the 1972 survey and would like to have another

one performed in order to determine the

changes that have occurred.

ORGANIZATION OF THE VITAL AND

HEALTH STATISTICS SYSTEMS

National Level

No ministry of the national Government of

Honduras is responsible for civil registration of

vital events. The secretaries of the 282 municipalities of Honduras prepare weekly reports on

births,. deaths, marriages, and divorces and send

them to the General Board of Statistics and Censuses. Volunteer “health guardians” in villages,

hamlets, and towns of rural Honduras report

their data to a municipal secretary. The General

Board of Statistics and Censuses, an arm of the

Ministry of the Economy, publishes a statistical

yearbook containing 21 tables of vital statistics.

The issue relating to 1975 was published in

January 1977.

The Population and M&-ation Policy Board,

which answers to the Ministry of the Interior

and Justice, intends to estabIish strict control

over the registration of births. This Board also

plans to have a departmental supervisor for each

of the 18 Departments that the 282 municipalities comprise. A pilot program to this end was

put into operation in April 1977.

Another important user of vital statistics is

the Higher Economic Planning Council, attached

to the presidency of the Republic as an advisory

body with power to introduce regulations. It is

made up of the ministers or secretaries of state

and representatives of industry, commerce, and

labor. The secretariat of this body is under the

supervision of an executive secretary and an

executive undersecretary. Subordinate to these

is a technical director who has authority over 21

units or sectorial offices whose purpose is to

investigate and analyze special socioeconomic

planning sectors and coordinate their activities

with other sectors. Among the sectorial offices

are a health office and a nutrition office.

The members of the Higher Economic

Planning Council think that it is time to convene

a coordinating committee of producers and users

of vital statistics. They propose that each sector

report the type of information it needs and the

form and frequency of reporting needed. They

are also interested in methods to improve the

coverage, quality, and timeliness of the information.

The Population and Migration Policy Board

has a project that will require municipal secretaries to send birth and death registration forms

to the Ministry of the Interior. The Board will

have inspectors and supervisors in every Department.

The General Statistics and Census Office,

neither aware of health information needs nor of

the types of analyses that can and ought to be

carried out on data of births and deaths, has no

technical personnel trained for health and vital

statistics analysis. This Office has prepared a

handbook to help coders adjust to missing data.

The Ministry of Public Health takes no real

interest in statistical information. Although

technicians interviewed pointed out the lack of

vital statistics needed to evaluate the health situation and programs in the Republic of Honduras, not much has been done to improve the

aThe Chief of the Planning Unit, the Director of the

Maternal and Child Health Department, and the Chief of

the Epidemiological Division.

7
situation. No close and continuous communication about information gaps, tabulations to aid

analysis, or problems of gathering, analyzing,

and publishing the data was found. Those in the

Ministry of Public Health appear well satisfied

with the tables published annually in the Statistical Yearbook. Even if more detailed data be- “

came available, the Ministry of Public Health

has no professional statisticians who know how

to analyze or use these data.

Local Level

The departmental political governor. -Reporting to the Minister of the Interior and

Justice, he is responsible for the municipalities

in his department. He is appointed by the Minister of the Interior. As far as the civil registry is

concerned, this office should sign and stamp all

the ‘sheets in the registers used to record births,

deaths, marriages, legitimation of children, recognition of illegitimate children, conferment of

early legal capacity (“emancipation”), appointment of guardians, and decisions concerning separation, divorce, and annulment of marriage, and

declarations of absence and presumed death.

Furthermore, a note with his signature should be

placed at the beginning and end of each register

indicating the number of sheets it contains.

In fact, the sheets in the registers are numbered from 1 upwards; the numbering begins

with 1 again in each new register; the registers

are stamped by the departmental political governor’s office but not signed. The departmental

political governor signs at the beginning and end

of each register to certify that it contains a specified number of sheets.

The department political governor has no

authority to encourage, supervise, or advise the

municipal secretaries regarding civil registration.

He merely provides them with the necessary

forms or registers for carrying out their duties.

In the case of the Mayor’s Office of Tegucigalpa

(the municipal corporation of the Central District), the Minister of the Interior and Justice

himself signs the registers, since there is no departmental political governor.

The municipal secretary.-The secretaries of

the municipalities are responsible for keeping

civil registers. These duties and the procedure

for civil registration are regulated by the Civil

Code of 1906. The 18 Departments of the Republic of Honduras are subdivided into 282

municipalities.

The secretaries are appointed by the mayors

of the municipalities and in general remain in

office for a long time. The mayors are elected by

popular vote for a period of 1 year. Under the

present Government, the mayors are appointed

by the Ministry of the Interior and Justice. Even

for cities like Tegucigalpa and San Pedro Sula

(300,000 inhabitants) there is only one civil

registration office. In large towns (10,000 inhabitants or more) the municipal secretary does

not personally keep the civil registers; one or

more municipal employees are in charge of these

activities. Nevertheless, the municipal secretary

has to sign all the certificates in the register.

Entries of births, marriages, the legitimation

of children, the recognition of illegitimate children, the conferment of early legal capacity, the

appointment of guardians, deaths, separations,

divorces, and certificates of presumed deathsb

are recorded in separate registers. The registers

have hard covers and contain approximately

200-400 pages (this number varies since each

municipality has to buy its own registers).

According to the law, the registers must be

kept in duplicate. The original with the signatures of the informant and the witnesses is kept

in the municipal archives. The copy, with only

the signature of the municipal secretary confirming the contents of the certificate, is sent to

the Central National Archives kept by the Ministry of the Interior and Justice. Some small

municipfllties with scanty resources do not keep

duplicate registers (Jacaleapa). Otheq municipalities have stopped sending these duplicate registers and are in the process of copying them with

the help of extra personnel (El Paraiso). The

municipality of Tegucigalpa does not send duplicate registers to the National Archives.

The Civil Code of 1906 specifies that a new

register must be used for each year; but a later

amendment (1909 ) stipulates that in view of the

fact that this procedure is very expensive for the

municipalities, the registers need only be

changed when they are full. Some municipalities

with few entries for births and deaths (less than

50 a year) may take more than 5 years to fill a

register.

bNo recordiof fetaldeathsarekept.

8
Only Tegucigalpa keeps registers in which

the entry is printed and blank spaces are left for

the relevant data to be inscribed. In other municipalities the registers consist of blank sheets

and the entries have to be written entirely by

hand. There is a legal formula that the municipal

secretaries have memorized, and one entry requires between half and three-quarters of a page.

In general, three entries can be made on every

two pages.

Auxiliary mayors.–Within each municipality

there are auxiliary mayors for the rural area (an

estimated 2,000 villages and 12,000 hamlets).

These auxiliary mayors act as justices of the

peace, police authorities, and political authorities in the village or hamlet and are responsible

for having the streets cleaned. They are appointed by the mayor of the municipality from

among the leading figures in the village. According to the law, this post is compulsory and unpaid. The honorary and influential nature of the

post means that many people remain for many

years in this position, some not fulfilling their

duties. It is estimated that 60 percent of the

auxiliary mayors are illiterate. They have to appear at least once a month before the mayor of

the municipality and report on activities and

events in their villages.

Regarding civil registration, they have to report to the municipid secretary on the births and

deaths that occur in the village or hamlet under

their jurisdiction. As for births, they can report

those that have occurred, but only the father,

mother, or relatives living in the house in which

the birth occurred can have them entered in the

register. For deaths, the municipal secretary fills

in the certificate in the relevant register upon

notification by the auxiliary mayor. In practice,

only very few deaths are recorded on the basis

of notifications by these officials.

Hospital personnel.–At the national hospitals (five in the city of Tegucigalpa), the regional hospitals (six), and the area hospitals

(seven emergency hospital centers) belonging to

the Ministry of Public Health and the two hospitals of the Honduran Institute of Social Security (one in Tegucigalpa and the other in San

Pedro Sula), personnel are obliged to fill in the

statistical

of death)

occurs in

forms of death (medical certification

and birth for every death or birth that

the hospitrd. In practice this obligation

is not strictly met. In many cases, members of

the family leave the hospital without asking for

the birth or death certificate. When registering a

birth or death, the municipal secretary fills in

the relevant form according to the declaration of

the informant. In other cases, the forms remain

in the hands of the family as birth or death certificates and are not passed on to the municipal

secretary for registration of the event. According

to the Regulation for the Medical Certification

of Death, the secretaries have to ask for the

death certificate. Even if the deceased has died

without receiving medical care, the doctor in the

hospital or health center is responsible for issuing this certificate free of charge. Private physicians also have this duty but can charge 5

lempiras (about $2.50) for the certificate.

MECHANISMS OF REGISTRATION

AND CERTIFICATION OF

VITAL EVENTS

Births

Time limit.–Registration of births is governed by the Civil Code of 1906 (Articles 304-

316). The law allows a period of 8 days for registration of the birth. Registration of the birth is

completely free of charge, as is the certificate

(the form provided by the General Statistics Office). Some municipalities require the payment

of local and property taxes before a birth can be

registered.c

cThe authors personally observed the situation in

the municipalities of Dardi and El Paraiso in the El

Paraiso Department. In the case of Danli, the impression

was gained that the municipality will usually make a

compromise in the form of partial payments of thearrears of taxes (usually many years) and, when the

El Paraiso the person concerned has to pay all his taxes

before the event is registered. In the municipality of

Jacaleapa no such requirement exists. After this period

and 1 year after the birth has occurred, the father, the

mother, or the relatives in whose house the birth took

place, may ask for it to be recorded, subject to the payment of a fine of 1-20 lempiras (504 to $10) which is

fixed at the discretion of the mayor or the municipal

secretary. In practice in many cases this fine is waived

completely if the person concerned is very poor or, at

most, a fine of 1-6 lempiras (504 to $3.00) is levied.

Whena yearhaselapsedsincethe dateof birththeprocedurefor registrationhasto be carriedoutbeforeacivil

judgewith statements of witnesses.

9
Place.–The law requires that the birth must

be registered in the municipality in which it occurred. When the birth occurs in a municipality

other than the mother’s residence, the municipal

secretary of that other municipality must be

notified and the birth must be registered there.

The municipal secretary sends a copy of the certificate to the departmental politicaI governor

who then forwards a copy to the secretary of

the municipality of the mother’s residence, so

that it can be copied in the register of births and

put into the archives.

In practice,:this procedure is not followed. If

the mother has given”birth to a child in a hospital of a municipality different from her usual

place ‘of residence, she or the father will enter

the child as ~born in the municipality of residence and wdl not produce the statistical form

for birth provided by the hospital. This occurs in

most cases with the knowledge of the municipal

secretary, who claims that he could not record

the birth in accordance with the law in any

other way.

Person responsible for requesting registration.–In the case of a legitimate live birth, the

father must ask for its registration. If he does

not do this, the mother and/or relatives living in

the same house must have it registered. In practice (to judge from a glance at the register For

1976), it is generally the father who asks for

registration and brings with him his own and his

wife’s, identity cards.

In the case of an illegitimate child, it is up to

the mother or to the relatives living with her to

ask for registration. In this case, the name of the

father must be omitted. In practice it is usual for

the father to request the registration of the

birth; the mother’s name is entered, and the

father produces the identify card of the child’s

mother.

The law provides, furthermore, for directors

or administrators of hotels, hospitals, maternity

homes, hostels, and other similar premises to report to the registrar within 24 hours births occurring in their establishments. In practice, none

of these establishments complies with the law.

Even if they did, the registrars could not do

much with the information since they cannot

record it in the register unless the father,

mother, or relatives come. However, they have

no legal authority to force the parents or their

relatives to register the birth.

Contents of the register entry .-The law provides for the following data to be included in the

birth register:

- Name and sex of the newborn child

- The day on which the birth occurred.

- The first names and surnames of the father

and mother.

- The first names and surnames of the grandparents.

In practice the entry recording the birth contains in addition the place of birth (village, hamIet, or town) and the age and nationality of the

parents. Apparently the contents of the entry

vary with each municipality and with the style

of each secretary. The statistical form for recording births contains, in addition, information

on the premises in which the birth took place

(hospital, home, or elsewhere) and medical care

if provided. (See appendix, “Forms.”)

The declaration is made.–Although the law

does not specify how the declaration of birth

should be made (i.e., whether it should be verbal

or written), in practice the deckiration is made

by word of mouth. When the child is born in a

hospital and the statistical form is filled in by

hospital personnel, the recording of the birth for

the purposes of the legal entry is still by word of

mouth.

The essential requirement is that the father,

the mother, or a relative living in the house in

which the birth occurred must go in person to

the civil registration office to register the birth.

The auxiliary mayor can only encourage or advise the family in a village or hamlet to go to the

municipal offices and register the birth. The

auxiliary mayor cannot, as in the’ case of deaths,

go to the municipal secretary to record a birth.

Witnesses.–The law stipulates that the person in charge of the register shall enter the birth

in the register in the presence of two witnesses.

He must read the entry to the witnesses and to

those concerned and they all sign it. The law

does not specify that the witnesses should swear

that the birth has taken place and that the per10
sons declaring the event are the father, mother,

or relative, or that what they declare is correct.

The witnesses testify that the person concerned

has given to the municipal secretary the information that is recorded in the register and that the

information written down in the register corresponds exactly to what th~ person concerned

declared. In practice, in all the municipalities

visited, other employees of the mayor’s offices

are used as witnesses. This is the general practice

throughout the Republic.

Procedure for regzktration.-In brief, the declarer (father, mother, or relative) presents himself or herself before the secretary and declares

orally that a birth has taken place. The secretary makes an entry in the births register. The

informant may submit his identity card if he has

one or that of the mother of the child. Once the

entry has been made, the municipal secretary

reads it, the declarer signs or places a cross (if he

does not know how to write), and two employees of the mayor’s office, together with the

municipal secretary, also sign the register. Then

the municipal secretary fills in a statistical form

of birth registration, if the person concerned has

not already brought it with him. If the person

concerned so requests (and in the majority of

cases this occurs on the secretary’s initiative),

the secretary gives him/her a certificate stating

that the entry has been made and indicating the

numbers of the register and the page in the register. The form is provided free of charge by the

General Statistics Office. This form is not really

a birth certificate and has no legal value. Then,

at the end of the day, the week, or the month,

or when he has some spare time, the municipal

secretary or his employee copies the entry in the

register into the duplicate register (few municipalkies keep a duplicate register). (See figure

I-l.)

The registration ends here. It may have

taken 20-40 minutes. In the Municipal Corporation of the Central District (Tegucigalpa), the

procedure does not take long because the majority of the informants bring the statistical forms

with them. and the registers have printed entries

meaning that the text does not have to be written out for every birth.

Birth certificate. –When a certified (legal)

copy of the birth certificate is required, it must

be requested from the municipal secretary on

paper stamped with 0.50 lempira ($0.25). According to the municipal regulation, the cost of

the certificate is 2 lempiras ($1.00).

The law stipulates that a certificate “of this

entry” shall be issued free of charge (Article

308) but does not specify its contents. The municipal secretary fulfills this requirement by issuing a certificate that the birth has been registered. This has no legal standing (see appendix,

“Forms”).

Registration of illegitimate children that are

recognized. -When the father and the mother, or

the father alone (with the mother’s identity

card), goes before the municipal secretary to

register an illegitimate child, entries are made in

both the birth register and the register of recognitions of illegitimate children.

When the recognition is made by the father

later, before a judge, an entry is made, based on

a document of the court certified by the judge,

in the register of recognitions of illegitimate

children; a marginal note is also made in the

birth register.

“When the act of recognition takes place in a

municipalityy different from that in which the

child’s birth is registered, the judge sends a copy

of the document of the court about the recognition to the appropriate departmental political

governor. The Governor then sends a copy to

the municipal secretary of the municipality

where the child’s birth was registered, has the

I

‘ Prep8r0k* stathtlcdl Smd$ the formswmkly

form of birth to tlm Gmml

Statktlc$ Offica

I

COpim tlM entrf from When th rechter is

the registerInto tha -

full, 9wldsit to the

duplicate mgitter Natloml Archiws in

Twcl#lP#

I

1v

Figure 1-1. The civil registration of births in Honduras

11
entry made in the register of recognitions of il- .

legitimate children , and has a marginzil note

placed in the register of births.

Registration of a newborn who dies shortly

after birth.—Article 309 of the Civil Code says

that the death of a newborn child does not abrogate the obligation to record the birth. In general this obligation is not fulfilled. In some cases

it is indicated that the child was stillborn (when

the child died after a few hours or a few days).

In other cases, the child is simply buried without

any record whatsoever. It is only the “burial permit” that is filled in. To buy a burial permit, no

proof is needed that the birth and the death

have been recorded.

Marginal notes in regz&ers.–The law stipulates that on each page in the registers one-third

of the width of the paper must be left blank for

notes on any incidents or modifications occurring in civil status (Article 302). These incidents and modifications relate to the legitimation of children, the recognition of illegitimate

children, and the granting of legal capacity to

someone under age. Although these acts are recorded in separate registers and always constitute certified decisions of the court, the changes

that have occurred in civil status are entered in

the margin of the register of births, and the

register and page number on which the decision

of the court is to be found are indicated.

index to the registers of births.–The law

states that at the end of each register (original

and duplicate ) a comprehensive alphabetical index shaU be made of the entries it contains and

that sufficient pages must be left in the register

to write the index.

In practice this is done. The problem is that

in some municipalities many years may pass before the register is finished and during that time

there will be no index. When someone asks for a

certificate, the three municipal secretaries search

the as yet unindexed register 2 or 3 years before

and after the date when the person was said to

have been born or to have been registered. In

many cases this search is laborious and time consuming.

Late registration. –After 1 year from the

date of birth, births cannot be registered by the

municipal secretary without an order of the

court.

To carry out late registration of a birth, the

person concerned must ask the municipal secretary for a certificate indicating that there is no

entry for the birth in the corresponding year in

the registers of births of the municipality. After

searching the appropriate registers, the municipal secretary sends the certificate and goes before the judge accompanied by a lawyer and two

witnesses. The judge notifies the district attorney and questions the witnesses; they must

swear that they know the individual concerned

and know that he was born at the place and in

the year stated. The judge has the right to ask

for more evidence and may reject the testimony

of the witnesses if he is not convinced of the

truth of their declarations. Once the judge is satisfied by his investigations, he hands down his

decision and orders the municipal secretary to

enter the birth in the register. The municipal

secretary makes the entry by copying the decision of the judge and signing it together with

the person concerned.

No standard form or formula exists. Every

judge and every municipal secretary will write

out different decisions and make entries that dif.

fer slightly.

Replacement of the entry .-when an entr)

in the register of births is destroyed or lost, the

municipal secretary will send a certificate on

what has occurred to the person concerned, who

then appears before the judge with lawyers and

witnesses. As in the previous case, the judge

listens to the witnesses and their evidence and

then orders that the entry be replaced in the

birth register. The municipal secretary then enters the birth in the birth register of the current

year, with the indication that this entry replaces

the entry that should have been made in the

register for the year of birth. No statistical form

is prepared.

The statistical form for recording births.–

The statistical form for recording births was

drawn up by the General Statistics Office in consultation with the Ministry of Public Health. It

was designed as part of the Improvement of

Vital Statistics Project. M%en a child is born in a

hospital, the form i: filled in by the resident

physician or the nurse. When the birth takes

place at home, the form is filled in by the

registrarat the time of registration.

12
At the Mother and Child Hospital in

Tegucigalpa, just after delivery, the resident physician fills in the statistical form and attaches to

it the clinical case history. On dkcharge, the

child and its certificate are handed over to the

mother. At present, the forms provided by the

General Statistics Office are out of print and the

hospital had them reprinted in the same way.

Should the child die, a death certificate is also

issued, but in many cases these dead newborn

babies are left at the hospital by their mothers.

The hospital arranges for the baby to be buried

in the town cemetery and supplies the medical

certificate of death with the body. The birth

certificate remains with the clinical case history.

Should the mother lose the statistical form supplied by the hospital, she is charged 1 lempira

($0.50) for a copy. In this case the statistical

form is filled in by the employee of the medical

records department who signs it.

In practice, in many hospitals the form is

not filled in, either through negligence or because the mother leaves the hospital without requesting the document.

In some cases the mother lives in a municipality different from that in which the hospital

is situated. In these cases, when the mother presents the form at the municipality of her residence, the municipal secretary fills in another

one indicating that the birth took place in the

municipality in which the mother lives, since the

law requires that the birth be registered in the

place where it occurs.

In many cases, mothers keep these forms as

birth certificates and, at the time of registration,

the secretary of the municipality of the mother’s

residence fills in another form.

The statistical forms are sent on Mondav of

coded as male (1) in the first case of omission

and female (2) in the next case. There are standards for every omission. Also no attempt (survey

or study) is made to check the quality of the

information, that is, to determine whether the

data recorded in the statistical form are in agreement with the actual facts. It is obvious that

errors occur, for example, with the “municipality of birth” when a child was born in a

hospital of a different municipality than that of

the mother’s usual residence.

Deaths

Registration of deaths is regulated by the

Civil Code of 1906 (Articles 337-356).

Unlike the registration of births, death registration may be made ex officio upon receipt of a

report or information from the police, the auxiliary mayor, the hospitals, or the municipal secretary when the relatives have not made the registration personally or in the case of an unclaimed

body.

Time limit.–The law stipulates that if the

death occurs in a town or village the municipal

secretary must be notified within 24 hours. If

the death occurs in the country (fields, mountains), the auxiliary mayor must be informed

within 24 hours (but before the body is buried)

so that he can transmit the information to the

person responsible for civil registration.

In practice this is not done. Those concerned

go to the municipality to buy the burial permit,

which costs 3 lempiras ($1.50) and gives permission for the burial of the dead person. Later (2-3

days later if they do it at all) they go to register

the death (particularly in the case of an adult,

for reasons of inheritance and other judicial or .

I each week by the municipal secretaries to the administrative procedures: work, claim for social

General Statistics Office. According to the General Statistics Office and the Office of the Census, the amount of information lacking on these

forms is immense (sex, age of the parents, area

of domicile, place of birth, medical care at birth,

etc. ). There is no system of verifying the information put on the forms by municipal secretaries or hospitals. An internal system solves the

problem. For example, if “sex” was omitted, the

information is entered according to the person’s

name. If the name does not give clues, it is

benefits, payment of taxes, etc.). No fine or

punishment is applied for such late registration

(over 24 hours). Once or twice a month the hospitals send the medical certificates of death for

those bodies that have not been claimed, either

to the cemetery with the corpse for bL1ri:Llor to

the secretary of the municipality.

Place.–The law stipLdatesthat the municipal

secretary in the-place where the-dc:Lth occurred

must be notified. When the corpse has to lx

transferred to another municipality (the place of

13
residence of the deceased person), a special permit issued by the municipalityy is required. Howm“er, this does not ensure that the dead person

rwcessarily has a death certificate or that the

d.:ath was registered. It is much more a question

of administrative procedure or payment of

taxes. Usually registration takes place in the mui-wipality where the dead person had resided.

Person” responsible for requesting regiktration.—The law says that the surviving spouse has

to report the death. Failing this, the next of kin

aod after them more distant relatives must do

so, In addition, the physician or surgeon who

treated the deceased and the head of the family

in whose house the death occurred are required

to notify officials of the death.

b practice, it is the relatives who ask for

death registration. When a dead body is not

chimed from a hospital the hospital sends the

medical certificate of death to the cemetery; the

person in charge of the cemetery sends it to the

municipal secretary. On the basis of these certificates alone (without an informant), the secretmy makes an entry in the re~ster of deaths

(sometimes a month after the corpse has been

buried).

The law also stipulates that any person who

finds a corpse mqst notify the municipal secret:lry. In practice it is the local police or municip~~ authorities who do so. They take responsibihty for making the necessary enties, carrying

cwt the investigation, burying the body, and entering the death in the civil register.

Bun”al @emzit.–The law stipulates that the

municipal secretary shall give to i%ose concerned,

f~-eeof charge, a form stating that the death was

registered so that the manager or caretaker of

the cemetery can have We corpse buried.

Furthermore, the law stipulates ,Othatno body

may be buried in a public or private cemetery

until this form has been given to the sexton or

t!le caretaker.

In practice this provision is not complied

with. This part of the law has become so confused and distorted that in the four municipzdities visited, those concerned go to the municipality to buy a burial permit which costs 3 Iempiras

($1.50) (and is like a tax). They buy or rent the

kind, the niche, or the mausoleum and bury the

dead person without entering the death on the

civil register.

The mayors or municipal secretaries explain

this deficiency by saying that at the time the

bereaved are crushed by grief and are in a hurry

to bury the corpse and that this is not the

moment to try to compel them to register the

death in the civil register. They say that after

some 3 days or more, the relatives will come and

have the entry made. Those concerned send the

certificate to the person in charge of the cemetery,’ who makes a list of those buried there. In

other cemeteries (i.e., municipality of Jacaleapa)

there is no one in charge and no sexton. In any

case the relatives pay this tax or stamp for the

burial permit and have the corpse buried. In villages or hamlets where there are no municipal

authorities but only an auxiliary mayor, who is

unpaid, none of these requirements is met and

there are no organized or official cemeteries.

In the Central District, the municipal secretary issues a certificate to the effect that the

entry was made in the register of deaths, to aid

in finding the register and page of the entry later

on when a death certificate is requested. This

document is’ not necessary for burying the

corpse.

Information content.–The law stipulates

that the following information shall be contained in the register of deaths:

The day, hour, month, year, and place of the

death.

The given names, surname, sex, age, domicile, and nationality of the deceased.

The names, domicile, nationality, and occupation of the parents of the dead person if

known.

The name of the surviving spouse if the deceased was married.

The disease or cause of death if known.

The existence or otherwise of a will.

In practice all this information is mentioned

in the entry in the register of deaths. It is generally observed that only the parents are mentioned without information being given regarding their domicile, occupation, or nationality. There is a frequent failure to indicate the

sex of the deceased. Less frequently, but it does

14
occur, the age of the deceased is omitted. In the

few cases where the relatives bring a medical

death certificate from a hospital, the cause of

death is noted in the register entry. (This occurs

in approximately 13 percent of all registered

deaths, most of them in Tegucigalpa and San

Pedro Sula.) In the other cases, information the

relatives provide is noted down.

The declamtion.-The law indicates that the

declaration is by word of mouth (relatives go in

person to notify the municipal secretary about

the death). In practice, both oral and written

declarations are used; but in most cases they are

oral. In cases where death has occurred in a hospital and no one has claimed the body, the body

is sent to the cemetery together with the relevant medical certificate of death. From there the

certificate is sent to the municipal secretary who

makes the entry in the register of deaths on the

basis of this certificate alone. This was observed

only in Tegucigalpa. The authors were unable to

find out for certain whether it is also done in

other large towns. If the body was found in the

street, on a ‘public highway, or elsewhere in the

country, it is the police or, in villages and hamlets, the auxiliary mayor, who notifies the municipal secretary so that the entry can be made

in the civil register. The authors were unable to

see any registration of this kind.

Witnesses.–The law does not stipulate that

witnesses must be present for the registration of

deaths and, in practice, they are not required.

Deaths occurring in villages or hamlets (rural

areas).–In the case of deaths that occur in rural

areas (in villages or hamlets), it is the duty of the

auxiliary mayor during his compulsory monthly

visit to the mayor of the municipalityy to report

on the situation in his village and to notify the

municipal secretary of all the deaths that have

occurred. On the basis of this notification, the

secretary should have an entry made in the civil

register of deaths. In practice this is not done;

more often the authorities wait for the relatives

of the deceased to register the death when they

go to the town that is the seat of the municipal

authority. The authors did not see entries based

on a declaration from an auxiliary mayor and

the secretaries themselves admit that these auxiliaries do not make such notifications.

Procedure for making entries.–In brief,

some relative of the deceased person declares the

death. If the death has occurred in a hospital, a

medical certificate of death can be obtained

(this is made a compulsory requirement only by

the Municipal Corporation of the Central District, Tegucigalpa). Even if the death has occurred in a hospital or if medical attention has

been given, it is not essential for the relatives to

submit a medical certificate of death. The municipal secretary makes the entry in the register

of deaths. In the case of persons who have died

in a hospital and whose bodies have not been

claimed, the secretary makes the entry in the

register of deaths on the basis of the medical

certificate of death prepared by the hospital and

sent to the cemetery (see figure I-2). The authors noted that only in Tegucigalpa (Municipal

Corporation of the Central District) did the municipal secretary (or the employees in charge of

the civil register) supply the person concerned

with a certificate or form certifying that the

death has been entered in the register and indicating the number of the register and the page.

The only purpose served by thk certificate is to

n

Declarationby the

auxiliaty mayor In tie

caseof d+athsIn

vill~s or hamlets

(rural areat)

Lt Declarationby thn

hospitalin the caM of

bcdiesnot claimedby

relatives(medical

certificateof death)

m

h

Preparesa statistical

form recordingthe

death (medical

certificateof death]

o

Preparesa certificate

statingthat the d+ath

hasbeenenteredin the

registerof deaths

m

-El The personin charm of

the cemetery receives

the dmd bcdy with

the relevantdeath

certificate and sends

the certificate to the

municipaltecmtaw

I

Sendsinformation

weekly to the General

Boardof Statistics

and Cenwtes

ITSendsthis certificate to

the personconcerned

to make it easierfor

him to requesta

deathcertificate

kEE?&.1

Figure 1-2. The civil registration of deaths in Honduras

15
make it easier later on to obtain a death certificate that can be used for legal or administrative

purposes (probate, social welfare, tax questions,

etc. ). When a duplicate register is kept, the entry

recording the death is copied into it. As soon as

the entry is made in the register of deaths and

duly signed, the statistical form for recording

deaths (medical certificate of death) is prepared

whenever the relative does not bring one from

the hospital. These forms or certificates are sent

weekly to the General Statistics Office.

Index to the registers of deaths.–As in the

case of births, the law stipulates that pages must

be left free at the end of the register of deaths

for the insertion of an alphabetical index.

This is done in the municipalities, but we

observed in Jacaleapa that it takes more than 5

years to fill a register. During that time, to find

aq entry, the register has to be reviewed page by

page for the previous and following years.

The statistical form for recording deaths.–

The medical certificate of death is in reality the

statistical form for recording deaths. This form

is prepared in about 90 percent of the cases by

the municipal secretaries when they have made

the entry in the appropriate register of deaths.

In the case of a de;;h ;n a hosp&l, this form is

prepared in the hospital if the relative asks for it.

This form, which should be compulsory in every

case has not had the anticipated impact on the

system of vital statistics. Only the Municipal

Council of the Central District (Tegucigalpa) has

made compulsory medical certification of death.

The rep”stration of fetal deaths.–The law

does not require the registration of stillbirths

and there is no system of legal or statistical

registration for this type of death. The Mother

and Child Hospital prepares a certificate of stillbirth which was designed by the General Statistics and Census Office in 1970-73 during the

Project for the Improvement of Vital Statistics.

That is the only hospital which, to our knowledge, continues to use the form. The General

Statistics Office has stopped receiving and tabulating these certificates.

THE HEALTH STATISTICS SYSTEM

The Statistics Department of the Ministry of

Public Health of Honduras is responsible to the

Planning Unit, a body that reports directly to

the Minister of Public Health.

Purpose

The main purpose of the Statistics Department is to satisfy the statistical needs of the

various sections of the Ministry of Public Health

at their specific levels of operation and, eventually, those that might arise in institutions in

other national sectors and international organizations.

Objectives

To fulfill its purpose, the Statistics Department has established the following specific objectives:

Process the statistical information generated

in the health establishments in the public

and private sector and collected periodically.

Publish this information, analyze it and disseminate it among the users in the sector.

Give technical advice to the other units in

the Ministry of Public Health.

Draw up technical standards for data collection at the local level which will have to be

approved by higher authorities.

Supervise and coordinate the statistical activities in the regions and to assist them to

meet the technical standards laid down by

the Ministry of Public Health.

Functions

The Statistics Department has the following

specific functions:

Collect all the statistical forms filled in at

health establishments and sent through the

regional statistical offices.

Ensure that these documents are received ,

promptiy and regularly.

Review the forms, detect omissions, inconsistencies, and errors, and take steps to correct the deficiencies noted.

Code the information on specific forms for

electronic processing.

16
Tabulate the information manually which,

by its nature, does not require the use of

electronic or electromechanical equipment.

Punch and check cards containing information on hospital dkcharges and outpatient

consultations.

Cooperate with the Unit for the Investigation and Development of Administrative

Services by providing it with the necessary

information for the establishment of the

system of supplies and costs. This involves

coding and punching cards.

Periodically send the cards mentioned to the

General Board of Statistics and Censuses for

computer processing.

Solicit from the General Statistics and Census Office the “annual tabulations of hospital

discharges and outpatient consultations produced from these cards.

Ask the General Board of Statistics and Censuses for the special tabulations on live

births and deaths that this organization develops and that the Ministry of Public Health

requires for purposes of planning and/or

evaluation of programs.

Make available to the users at the Ministry of

Public Health all the information tabulated.

Prepare special tabulations as solicited.

Analyze the data in cooperation with the

users or independently.

Carry out a periodic evaluation of the effectiveness of technical standards for statistical data collection and to make suggestions

for modifications and/or expansion.

Make supervisory and/or advisory visits to

the eight administrative health regions of

Honduras.

Maintain permanent contact with the

regional statisticians.

Encourage programs for training statistical

personnel for the various operating levels

and the various subdivisions of statistics and

to take an active part in

ecution, and evaluation.

their planning, exPrepare for the Higher Economic Planning

Council the information necessary for the

evaluation of the programs envisaged in the

operational plan.

Estimate the quantity of forms and stationery to be used in the establishments, and sec

that they are made available and distributed

promptly.

Coordinate work with other national statistical organizations in matters of joint interest.

Represent the Ministry of Public Health in

the National Statistics Council.

Establish the system of rural health statistics

in each Centro Salud Rural (CESAR) in

areas where the program for the extension of

coverage is being implemented.

Take a direct and active part in the preparation of the annual report of the Ministry of

Public Health.

Collaborate in the establishment of the Epidemiological Surveillance -Program and the

Malnutrition Program.

Prepare the statistical information which has

to be sent periodically to international

organizations.

Types of Data

The Statistics Department collects the following types of data:

Monthly report on hospital activities (finaI,

intermediate, and general services).

Causes of hospitalization.

Daily report sheet for the monthly report on

medical consultations (consultations, treatment, preventive dentistry, immunization,

population examined, environmental sanitation, clinical laboratory, monthly report on

communicable diseases, and monthly report

on noncommunicable diseases).

Form for users of family planning.

Report on hospital discharges not subordinate to the Ministry of Public Health.

17
Form for recording tuberculosis incidence.

Forms for CESAR-community activities.

Organization and Structure

The Statistics Department is organized in

working groups that have no formal structure

due to their simple nature and small number of

officials, some of whom perform several types of

duty.

Nevertheless. a chief and subchief level can

clearly be identified, as well

punching aqd verification

coding, manual tabulation,

forms.

Manpower Qualifications

as a group for card

and a group for

and correction of

All of the 14 officials working in the Statistics Department have completed secondary

school and five of them have attended speciaI

courses ranging from a 4-month course on administration to a 10-month health statistics

course.

In each of the eight administrative regions

there is a statistician and all eight have attended

a 6-week course given by the Ministry of Public

Health. Two of these officials have also attended

a 5-month course on medical records and health

statistics.

In the hospitals, officials working on statistics and medical records range from people with

no, statistical training to those who have studied

the subject abroad for 1 year. Most frequently

the course attended was a 6-week course on

medical records and statistics at Tegucigalpa.

UTILIZATION

No effective use is made of the available statistical information for health activities. Recently, great concern about this situation has

been expressed by some health program managers who urge improving the system.

The Ministry of Public Health, the main user

of the statistics of birth and death, does no analysis of death data in view of the high degree of

under-registration of deaths and the poor quality

of medical certification of causes of death.

There is no mechanism for coordination between users and producers of vital statistics. No

committee or working group has been organized

as yet. In addition, at the moment there are no

reliable and useful data available and only the

results of the demographic survey of 1972 are

being used.

The Higher Economic Planning Council collaborated with and partly financed the demographic survey of 1972 and would like anothefi

one to be carried out in order to determine the

changes that have occurred.

The members of this Council think that it is

time to convene a coordinating committee of

producers and users of vital statistics. They are

interested in having each sector report the type

of information it requires and the form and frequency of reporting needed. They are also interested in methods to improve the coverage,

quality, and timeliness of the information.

EVALUATION

The Statistics Department of the Ministry of

Public Health is making praiseworthy efforts to

achieve the objectives stated earlier in the section of this chapter entitled “The Health Statistics System.” —

Limitations and Defects

Despite the constant efforts made by all responsible staff, important limitations and defects can be found in the statistical system.

These hinder the achievement of the goals set

forth at the beginning of this report and have

become a source of dissatisfaction and frequent

criticism from the users’ side. Among these

defects, the following would appear to be the

most marked:

Planning.–As part of the reformulation of

health policy, there is a plan for collecting statistical information (including the design of forms

and instructions as to how they should be filled

in and distributed). The remaining stages in the

statistical process have still to be defined:

Types of data needed at the various levels of

the system.

18
Tabulation programs for each level (preparation of the tables and forms of presentation).

Necessary indicatom.

The utilization of the information (specific

analysis for concrete actions).

Moreover, not all the information that is collected is necessary and some that is necessary is

not collected.

Finally, manuals for processing the information in the Statistics Department are lacking.

Publication.-The statistical information

published is restricted to that contained in the

annual report of the Ministry of Public Health

and the monthly epidemiological report. The report contains the main statistical data, region by

region, as well as indicators on resources, production, and costs for some hospitals in the

country but not for others at a lower level.

The monthly epidemiological report is distributed to all health establishments in the

country. The annual report reaches only the

regional level and the main hospitals.

Some users emphasize the disadvantages due

to the lack of continuity in the series published.

Nevertheless, the Statistics Department collects and analyzes additional data and statistical

series which are not regularly distributed, but

made available on request.

Ana@’s.-The analysis that is done of the

information processed is very limited. The Statistics Department devotes the bulk of its efforts

to the preparation of tables, both for publication in the annual report and for other technical

departments. Some users carry out their own

analyses, but these do not always reach the

required level of thoroughness nor are they

carried out with statistical expertise.

In the regions and individual establishments,

this situation seems to be more acute.

Consultancy.-This is limited to meeting the

requests of certain units and is not of any great

complexity.

Technical standards.–The Statistics Department prepares technical standards for the collection and dispatch of the statistical forms, but

some other units in the Ministry occasionally

design their own forms and sets of instructions,

and use channels of communication parallel to

those of the Statistics Department.

Supervision. -Supervision and advice are provided at the regional level, but are sporadic and

not carried out in accordance with a preestablished program based on a schedule of needs and

priorities.

Defects inherent in the Department. –’I’he

Department of Statistics lacks professiomd, technical, and auxiliary staff in statistics and medical

records for the work of analysis, consultancy,

and supervision. Also lacking are technical and

auxiliary personnel in statistics and medical

records for the work of registration, data collection, tabulation, and analysis in the regions and

in health establishments. In addition, there is a

lack of economic resources for carrying out

supervisory and consultancy programs in the

field.

Defects inherent in the health system.–The

program for the extension of coverage does not

include the whole country and in the places in

which it is operating, the technical details for

the tabulation, analysis, and utilization of the

statistical information have not been worked

out. No effective use is made of the available

statistical information for health activities.

There is a lack of close communication between

the technical divisions and the Department of

Statistics, which would allow the Department to

gain a better knowledge of the interests, needs,

and justification for the statistical information

requested by the divisions and which would

enable the technical divisions to understand the

role, knowledge, experience, and methodology

that the statistician could bring to the analysis

of information.

Defects on a local level.–The mayoral offices carry out the work of civil registration

more or less by tradition and because the Civil

Code so orders. They do not feel that this work

is very important and they do not do much to

improve the quality of the data or to encourage

total coverage. The economic resources of many

municipalities make it impossible for them to

keep duplicate registers or to pay a person to

take charge of the cemetery. The desire to

recover rates and property taxes leads some

mayors to insist on payment of back taxes as a

19
condition for an entry being made (Jacaleapa

and El Paraiso).

The cemeteries do not keep detailed registers

of the dead buried therein and many of them do

not comply with the legal obligation to send to

the municipal secretaries, once every 15 days, a

list of the persons buried during that period,

their given names, surname, and place of residence of the deceased (Article 349, Civil Code).

The auxiliary mayor is a community volunteer worker, illiterate in 60 percent of cases,

who receives little or no encouragement to carry

out his duties in regard to the civil register.

The burial permit, which in the spirit of the

law would help to guarantee that no deceased

person isburied without having been registered in

the civil register, was simply transformed into a

tax or income of the municipalities. It is not

necessary to register the death to obtain the

permit, but simply to pay 3 Iempiras ($1.50) to

the municipal treasury.

The provisions of the regulations governing

the medical certificate of cause of death are not

complied with. Only a few hospitals have forms

for the purpose. Private physicians do not fill in

these forms. The municipal secretaries are not

strict in carrying out the”regulations, even when

the death occurs in a hospital. ~

Fetal deaths are not recorded except by one

hospital, but the information is not used.

It is essential to improve the content of the

Birth and Death Certificates; the Ministry of

Public Health may be interested in certain

essential data that may be incorporated into

them.

There is little interest in investigations or

surveys by either the General Statistics Office or

the Ministry of Public Health. The demographic

survey was promoted, conducted, processed, and

analyzed, and its results published, by CELADE.

Although health or planning bodies ask for

valuable information, their interest does not

seem to be strong enough to ensure the settingaside of part of the budget for its collection and

analysis.

EDUCATION AND TRAINING

PROGRAMSIn Honduras there are only two programs for

teaching vital and health statistics:

1.

2.

The statistics course at the School of

Medicine (Department of Preventive Medicine ), Honduras Autonomous National

University.

A course on Medical Records and Statistics for auxiliary personnel organized by

the Ministry of Public Health.

Statistics Courses at the

School of Medicine

In the third year of medical school, students

are offered 30 hours of instruction that includes

foundations of statistics (rates, ratios, proportions, means, and averages); foundations of

demography and epidemiology; and a description of the health situation in Honduras.

In the fourth year another 30 hours are

offered on statistical method, probability

theory, main types of distribution, significance

tests, sampling techniques, and the main types

of experimental design. Analysis and criticism of

scientific papers pubIished in medical reviews

and bulletins are done as part of the training.

In the fifth-year course, which is 7 weeks

long, the student studies the health situation.

Health programs are developed to solve the

problems encountered. Classes or meetings are

held on public health statistics, hospital statistics, and medical certification of death.

During the sixth year the students do practical work in the communities and, many times,

specific studies (tuberculosis, _rneasles,’ diarrhea,

etc.). For these practical activities and studies,

statistical information on the population is

prepared and analyzed (the number of cases,

deaths, vaccinations, etc.). The professor of

statistics supervises and advises the students in

this practical work. The practical sessions last 6

weeks. The medical school and particularly the

Department of Preventive Medicine are quite

interested in improving the quality and coverage

of vital statistics. On some occasions, seminars

were organized for the auxiliary mayors and

municipal secretaries about the registration of

vital events. The medical students who do

Practical work in the rural communities are

:

instructed to

secretaries in

certificates of

collaborate with the municipal

the completion of the medical

death. The certificates not stating

20-
cause of death are sent to the physician who,

according to the symptoms at death, establishes

a cause.

Courses on Medical Records and

Statistics for Auxiliary Personnel

The department of medical records and

statistics is considered an essential part of every

health establishment.

The health care that is gken to an individual

in a health establishment is recorded in the

clinical history which is kept and handled in the

department concerned. To carry out their duties

in a satisfactory manner, the personnel in the

department must receive the necessary training.

In Honduras, the staff of the departments or

.services of medical records and statistics are in

general responsible for keeping, handling, and

analyzing clinical histories; preparing health and

administrative statistics and inpatient statistics;

for maintaining case histories and other records

in the inpatient, outpatient, and emergency

services, and in the archives. These duties va.rY

from establishment to establishment according

to the degree of complexity and specialization

of the establishment. and it is obvious that for

these functions, trained staff should be available

at the technical and auxiliary levels. It has been

necessary to train technical personnel in regular

courses outside Honduras since facilities for this

type of training are not available in Honduras

and the availability of this kind of personnel is

low. On the other hand, it was decided that

auxiliary personnel would be trained in Honduras since the auxiliaries are very numerous and

the courses can be short. The national authorities have requested that a program be developed

to continue the preparation of auxiliary personnel for all of Honduras.

The program described below consists of

194 hours; it is planned to use it over several

years until the needs for auxiliary personnel are

met. The program includes material for auxiliary personnel at different levels of medical care:

It may sometimes be necessary to bring the

content of the curricula up to date according to

the needs of the moment. The organization of

the 1976 program is described below.

General objective.–The general objective of

the course is to impart knowledge of medical

records and statistics to the auxiliary personnel

working in medical record or statistics departments or services so that they can carry out their

respective duties efficiently.

Specific objectives. –The specific objectives

of the course are:

To record information on admissions and

registration efficiently for each patient.

To carry out quantitative analysis of the case

histories and the coding of diagnoses and

operations.

-,

To keep and check clinical histories in

accordance with the established standards.

To keep archives on the basis of the terminal-digit method and the conventional

method.

To carry out efficiently the various checks

on the maintenance of clinical histories.

To keep indexes of patients, diseases, and

operations.

To collect, tabulate, and present statistical

information daily and monthly.

In simpler types of establishment, to direct

and supervise’ the medical records service in

accordance with the standards laid down at

the national level.

Sponsor.–The course is sponsored by the “

Hospital-School Project in cooperation with the

Ministry of Public Health and Social Welfare, the

Honduras Autonomous National University, and

the Pan American Sanitary Bureau.

l%rticipants.–The participants will be hospital and health center staff working on medical

records and statistics.

Duration.–The course will last 6 weeks.

Theoretical and practical training will be given

34 hours a week.

Requirements for admission. —To be admitted to the course, the applicant must have

graduated from secondary school, attended a

typing course, be at least 18 years of age, and

show an ability to deal with the public.

Syllabus. –The course for auxiliaries in medical records and statistics comprises the following

subjects:

21
Subject Hours

Administration ................................

Medical records, including coding .....

Mathematics .....................................

Statistics...........................................

Anatomy, medical terminology, and

pathology ........................................

Human relationships .........................

Total ............................................

RECOMMENDATIONS

12

86

10

56

22

10

196

It is urgent to implement the remaining

stages in the statistical information plan as part

of the program for extension of coverage. The

items that still remain to be defined are tabulation programs, levels of consolidation of the

data, establishment of indexes, and the analysis

and utilization of the information. Information

flows should be specified clearly and the persons

responsible for each activity .Vould also be

identified.

The extension of the statistical information

system should realistically include an expansion

of manpower and, equipment at the local,

regional, and national levels. Otherwise, the

program proposed must be reexamined and

information priorities defined.

It is essential for the Department of Statistics to play a continuous part in the existing

coordination system with a view to ensuring that

the technical standards proposed by the department are known, discussed, and endorsed by the

coordination committee. In this way, unilateral

action by the division which is ,developing

procedures for data collection and analysis can

be avoided.

It is urgent to formulate and encourage the

development of an integrated and dynamic

program for training in health statistics, in the

sense that:

Continuous training and identification of

manpower needs in order to determine

training methods and possibilities (courses,

short courses, seminars, fellowships, inservice training, etc.)

Integrated training from the departmental

head at the central level down to the

auxiliaries employed in collecting data at the

local level. This program should also cover

the users of the information for training in

techniques of data collection and analysis.

The program designed for statistical staff

should cover areas of specialization such as

statistics, medical records, systems analysis,

and disease classification, according to the

needs of the health sector. In highly specialized subjects for which no permanent staff is

required, national or international sources of

manpower should be identified (sampling

techniques, operations research, etc.).

The statistical information system should be

periodically evaluated and improved and the

statistical functions oriented toward the information needs and the utilization of the

information.

It is essential that the Ministry of Public

Health take a more active role in the promotion

of activities designed to improve the registration

of vital statistics and their collection, processing,

and analysis.

It is necessary to coordinate these activities

with other activities in the public sector through

the establishment of a National Vital Statistics

Committee or an ad hoc working group. Until

vital statistics are integrated in a satisfactory

way, the Ministry should encourage the conduct

of surveys that yield better estimates of demographic indexes needed in health programing.

22
APPENDIX

CONTENTS

Forms.

Reproduction of Statistical Report of Birth (Translated) ...................................................................

Reproduction of Statistical Report and Certification of Death (Translated) ......... .................!...... ..... $

Reproduction of MedicalCertification of Birth (Translated) ...... .......................................... ............. 26

Reproduction of Me&cd Cetiification of Deafi(Trmdated) ............................................................ 27

Rcptoduction of Birth Certificate Receipt (Translated) ..................................................................... 28

Reproduction of Death Certificate Receipt (Translated) .................................................................... 29

.T{
Reproduction of Statistical

APPENDIX

Report of Birth (Translated)

REPUBLIC OF HONDURAS

GENEML ADMINISTRATION OF STATISTICS AND CENSUS

STATISTICAL REPORT OF BIRTH

If the biih occumed io a hospital or clinic, this report will be completed in the hospital or clinic snd given to the parents for

&livery,to the Civil Registrar.

If the biih occurred without professional attention, thii report will be completed by the Registrar at the time of registration.

L Nsme of the baby:

2. Sex of the baby: Femak 3. Date of Birth:”

HI ❑ 2 Day _ Month _ Year

4a. Father’s age in completed years

— years 4b.

Nationality of fiwher

5. Father’s occupation:*

6. Father’s education:

University or CoIlege.,..o.o.., ❑ 1 .%ccmdsry ................. H 2

Elementary-... o..-........... H 3 None ......................... H 4

7. Name of mother:

Ss. Mother’s age in completed years

yesrs 8b.

Nationality of the mother

9. ISthe mother married? Yes ❑ 1 NoD2

10. Permanent address of the mother:

City or town

.

Village Township

11. Mother’s education:

University or College .......... ❑ 1 .%ccmdsry ................. ❑ 2

Elementary ........................ ❑ 3 None ......................... ❑ 4

12. Total number of births that the mother has had including the present b~h, whether actually she or not:

13. dild’s place of birth: 14. MO attended the mother at the birth?

Ina - Ina In another Nurse Folk

Hospital house place Doctor or &lcensed) pr;~ac

Other

HI ❑ 2 ❑ 3

midwife person

❑ l ❑ 2 ❑ 3 ❑ 4

15, ‘lIris birth - single, twins, triplets, etc.? 16. Thii report was completed by:

Sigle Twins Triplets or more Nurse

❑ I U2 l-J3 Doctor or R@trar

midwife

Lrave

blank

2.

3.

4a.

4b.

5.

6.

i’.

&.

8b.

9.

10.

11.

12.

13.

14,

15.

16.

Name of the Hospital

Sigoature of the person who completed the report

State Registration number

Township Registration date

*The Spanish term “trabajo Airado” is not the equivalent of occupation (ocupacic$ n),and may thus elicit answers not clmifiible as “m

occupational such as worked in a factory.

24
— . . —

Reproduction of Statistical Report and Certification of Death (Translated)

RBPUBLIC OF HONDURAS

GENEWiL ADMINISTRATION OF STATISTICS AND CENSUS

STATISTICAL REPORT AND CERTIFICATION OF DEATH

If the death occurred in a hospital or clinic or the deceased received professional attention, thw report will be completed by a

doctor and given to the family for delivery to the CM Registry.

If the deceased did not receive professional attention (rural areas) th~ report will be completed by the Registrar at the time of

registration.

1. Name of the deceased:

2. Date of death: Day Month Year

3, Age of the deceased in completed years:_, years

If the deceased is a child less than one year of age: months and days

4a, Sex of the deceased: Mde Femak 4b.

HI ❑ 2 Natiomdky of the deceased

1

5. Marital status of the deceased: Single Married Widowed Divorced Consensual

union

❑ 1 ❑ 2 ❑ 3 ❑ 4 ❑ 5

6, Deceased’s education:

University or College .......... l-Jl Secondary ....................... ❑ 2

Elementary ,.,,,.,,.,,..,..,, ...... ❑ 3 None ,............ .................❑ 4

7. Deceased’s occupation*

8, CAUSE OF DEATH LENGTH

la. Immediate cause ...................... Terminal sickness which directlv.

caused the death

lb. Underlying causes* *,.......,,,,.,,, Sicknesses that led to the immediate

cause I

9. The death was due to: Sickness Accident Homicide Suicide

❑ 1 ❑ 2 ❑ 3 ❑ 4

10. If the death was due to an accident at work, indicate where or for whom the deceased worked.

11. If the deceased was less than one year of age, give the following information on the mother:

Age in completed years Marital Status

Occupation* tiows how to read and write

12. The death occurred in:

In a Ina Irr another

Hospital house place

❑ 1 Q2 H3

13, Permanent address of the deceased:

City or town Village Township

14. This certificate was completed:

In a In the

Hospittd Registrar’s office

❑ l J-J2

Leave

blank

2.

3.

4a.

4b,

5.

6.

7.

8.

9.

10.

11,

13.

14.

Name of the Hospital:

Siiature of the person that completed this report

State: Registration Number

Township: Registration Date

*Ths Spanish term Wrabajo realizado” is not the equivalent of occupation (ocupad6n), and may thus elicit answers not classifmble as “an

occupation;’ such as worked in a factory.
Reproductionof MadicalCertificationof Birth (Translated)

Ministry of Public Health and Social Assistance

Honduras

MEDICAL CERTIFICATION OF BIRTH

Date of birth

Sex Mu Fn

Name of the mother

&of the mother

Number of previous live births

of the mother

Attention at Birth

Place ❑ House

Assisted by ❑ Midwife

Birth registered by:

19

❑ Other .............................................................

(specify)

❑ Health auikry

Name

Date 19

Place

Region

❑ Health auxiliary

❑ Hospital Superintendent
I Reproduction of Medical Certification of Death (Translated)

Ministry of public Health and Social Assistance

Honduras

MEDICAL CERTIFICATION OF DEATH

Date of death

Age of the deceased*

(*in months if less than 1 year old, in years if 1 year old or older)

Sex ❑ Male ❑ Female

Residence

If the deceased is less than 1 year old, please indicate:

Age of the mother

Total number of live births

that the mother has had

GUSe of the death

Death Registered By:

Name

Date 19

Place

19_

months

H Assistant

❑ Hospital Superintendent

27
Reproduction of Birth Certificate Receipt (Translated)

COUNCIL OF THE CENTRAL DISTRICT

BIRTH CERTIFICATE RECEIPT

NAME OF THE NEWBORN

NAME OF THE FATHER

NAME OF THE MOTHER

DATE OF BIRTH

REGISTRATION No. VOLUME No.

YEAR

Tegyigdpa, Central District , ................ .............................. 197 ....

(day) (month)

Secretary of the Council

of the Central ~strict

28
Reproduction of Death Certificate Receipt (Translated)

CIVIL REGISTER OF THE CENTRAL DISTRICT

DEATH CERTIFICATE RECEIPT

Name of the deceased ..................................................................................................................................... ..................

.,,,,................................................................................................................................. ................................. ....................

Name of the father ................................................................................................................................... .........................

.................................................................................................................................... ................................. ......................

Name of the mother .................................................................................................................................. ........................

,!,. ,., .,,,,,,,0,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................... ................

Date of death ............................................................................................................................................ ........................

Registration No .......................................... Book No ...........................................................

Year...........................................................

Te~cigalpa, ..................... ............................... 1973

(day) (month)

............................................................

secretary of the Council

29
Chapter II

The Health and Vital Statistics

Systems of Mexico

Dr. Hans A. Brmch, Silvia B. Harhan, and Jo;e Louis Sanchez-lhspo

World Health Organization Study Mission to Mexico

April 18-May 6, 1977
CONTENTS

Introduction ...........................................................................................................................................

General Information .........................................................................................................O...............

Organization and Operation of the Vital Statistics System ................................................................

Organization .................................................................................................................................. .

National Level ..............................................................................................................................

State and Municipal Levek ..........................................................................................................

Federal District ............................................................................................................................

Operation ................................................................................................................................. ......

Mechanisms of Registration and Certification of Vital Events ...........................................................

Births .................................................................................................................................. .........

Deaths ................................................................................................................................. ........

Organization and Operation of the Health Statistics System .............................................................

Organization ...................................................................................................................................

GeneAD~ctorate of Biostatistics oftie Dep@ment of Hedtiand Welfare ............................

Office of Planning and Evaluation of the General Directorate of Coordinated Public Health

Services in the States .................................................................................................................

Biostatistics and Information Office, Department of Health of the Federaf District ....................

Other Statistics Units in the Department of Health and Welfare

Operation

..................................................

................................................................................................................................. ......

Deaths .................................................................................................................................... .....

Communicable Diseases ...............................................................................................................

Human Health Resources .............................................................................................................

Institutional Health Resources .....................................................................................................

Morbidity of Hospital Inpatients .................................................................................................

Hospital Statistics on Bed Use .....................................................................................................

Vaccination Statistics ..................................................................................................................

Health Care Statistics ...................................................................................................................

Evaluation ................................................................................................................................. ........

Births .................................................................................................................................... .......

Deaths .........................................................................................................................................

Effectiveness of Function F1 .......................................................................................................

Effectiveness of Function F2 .......................................................................................................

Heafth Statistics ...........................................................................................................................

Problems Related to Education ...................................................................................................

Education and Training Programs .....................................................................................................

Educational Institutes ....................................................................................................................

School of Public Health of the Department of Health and Welfare ..............................................

Department of Sociaf Medicine, Preventive Medicine, and Public Health, National Autonomous

University of Mexico .................................................................................................................

Center for Economic and Demographic Studies, El Colegio de M&xico ........................................

Other University Institutions .......................................................................................................

Training Programs ..........................................................................................................................

General Directorate of Statistics, Department of Programming and Budget .................................

Generaf Directorate of Coordinated Public Health Services in the States .....................................

Office of the Chief of Preventive Medicine Services, Mexican Institute of Social Security ...........

Office of the Chief of Teaching, Institute of Social Security and Services for State Workers .......

35

35

36

36

36

38

38

38

39

39

39

40

40

41

42

42

43

43

43

43

44

44

44

44

44

44

45

45

46

46

46

47

47

47

47

47

48

48

48

49

49

49

49

49

33
References .............................................................................................................................................. 50

Appendix: Forms .................................................................................................................................. 51

Reproduction of Affidavit of Birth (Translated) ................................................................................. 52

Reproduction of Certification of Death (TrasIated) .......................................................................... 53

34
CHAPTER II

THE HEALTH AND VITAL STATISTICS

SYSTEMS OF MEXICO

Ham A. Bruch, Silvia B. Hartman, and JOS6Luis Sanchez-Crespo

INTRODUCTION

A system of health and vital statistics encompasses functions performed by different

data-producing institutions, users, sources of

information, sociocultural aspects of the society,

and the type and quality of resources available.

The objectivm of the statistics system are to

furnish all levels of government and the public at

large with relevant, reliable, coherent, and current data. These are its outputs. The inputs to

the system are primary data, models, requirements, and priorities.

It is WCIIknown that an organization scheme

is not a very accurate guide to the system in

which actual activities, or functions, arc carried

out.

The analysis of any ~ystem moves from its

starting point and proceeds through successive

stages, defined by inputs and outputs. Each

stage must include a control function to make

the entire system harmonious, The control

function must b~ capable of receiving signals

either from within the system or from outside

sources, and must be able to stimulate both the

systcm itself and the surrounding cnvironmtmt

through certain actions. Two examples of this

stimulation arc initiating requests for relevant

changes in law and influencing the choice of

budget priorities.

The effectiveness of the function defined

here, whi~h wc will call “F1 ,“ may be measured

by how much the statistics it produces are used,

their cost, and their regularity of appearance, as

well as by how many users are satisfied with

them and how important those users are.

Another function, which we shall call “F2 ,“

has the mission of maintaining the framework in

which F1 operates, in consideration of the

Government’s long-term statistics needs. This

long-term consideration is essential. Inevitably,

there is a period between the discovery of an

information need and the time by which it is

satisfied by time series statistics.

The inputs of F2 are: the Government’s

long-term plans, the signals emitted by F1 about

the nature and frequency of unsatisfied needs,

the reliability of the statistics, the methodology,

the concepts, and classifications.

The outputs of F2 are: the development and

revision of medium-term plans, new policies,

concepts, classifications, and methodologies.

The effectiveness of F2 is measured by the

relevance of the information provided by F1.

Although F1 may come from many different

institutions, F2 is the product of a central body,

though its organization may be divided among a

number of institutions.

General Information

Mexico. with an area of about 761.530

square

United

miles, is bordered on the north by” the

States of America, on the south by

35
Guatemala and Belize, on the west by the

Pacific Ocean, and on the east by the Gulf of

Mexico. Mexico is the third largest country in

Latin America (after Brazil and Argentina) and

about one-fourth the size of the continental

United States.

The topography of the country is varied,

ranging from low desert plains and junglelike

coastal strips to high plateaus and rugged mountains. Beginning in southern Mexico, an extension of a South American mountain range

runs north almost to Mexico City, where it

divides to form two coastal ranges, the Occidental (west) and the Oriental (east) of the

Sierra Madre. Between these ranges lies the great

central plateau, a rugged tableland 1,500 miles

long and as much as 500 miles wide. From a low

desert plain in the north, it rises to 8,000 feet

above sealevel near Mexico City.

Mexico’s climate is generally more closely

related to altitude and rainfaIl than to latitude.

Most of Mexico is dry (approximately 50 percent is deficient in moisture .throughout the

year) with only 12 percent receiving adequate

rainfall. Temperatures range from tropical in the

coastal lowlands to cool in the higher elevations.

Mexico is composed of 29 States, the Federal District, and two Federal Territories (the

southern half of Baja California and the eastern

half of the Yucatan Peninsula). Each State is

headed by an elected Governor. Powers not

expressly vested in the Federal Government are

~eserved for the States, but Mexican States’

powers are much less extensive than those of the

American States.

By the mid-1960’s, Mexico had almost

40,000 miles of paved and all-weather gravel

roads. Mexico has approximately 15,000 miles

of railroads; about 75 percent of this trackage

has been nationalized. Practically the whole

country has air service. A private company

provides virtually all of the telephone service in

Mexico. Telegraph service is furnished by a

government-owned company. Radio broadcasting is extensive, and television stations do

exist in Mexico City and several other cities. In

1965, Mexico had 460 radio-broadcasting stations, 8.3 million radio sets, 31 television stations, and 1.1 million television sets. Mexico also

has a modern postal system.

With a population of about 67,700,000,

Mexico is the second most populous country in

Latin America (after Brazil). More than half of

the people live in central Mexico; however,

significant internal population shifts have occurred since 1950. Many Mexicans have been

migrating from areas lacking in job opportunities-such as the underdeveloped southern States

and the crowded central plateau—to the industrializing urban centers and the developing

border areas of the northern States. The Government has tried to reverse this trend by launching

a major development program for the south.

Almost two-thirds of the Mexicans are

mestizos—mixed Indian and Spanish descent;

Indian is predominant. The remainder of the

people are primarily pure Indian, although a few

are of Spanish or other European ancestry.

Spanish is the official language, and over 70

percent of the people are literate.

ORGANIZATION AND OPERATION OF

THE VITAL STATISTICS SYSTEM

Organization

National Level

The Federal Statistics Law assigned national

responsibility for vital statistics to the General

Directorate of Statistics of the Department of

Programming and Budget. Pursuant to Article

382 of the Health Code, this work is done in

coordination with the Department of Health and

Welfare.

Among the important users of vital statistics,

the General Directorate of Maternal and Child

Care and Family Planning and the National

Population Council may be mentioned.

General Directorate of Statistics. —This

Directorate is under the Office of General

Coordination of the National Information

System of the Department of Programming and

Budget. The Office of Demographic Statistics,

under the Office of the Assistant Director for

Sociodemographic Statistics, has immediate responsibility for vital statistics. The General

Directorate of Statistics receives primary data

from its offices in the States. This informa36
tion is included on Forms 821, 824, and 823 for

births, fetal deaths, and deaths, respectively. It

also receives information on Forms 822 and

825, for marriages and divorces, respectively.

The General Directorate of Statistics edits,

codes, and processes these vital statistics by

computer and publishes them in annual publications. It also sends information in the form of

tabulations to the General Directorate of Biostatistics. By law, the data published by the

General Directorate of Statistics are the sole

official records of the Mexican Republic. This

information is also published in the Statistics

Journal (a monthly publication) and in some

special studies such as “Imagen Demogr5fica, ”1

“An~isis de Ios Sistemas de Informaci6n de

Estadi’sticas de Natalidad y Mortalidad que

operan en Am6rica Latina 1975,”2 and many

others.

General Directorate of Biostatistics. –This

Directorate is under the Office of the Assistant

Secretary for Planning, a part of the Department

of Health and Welfare. It receives vital statistics

information from the General Directorate of

Statistics in the form of tabulations that it

releases in an annual publication. The coverage

of birth and death records varies greatly from

State to State. This coverage has not been

measured by any direct method. Mortality statistics are the basic data in many public health

programs. They are considered valid indicators

both for establishing priorities and evaluating

results.

General Directorate of Maternal and Child

Care and Family Planning.–This Directorate is

in the Department of Health and Welfare. It

receives specific instructions in matters related

to family planning from the National Executive

Coordinator of Family Planning. This Directorate relies heavily on vital statistics, mainly for

making its decisions on establishment of programs. Some of its needs are not met because

the available information is too general for

application to the usually small areas where it

conducts its programs. In addition, the system

provides no information at all for specific areas.

One example might be behavior motivation in a

small program for breast feeding as part of an

overall maternity program. This type of information may be obtained in the future by taking

sampling surveys. At this time, the Directorate

has data on tape about some 600,000 women

who have used the family pIanning services of

the Department of Health and Welfare. The

Directorate does not have its own computer.

National Population Council.–The National

Population Council, established by the General

Population Law of 1973, sets standards for and

evaluates vital statistics collection. Its members

come from the Departments of State and decentralized institutes. Its principal spheres of interest are family planning, maternity, education,

welfare, and socioeconomic health indicators in

general. It has plans to conduct surveys to

measure the impact of programs that have been

carried out in these areas.

Department of Programming and Budget.–

Starting on December 1, 1976, important

changes were made in the organic structure of

Mexico’s public administration. Among these

was the establishment of the Department of

Programming and Budget, one of whose functions is to establish the foundation to coordinate

the operations of the national information system.3

To meet this responsibility, the Office of

General Coordination of the National Information System was established within the Department. The following agencies were attached to

that Office:

General Directorate of Statistics of the

Department of Industry and Commerce,

National Territory Studies Commission,

Secretary of Information for Economic and

Social Programming of the Office of the

Secretary of the President.

With these resources as its foundation, the

Office of the Coordinator was structured in the

following way. It was given a regulatory body,

called the General Directorate of Design and

Implementation of the National Information

System.4 This Directorate was made responsible

for designing the information policy and the

data processing to guide the actions of the

national information system, developing the

technical standards and managing the instru~

ments to coordinate the statistical work of the

37
public sector. There were also two operational

organs, the General Directorate of Statistics and

the General Directorate of National Territory

Studies which were assigned the task of producing the statistical and cartographic information, the basic responsibility of the Office of the

Coordinator itself. Finally, it was given a support organ, the General Directorate of Electronic Systems and Processing, which has

responsibility for supporting data processing

activities and general administration. Furthermore, this office provides processing services to

the rest of the Department.

The basic objective of this Office is to make

all the national information services into a unit

so that it can furnish reliably and promptly the

information required for decision-making, economic and social programming, and scientific

research, by making good use of the resources

available to the Federal public sector.

The hope is to establish a system whose

standards are centralized and whose operations

are decentralized. This means that the characteristics of different sectors and regions will be

used to determine their responsibilities in a

specific field of information. This field will have

to be based on previously established operating

criteria so that its outputs are reliabIe, and can

be aggregated and integrated into .a larger system.

Following this line of action, in early 1977,

the Office of the General Coordinator of the

National Information System and the Department of Health and Welfare undertook a number

of joint activities to improve data related to the

health and social security sector. Among the

most important of these joint activities were the

preparation of a basic statistics manual for the

Health and Social Security Sector, the initiation

of work to unify the instructional framework of

health sector statistics, and a review of programs

and strategies to resolve these problems.

From all this effort will come the definition

of the program to develop health and social

security sector statistics, which will contain

specific actions to take in the field of vital

statistics.

State and Municipal Levels

The civil registrar’s office is the primary

source of vital statistics. The rules that apply to

recording vital statistics are included in the civil

law. Each State has its own civil code and the

standards contained in these codes do not differ

substantially from those of the Federal District’s

code, although the interpretation of the definition of live birth contained in the Civil Code

(Article 337) could cause some confusion with

fetal deaths.

Registrar’s Office. –Each town has an office

of civil re#stration. In some States, the persons

responsible for public records are, by law, the

municipal chief executive; in others they are

Government employees, known as “registry officers.”

Statistics offices in the States. –Each State

has a branch office of the General Directorate of

Statistics. At every branch office visited, it was

stated that the office does not have sufficient

personnel for data gathering and supervisory

work or for secretarial duties.

Federal District

The Federal District covers an estimated

population of 12 million. Until decentralization

in 1972, the Central Office constituted the

archives of the Federal District. Since then, the

Federal District has been divided into 16 civil

registration zones with one or more registrars

per zone (32 public clerk offices). The persons

responsible for each of these offices are called

civil registry magistrates. The sixth auxiliary

office of civil registration is responsible for

completing the certificates of all violent deaths

for the Federal District and for all sudden deaths

on public ways. An unofficial certificate, which

is not forwarded to the Department of Health

and Welfare, is used for this purpose.

Operation

The input data on births that are recorded at

local clerk offices consist of data obtained by

direct gathering (interview of the parents or

guardians of the child) and, for deaths, two

copies of the death certificate submitted by the

relatives of the deceased.

The outputs are Forms 821, 823, and 824

(original and copy), which are sent to the

General Directorate of Statistics branch office in

the State; Form 6-65, original and copy, which

is sent to the State government; another copy

38
goes to the State Office of Coordinated Public

Health Services; and another copy to the local

health center, which also receives a copy of the

death certificate. The vital event is recorded in a

book at the office of civil registration. A copy of

the book is sent to the superior court of justice

of the State. (See appendix, “Forms.”)

MECHANISMS OF REGISTRATION

AND CERTIFICATION OF

VITAL EVENTS

Births

The father or the mother goes to the

municipal civil registrar’s office with the newborn and two witnesses 21 years of age or older.

The data for all of them are entered into two

books that are assumed to be identical. One of

these books is kept at the municipal office and

the other is sent to the State superior court of

justice.

The method of entering the data into the

books varies horn one municipaJ office to

another. Some record data in one of the books

(either one) and leave the corresponding page in

the other book blank for later completion.

Others take the data by voice and two persons

copy them at the same time for the purpose of

avoiding errors. One difference is that some

books are preprinted, others are not. Finally, in

some municipalities there is one form for recording the data and then data are taken from

this form and entered into the books.

The registration term is 15 days for the

father and 40 days for the mother. If the

recording is late, a fine is charged. The amount

varies according to municipality and the amount

of delay in the registration.

The fine, which is usually not less than 8

pesos (about $0.35), can be suspended if the

person is poor. Some municipalities ch”arge a

registration fee of at least 31 pesos (about

$1.16) even though the Civil Code states that

this act is free of charge.

When the newborn lives only a few hours,

some municipalities fill two forms, one for birth

and the other for death, in accordance with the

Civil Code (Article 75). However, other municipalities just complete the latter, that is, the

record shows a child died but not that it was

ever born. This causes a discrepancy in mortality

and birth rates.

A large percent of the recorded births are

for births in previous years. The General Directorate of Statistics estimates that 33 percent of

the births registered in 1975 had occurred in

previous years. (This figure has not yet been

published but was provided by General Directorate of Statistics officials. ) These late registrations are usually made for persons who need the

birth certificate for purposes such as social

security or medical treatment.

The civil registration books provide the data

for the total number of births, without mention

of the year of occurrence and the data, are

entered on Form 6-56, which should be sent

during the first 5 days of every month, both

original and cop y, to the State government;

another copy to the Coordinated Public Health

Services in the State; and a third copy to the

public health center of the local area. A fourth

copy is filed.

Form 821 (data for birth statistics) is also

completed. The original and a copy are sent to

the local official of the General Directorate of

Statistics in the State. This form yields information on the year of occurrence and the year of

registration of the birth.

Deaths

A Certificate of Death is an essential requirement for recording a death and obtaining the

burial permit. Nonetheless, this rule is not

followed in some cases. The certificate is replaced by a declaration by the judge and the

forensic medical officer, a visit by a physician to

view the cadaver, or by the family declaration.

The certificate is submitted by the relatives of

the deceased, and is witnessed by two persons,

21 years of age or older. These persons submit

to the person in charge of civil registration two

copies of the Certificate of Death. One remains

at the local civil re<gistrar’soffice and the other

goes to the health center for epidemiological

purposes, although apparently this dots not

always occur.

When the death certificate data are entered

into the vital registration book, the responsible

officers in some municipalities com.ult a physician if they do not understtmd the entry (ics)

39
under causes of death. Others merely enter (in

any order) the most legible causes of death.

The civil registrar’s officer completes Form

823 for the General Directorate of Statistics and

a copy for the Coordinated Public Health

Services in the State. In most cases, the information to complete Form 823 comes from the

registry book. The duration of the illness associated with each cause of death is omitted.

If the cadaver is to be transferred to another

municipality for burial, a new record must be

made. This procedure could very easily result in

a doubling of the actual number of such deaths.

In the municipalities visited, the percent of such

records varied from 2 to 50 percent.

Each State statistics office should receive all

information before the 10th day of the month

and remit it, in turn, to the General Directorate

of Statistics before the 20th. In fact, it sends the

information twice. The first instance occurs as

soon as data are in from 75 percent of the

municipalities, and the second occurs as soon as

the other 25 percent becomes available.

At one of these statistics offices, it was said

that the data are reviewed to find any gross

errors. These are confirmed and corrected by

telephone calls to the respective municipal office

of the public clerk. However, in practice, this

does not occur very often. The statistics office

does not have any allotment (for travel and per

diem expenses) to visit public records offices. In

a systematic fashion, a checking procedure is

kept for the registry of vital statistics by using

the sequential numbering of the books.

ORGANIZATION AND OPERATION OF

THE HEALTH STATISTICS SYSTEM

Organization

The Mexican public health sector consists of

a great variety of governmental institutions and

organizations. These agencies, however, have

different degrees of autonomy and little or no

coordination exists among them. Some of the

principal agencies are:

Department of Health and Welfare.

Mexican Institute of Social Security.

Institute of Social Security and Services for

State Workers.

Medical services OE

Petr61eosMexicanos.

State railways.

Armed Forces.

National Institute for the Protection of

Children and the Family.

National Indian Institute.

Others.

Each of these organizations has its own

doctors’ offices and hospitals and offers preventive medicine programs.

At State and municipal levels, those governmentsalso have hospitals and outside consultation facilities.

Efforts to coordinate health activities have

been made through the National Committee to

Coordinate Security, Health and Social Welfare

Activities. This Committee operated for several

years without much success. The Office of the

Assistant Secretary for Planning has been established within the Department of Health and

Welfare, with a General Coordhation Office

responsible for promoting the coordination of

statistical information, and other functions. As

for the coverage of these health services, social

security agencies serve approximately 35 percent

of the population, especially in urban areas

where most industrial and transport workers,

and trade and government employees live.

Approximately 15 million of the rural population have only partial health service coverage.

The Government and the Department of Health

and Welfare are concerned about providing these

people with primary health care services. Programs for the extension of health service coverage will be started soon. These programs will

employ more than 10,000 community promotion agents. An estimated 15 percent of the

population receives private medical care. These

figures come, through personal communications,

from staff members of the social security agencies and the Department of Health and Welfare.

The foreRo& reveils that the health statistics system i; dis~ersed among a large number of

40
agencies that provide health services. Each

agency, depending on its own basic interests and

its degree of complexity or sophistication, has

its own rules for recording, gathering, classifying, tabulating, and analyzing data on the

people it cares for, the medical care services it

delivers, and how it uses its health resources.

This fact makes it very difficult, and, in many

cases, impossible, to produce national figures on

health conditions, morbidity, services provided

and health resources available.

The Department of Health and Welfare does,

however, have health statistics systems and

statistics offices for special programs (e.g., malaria and tuberculosis) or specific geographical

areas (the Federal District, on the one hand, the

States, on the other). Each one of these systems

has its own standards for gathering, processing,

and analyzing data but they are not compatible.

There are no uniform national standards.

At this time, the new Government administration is reorganizing the Department of Health

and Welfare and its health statistics system. It

has a plan to centralize and coordinate the

health statistics system by providing it with all

the human and material resources it needs. The

plan includes resources to carry out health

sampling surveys, at both national and regional

levels. These will help to complement or supplement information for health proWam planning

and evaluation.

The 1973 Health Code of the United States

of Mexico provides that the Department of

Health and Welfare will be responsible for

certain health statistics, in coordination with the

General Directorate of Statistics of the Department of Industry and Commerce (the Directorate is now part of the Department of Programming and Planning). These statistics are for

the following areas:

Births, deaths, and marriages.

Illnesses and physical disabilities.

Personnel, equipment, medical units, and

other resources.

Health services delivered to the public.

National health situation, by geographic

area.

Health-related ecological factors and other

subject areas that the Department of Health

and Welfare determines.

The Federal Statistics Law (Article 2) instructs the General Directorate of Statistics to

compile statistics on facts and events in the

Federal sphere of competence. Article 6 of that

Law states that Departments of the Federal

Government may be authorized to compile

statistics in special areas if it is done according

to the requirements of this Law.

Mexico has two health data gathering systems which operate in parallel and without

coordination. First, every public and private

health facility must report annually to the

General Directorate of Statistics of the Department of Programming and Budget on its activities, resources, and morbidity with respect to

hospital discharges (Form 933). The health

facility must provide this report, regardless of its

parent institution or organization. Second, each

agency operates its own data system to meet its

own needs in planning, administration, and

evaluation of health programs. The two data

systems involved are not compatible with each

other and use different classifications. Thus

staffs of these facilities have to maintain two

classification systems.

The Organic Law of Public Administration,

Article 32, Section III, states that the Department of Programming and Budget is responsible

for drafting and establishing the outIines of all

statistics systems in Mexico. Article 8 of Chapter

V, Internal Rules of the Department of Programming and Budget, sets forth the powers of

the General Coordinator of the National Information System. First, the coordinator programs

and coordinates the operation of the national

information system and second, coordinates the

collecting and processing of data and information services.

General Directorate of Biostatistics of

the Department of Health and Welfare

The General Directorate of Biostatistics has

just become the main body of the Department

of Health and Welfare health statistics system. It

41
will set the rules, advise, coordinate, and supervise this work. Its principal function will be to

establish the national rules for collecting, processing, and analyzing national health statistics.

In conjunction with Department of Health and

Welfare technical units, it will establish and

define what data and how often they should be

gathered, and how they will be analyzed. The

General Directorate of Biostatistics has four

offices.

Processing and publications. –This office has

Federal responsibility for processing and publishing data on communicable diseases, hospital

discharges, and certain statistics about health

resources. It uses the information from the

General Directorate of Statistics of the Department of Programming and Budget and process

and publishes information on population, births,

and deaths. The latest publication prepared by

the Dkectorate of Biostatistics covering 1974

data was published in 1976.5 In the future, this

office will process and publish all the statistics

that the General Directorate of Biostatistics

gathers and analyzes.

Research and Statistics Advisory Serva’ces.–

This new office is being organized at present. Its

purpose will be to design and conduct health

surveys to develop rapid, reliable, and specific

data for health program planning and evaluation.

Further, this office will provide technical assistance in statistics to all Department of Health

and Welfare technical units.

National Health Information and Documentation Center.–This unit is attached at the level

of a directorate. It works exclusively on finding

and researching scientific documents and bibliographical materials on health. It is connected to

foreign documentation centers by terminal

hookups (MEDLAR, MEDLINE, BIREME, and

others). It works with all of Mexico’s documentation centers.

Demographic, Environmental, Resource, and

Health Services Statistics. -This is another new

office that is now recruiting personnel and

developing an organizational structure. It will be

responsible for analyzing and preparing demographic statistics (population served by water

supply and sewage systems, and other areas),

statistics on health resources (human, physical,

and financial), and statistics on health services.

Office of Planning and Evaluation of

the General Directorate of Coordinated

Public Health Sewices in the States

One part of this Office, the Office of the

Assistant Director for Evaluation, is actually a

statistics unit. This Office has the main function

of standardizing and organizing the statistics

offices of the Coordinated Services in each

State. It gathers information in monthly reports

about the activities of the health facilities

(hospitals and health centers) and about special

programs.

It keeps a current catalog of each State’s

health resources. It classifies health establishment “by locality and degree of sophistication

(urban hospitals, rural hospitals, health centers,

health houses, and others).

The Office keeps records for each State on

health personnel by profession, hours of work

contracted, and locality.

It gathers information about vaccinations

given by health establishments and special vaccination campaigns. This information covers types

of vaccines, dosage, and age of the person

vaccinated, by locality.

Taking the information it receives from the

General Directorate of Statistics, this Office

prepares and publishes information about births,

deaths, and population for each State. It also

prepares and publishes data covering the activities of all health establishments (a recent publication covers 1975).

Biostatistics and Information Office,

Department of Health of the

Federal District

The principal function of this Office is to

process and prepare statistics on the activities of

the Federal District health centers.

Using the death certificate, this Office codes

the cause of death and processes the mortality

statistics for the Federal District. Note

that certificates are not received in cases of

violent death or for deaths of Federal District

residents that occur in other States. Obviously,

this is a duplication of the work performed by

the General Directorate of Statistics, but the

data We used strictly for internal purposes; the

42
official statistics of the Gener”hl’Directorate of

Statistics are released to the public.

Other Statistics Units in the

Department of Health and Welfare

Certain programs and special campaigns have

their own statistics units that gather, process,

and publish statistics. They prepare standards,

forms, and instructions which in many cases

duplicate and increase the workload of the staffs

of health facilities. Of these, the most important

programs are the following:

The National Commission for the Eradication of Malaria.

The National Campaign Against Tuberculosis.

The General Bureau of Maternal-Infant Medical Care and Family Planning.

The National Campaign Against Cancer.

The General Bureau of Epidemiology and

Public Health Research (programs for onchocerciasis, pinta, rheumatic fever and others).

Operation

Deaths

The Civil Registrar’s Office sends copies of

death certificates to the health center in its

jurisdiction. These certificates serve strictly epidemiological purposes. The rules state that these

copies must be sent as promptly as possible to

the General Directorate of Biostatistics for

statistical processing. This practice has been

neglected for a considerable tim,e, but new

instructions call for starting it again. The hope is

that the activities of these offices will be

coordinated so as to avoid duplicating the work

of the General Directorate of Statistics.

A copy of Form 823, the Statistical Report

of Deaths, is sent by the State delegate of the

General Directorate of Statistics to the Office of

the Chief of Coordinated Services in each State.

This Form is used for epidemiological purposes

at local, State, and national levels. Forms are not

sent for State residents who die in other States

and, therefore, the data cannot be used for State

mortality statistics.

Every year the General Directorate of Statistics lends its detailed tabulations of births,

deaths, and population to the General Directorate of Biostatistics. This information is 2 or 3

years old. Until 2 years ago, the General

Directorate of Coordinated Public Health Services in the States also received tabulations on

mortality, by state and municipality, from the

General Directorate of Statistics.

The General Directorate of Biostatistics published national and State data on the principal

causes of death by age group and sex. The

General Directorate of Coordinated Public

Health Services in the States also published State

data on the principal causes of death by age and

sex. It used to send each State a tabulation of

mortality by municipzdity, cause of death, age,

and sex.

The department of health of the Federal

District also publishes causes of death for the

Federal District. It takes these data from its

own tabulations of death certificates, which are

processed independently of the General Directorate of Statistics.

Communicable Diseases

All Department of Health and Welfare health

facilities (hospitals, health centers, and health

houses, as well as many facilities of the social

security institutes) notify, on a weekly basis, all

cases of illnesses that must be reported to the

Office of the Chief of Coordinated Services in

the States. These offices send reports to the

General Bureau of Epidemiology and Public

Health Research, Department of HeaIth and

Welfare, which in turn transmits the information

to the General Directorate of Biostatistics, Department of Health and Welfare, for processing,

analysis and publication. In some States the

Mexican Institute of Social Security does not

send information about communicable diseases

to the Department of Health and Welfare, but

publishes this information in the Boletz% Epidemiolbgico Mensual and the Boletin Epidemiohgz”co Anual. When this study was being prepared, the report for 1977 became available.6

43
The Health Code (Article 112) lists 78

illnesses that must be reported. In cases of

illnesses covered by the International Health

Regulations (cholera, yellow fever, plague, and

smallpox), and outbreaks of communicable diseases, the notification must be made immediately, by telephone, to the State and national

levels.

The States are now developing a new telex

communications system. This system would

furnish weekly reports to the General Directorate of Coordinated Services in the States. Cases

are published in the epidemiology bulletins of

the State, by jurisdiction. The General Directorate of Coordinated Services in the States is also

starting its own publication, a weekly national

bulletin with individual State coverage.

Human Health Resources

Currently a statistics system for human

resources in the health field does not exist.

Fragmentary information is available on the

resources of the health institutes. The estimates

are very gross (for example, Mexico has a total

of 45,000 physicians).

Institutional Health Resources

Complete information is available about the

number of health establishments (hospitals,

health centers, and health houses), and the

number of institutional beds. The facilities of

the. Department of Health and Welfare are

classified by level of complexity and services

provided. AU information is classified by State,

municipality, and locality. Information about

the health facilities of the social security institutes and other governmental institutes is published by each institute individually and very

often the information is old. Department of

Health and Welfare hospitals in the Federal

District (the Ju&ez Hospital, Women’s Hospital,

General Hospital, and others) publish yearbooks

containing data on resources, delivery of care,

and death rate.

As for the health facilities of the Department of Health and Welfare, this information

comes from the annual reports that each establishment prepares. These reports are processed

by the Coordinated Services in each State. The

General Directorate of Coordinated Public

Health Services in the States processes the

information at the national level and prepares

the catalogs for the individual establishments.

Morbidity of Hospital Inpatients

AU Department of Health and Welfare hospitals send to the General Directorate of Biostatistics their reports on hospital discharges. These

reports are processed every year at the national

level (latest information published for 1974).5

Each hospital prepares its own tabulations which

are processed at the State level.

Hospital Statistics on Bed Use

These reports provide the information

needed to tabulate total hospital releases, average stay, occupancy rate for the entire hospital,

and groups of causes. The data are processed for

each hospital establishment for each State, and

for the country as a whole. Once tabulated, the

information is published by the General Directorate of Biostatistics on an annual basis (latest

information published for 1974).5

Vaccination Statistics

Health facilities prepare reports on routine

vaccination programs and vaccination campaigns. The data are processed by health facility,

jurisdiction, and State. The individual State

reports go to the General Directorate of Biostatistics, through the Coordinated Public Health

Services in the States, for national level processing, along with information from the General

Directorate of Health of the Federal District.

Like the previous information, these data are

published by the General Directorate of Biostatistics in Estad&ticas Vitales de 10S Estados

Unidos Mexicanos. The latest information is for

1974.5

Health Care Statistics

Health facilities of the Department of Health

and Welfare prepare monthly reports on the

health care they deliver. These reports include

information on care of newborns, preschool

children, prenatal attention, school children,

dental care, home visits by health nurses, social

services, environmental sanitation, and other
subjects, depending on how sophisticated the

facility’s services are. Each type of facility

(health centers, health houses, and others) has

its own monthly report form.

This information is processed and analyzed

by facility, jurisdiction, and State, by type of

health establishment. The General Directorate of

Coordinated Public Health Services in the States

processes national information on a quarterly

basis.

EVALUATION

Certain information needs are not fully

satisfied by the types of vital statistics currently

available. There are many causes for this situation:

Delay in publication of statistics with respect to the best time that they could be

used. (In April 1977 the data being used

were for 1974. )

Large number of publications released by

different agencies containing statistics based

on the same raw data and showing, in some

cases, serious discrepancies.

Deficiencies in channek of communication.

Examples are the National Committee on

Vital Statistics, which has not met since its

establishment in 1975, and the earlier Committee on Demographic and Health Statistics, for which no information is available.

Lack of standards for analysis and use of

vital statistics by different agencies for their

own uses in forensic medicine, hospitals, and

health centers.

Out-of-date concepts, standards, definitions,

and classifications. Since 1973, only a few

isolated projects, a few of which were

financed by the United Nations Fund for

Population Activities, have been conducted

to modernize concepts, standards, procedures, and definitions in the area of vitaI

statistics. Plans and programs, as well as new

laws, exist to reorganize the entire national

information system.

Lack of programs to evaluate the quality and

coverage of vital statistics. At this time, the

fertiliti~ survey, which presumably will shed

some light on the quality of vital statistics, is

being processed. Likewise, under-registration

will be the subject of research by using the

sampling design of the General Directorate

for Statistics household survey. Also, the

coverage and quality of the civil registrar’s

office of the State of Neuvo Le6n is being

evaluated at this time. This evaluation will

make it possible to estimate the under-registration of births and deaths and the quality

of the vital statistics.

Births

Even though the civil codes of the States do

not differ substantially from the standards for

the Federal District, insufficient training and

instructions mean that the way that they are

applied varies from one State to the next and

this has an effect on coverage. For example, the

registration rates of some municipalities, the

period (longer than 40 days) for considering a

birth registration as delayed, the amount of the

fine, and the lack of a birth registration for

recently deceased newborns will all increase the

omissions and have an impact on birth and death

rates. At this time, the actual number of such

omissions is unknown.

The diversity of procedures that civil registrars use to enter data into the books and the

varying number of transcriptions made may lead

to errors, the magnitude of which also varies

from one municipality to another.

One component that acts systematically to

inflate the real number of births is the registration of birth after a reasonable length of time.

The amount of such registrations for the municipalities visited could be estimated at 22 percent.

Even though Form 821 can discriminate delayed

birth registrations, this is not possible on Form

6-56 (whose original and four copies are sent to

different agencies) because the latter form only

includes the total number of births, without

distinction as to year of occu~ence. The problem is also not resolved by segregating births

that occurred in previous years. The component

of omissions for the year in question is still

unknown and depends on many causes, which in

turn are different from one municipality to the

next.

45
One important factor as a generator of

duplications is the initiation of registration

campaigns that have no adequate control mechanism to avoid the registration of the same event

in two or more States. The activities of such

campaigns could perhaps explain the abnormal

behavior of time series for certain phenomena,

for example, the V-shaped curve of the number

of maternal deaths per 1,000 births (years

1970-76).

Another aspect that should be mentioned

here concerns the lack of information about the

characteristics and importance of vital statistics.

In the pilot programs of the General Directorate

for Statistics in Morelos, Tabasco, Chiapas, and

Puebla, the percent of civil registry officials who

understood the usefulness of statistics ranged

from 18.1 percent in Morelos to 35.4 percent in

Tabasco; the percent of those who understood

the concept of live birth ranged from 8.5

percent in Puebla to 91.2 percent in Chiapas.

In connection with the registry of births, we

may conclude that by eliminating the inflation

component due to delayed registration, the

principal problem lies with the coverage errors

(omissions and duplications) and the lack of

adequate training of the persons responsible for

the registration.

Deaths

The different criteria used by the various

public clerks working in civil registration offices

to transfer data from the death certificate to the

registration book lower the quality of death

statistics. Examples of these criteria are selecting

(in any order) the most legible causes of death,

omitting the duration of each cause, and completing, in some cases, Form 823 by using the

registration book.

Even though some omission and duplications

(for example, the case of moving the cadaver for

burial from one municipality to another resulting in a double registration) do occur,

omissions and duplications for deaths are not as

important as they are for births.

Another important aspect of errors of content is the high percent of registered deaths not

certified by a physician. Their magnitude ranges

from an estimated 71.5 percent in the State of

Oaxaca to 1.7 percent in the Federal District.

According to Mexican law, Certificates of Death

and Fetal Death cannot be issued by a physician

who is not from the same jurisdiction. The

existence in the Federal District of four times as

many physicians per thousand inhabitants as in

the rest of the country explains the large

difference between the percents just cited.

We reach, then, the conclusion that the

problem of death registrations centers around

errors of content.

Among the factors contributing to the poor

quality of statistics are:

In filling out the death certificate, the

official does not follow the correct order of

causes.

Poorly defined conditions are taken advantage of.

Some confusion exists about the concepts of

live birth and fetal death.

There are flaws in the Certificate of Death,

especially those for deaths from violent or

accidental causes.

Errors are committed in taking the data

from the Certificate and putting them in the

minute book resulting in omission of causes

when the person who performs this operation does not have a clear idea of the

importance of cause.

Errors of transcription occur in completing

Form 823.

Effectiveness of Function F1

The outputs of the system for the number of

births are not reliab2e because the coverage is

unknown; as to deaths, estimates are unreliable

because of errors committed about causes of

death and, with respect to fetaJ deaths, because

of faulty interpretations by registrars.

The outputs are not coherent; when different agencies tabulate results taken from identical

raw data, their results are different.

Finally, the outputs are not on time, as can

be seen by delays of more than 2 years.

Effectiveness of Function F2

It could be said at this time that the Fz

function is virtually nonexistent. It is regrettable

46

,
that the National Committee on Vital Statistics

has not met since its establishment in 1975. On

this committee are the General Directorate of

Coordinated Public Health Services in the States,

the Mexican Institute of Social Security, the

Institute of Social Security and Services for

State Workers, the Information System for

Economic and Social Planning, the Pan American Health Organization, the National Population Council, and the General Directorate of

Statistics.

In addition, a decree of March, 1956 notes

the existence of a National Demographic and

Health Statistics Committee, under the Department of Health and Welfare, whose purpose was

to implement World Health Organization recommendations. No legal antecedents for this committee have been found.

Health Statistics

The nature of the problems found in analyzing the vital statistics system–lack of timeliness, duplication of effort, incomplete coverage, low quality, absence of standards for

analysis and use, and the others mentioned-are

similar to those found in the analysis of the

health system. Listing them here, then, would be

an unnecessary repetition.

Nonetheless, it is wise to underscore the lack

of any regulatory body for the health statistics

system. Because this system is so fragmented

among many institutions, it must be coordinated

effectively to avoid a multiplicity of publications and to promote proper use of and demand

for statistics.

Problems Related to Education

The majority of medical professionals now

working in Mexico have little understanding of

how important health statistics are. Basically,

this translates into careless completion of death

certificates, medical records, and reports on

communicable diseases.

Today’s curricula of most medical students

in Mexico do not include health statistics

courses (the National Autonomous University

of Mexico prepares only 35 percent of all future

doctors in Mexico.) This means that many future professionals will have the same shortcomings in this area as have their predecessors.

Staff members of civil re~stration offices do

not understand the importance of their work.

This is reflected in deficiencies in registration,

especially of births and deaths.

The Department of Health and Welfare lacks

personnel skilled in health statistics and medical

records in its health facilities, State offices, and

central offices. This is due in part to skilled

persons transferring to work at decentralized or

private institutes that offer better pay.

EDUCATION AND TRAINING

PROGRAMS

Many institutions offering courses of varying

depth and length of training were found. They

offer courses to students of different academic

back~ounds who work, or hope to work, in

areas related to biomedical, demographic, and

public health statistics. These institutions can be

divided into two categories: educational institutes and noneducational agencies offering

courses in statistics.

Educational Institutes

School of Public Health of the

Department of Health and Welfare

Advanced courses.–Ten-month advanced

courses are offered for professionals holdin; a

master’s de~ee in public health or hospital

administration who work as health program

consultants or in teaching and research. The

courses offered are:

Advanced epidemiology.

Administration of medical care.

Public health administration.

Ten-month graduate courses are c~ffercd for

those with degrees in biomedical and social

sciences who perform executive, adviso~, and

teaching research functions in public health. The

courses offered are:

Master’s degree prosram in public health.

Master’s de,gree program in hospital administration.

47
Other specific courses for medical and administrative professionals are:

A 5-month health planning course, for staff

members perf~rming executive and advisory

functions in health planning.

A 3-month health services administration

course, for personnel who manage local

health services and programs.

A common objective of these seven advanced courses is that the student learns to make

proper use of data such as natality, general and

specific mortality, and population projections,

as well as morbidity statistics, and in turn either

directly or indirectly improves the quality and

use of morbidity and health resources statistics

and employs them in project evaluation.

Other courses.–The School of Public Health

offers a 1%-month course for professionals and

high level technicians responsible for planning

and management, and. the administration of

family planning programs. The graduates are

expected to know how to use data on natality,

marriage, and infant mortality, and to produce

data on the scope of programs and their effectiveness.

Since 1976, a 10-month undergraduate program at the bachelor level has been offered.

Statistics in public health is for personnel, who

will be responsible for activities involving regional or national statistics related to health

services.

Since 1955, a course for secondary school

graduates has been offered to more than 25

students a year. Its duration has fluctuated

between 5 and 10 months. At this time the

course lasts 5 months. The course, technician in

applied public health statistics, is for individwils

who will be working ivith local and regional

health statistics.

In addition, short field training courses of

varying durations are offered to staff members

of health institutions.

The purpose of these courses is to enable

course graduates to become part of a health

team working primarily in the areas of gathering

and preparing health statistics and medical

records.

Department of Social Medicine,

Preventive Mediciner and Public

Health, National Autonomous

University of Mexico

An 18-month master’s degree program in

biostatistics is offered to university graduates

(licentiates) of any profession who hope to work

in advisory assistance for public heaIth agencies

and statistical analysis of data for planning,

control, and evaluation; design and analysis of

health research; improvement of statistics systems and training of technical or intermediary

personnel in statistics. The purpose here is to

train medical and nonmedical professionals to

perform executive functions in health statistics

systems and departments by offering basic

training in preventive and social medicine and

public health prior to specializing in biostatistics.

A l-month special course in biostatistics is

given once a year to medical school graduates.

The purpose is to train medical professionals in

management and descriptive analysis of data

taken from clinical and public health research.

Medical school students study 20 hours of

basic statistics in a course entided “preventive

social and public health medicine,” which offers

concepts about medical records, data processing,

and data description.

Center for Economic and

Demographic Studies,

El Colegio de M4xico

A master’s degree in demography is offered

to university graduates who wish to specialize in

analysis of demographic phenomena related to

processes of social change. It is expected that

graduates will be able to use vital statistics and

contribute to the production of population data,

especially on birth and fertility rates.

Other University Institutions

Some schools of medicine, such as Zaragoza

and Guadalajara, offer a certain number of class

hours (10 - 20) in health statistics as part of their

undergraduate program in medicine. Other

schools have health professionals teach such

courses because if they are taught by engineering

48
or economics personnel, the medical students

might not appreciate the bearing that statistics

has on their own training. Generally speaking,

most schools of medicine in Mexico offer no

training in statistics to their students.

Training Programs

General Directorate of Statistics,

Department of Programming

and Budget

Training courses of varying durations are

available to staff members of the Directorate

itself, and of the Department of Health and

Welfare and decentralized institutes.

A 4-month intensive course in demography

has been offered every other year since 19T4.““

This course enables course graduates to participate in demographic evaluation and analysis

and to improve the data included in integrated

systems or general or specific surveys.

A l-month course on classifications of

causes of death in accordance with the International Classification of Diseases has been given

annually since 1974. The fundamental objective

of this course is to train students how to

identify the basic cause of death, starting with

the death certificate, and to improve the quality

of mortality reporting.

General Directorate of Coordinated

Public Health Sewices in the States

A 2-month course for statistical auxiliaries

of Health Facilities offers in-service training to

staff members who work with medical records

to develop communicable disease and hospital

statistics.

Off ice of the Chief of Preventive

Medicine Services, Mexican Institute

of Social Security

This Office offers courses of varying durations covering medical statistics and health

administration for professionals employed at the

different health facilities of the institute. Among

these are:

A course for newly hired epidemiologists.

A course for staff members of the Office of

the Chief of Preventive Medicine Services.

Training for students in preventive medicine

and nursing.

A 90-hour course in statistics and medical

coding.

An 80-hour course for coders.

A 45-hour refresher course in statistics.

A course in social medicine, in coordination

with the National Autonomous University of

Mexico.

Office of the Chief of Teaching,

Institute of Social security and

servicesfor State Workers

This office offers intensive courses in statistics for medical research. The courses are open

to resident physicians and last 1 week.

49
REFERENCES

1General Office of Statistics: Demographic picture

1960-1973. Vital Statistics. Series I-No. 1. Mexico City.

General Office of Statistics, Secretary of Industryamd

Commerce, Dec. 1975.

2General Office of Statistics: Analysis of the systems of information of natality and mortality that

operate in Latin America 1975. EvaIuatt”onand Analysis

Series 111-No. 4. Mexico Chy. General Office of Statistics, Secretary of Industry and Commerce, Sept. 1976.

3Department of Programming and Budget: Gz&&-

lines for the Implementation of the National Infomnation System in the Health and Soctkl Security Sector.

Mexico City. Department of Programming and Budget,

Office of the General Coordinator of the National

Information System, Jan. 1978. Draft.

4Commu&cation from the Director. General of

Design and Implementation of the National Information

System of SPP (the Department of Programming and

Budget), Mexico City, Dec. 1978.

6Deptiment of Health and Social Welfare: V{tUf

StatiWicsfor the UnitedStatesof Mmico 1974. Mexico

City. Department of Health and Social Welfare, General

Diictorate of BIOStfLtiStiCS, 1976.

6kfexican Institute of Social Security: Annual ifpidenaidogical Report. Mexico Chy. Mexican Institute of

Social Security, 1977.
APPENDIX

CONTENTS

Forms

Reproduction of Affidavit of Birth (Trmslated) ................................................................................. 52

Reproduction of Medical Certification of Death (Translated) ............................................................. 53

51
APPENDIX

Reproduction of Affidavit of Birth (Translated)

No.

IN THE NAME OF THE MEXICAN REPUBLIC AND AS JUDGE OF THE CIVIL REGISTRY OF THIS

PLACE, I CERTIFY THAT IN THE VOLUME ........ ...... .. .... OF THE CIVIL REGISTRY, WHICH IS IN MY

CHARGE, ON PAGE ..... .... . IS TO BE FOUND AN AFFIDAVIT OF THE FOLLOWING NATURE

AFFIDAVIT OF BIRTH

:

In .................................................., Federal District, at .......ltir.~ . .............. on the ,....ij~..j... of ............... of nineteen hundred

(month)

....~.~j ........ before me .............i~.rn~j ................. Judge of the Civil Registry, appears ........................................ presenting

(name of declarant)

......... ........... the child* .,, .....+............................... who wits botn at .................................................. of the

(Iivc or dead) (name)

................... of,,..,.,,,,

(time - written out) (day) (month

.. ......................... ............. an..,...,., ............................................. ........................... ............

snd year - written out) (place)

PARENTS

Names:

Age:

Occupation:

Nationahty:

Residence:

1

PATERNAL GRANDPARENTS

I

Names:

Residence: I

MATERNAL GRANDPARENTS

1

Names:

Residence: II

WITNESSES

Names:

Age:

Occupation:

Residence:

I

The witnesses declare that ...................................................................i,., ,,,.,., ,...’........,..,..,,.,,..,.,..,, ....................,.....................

(the parent or parents)

of .................................................. presented .......... of b..,..,.........................s.................

(child*) (srelis)

nationality and the declarant who has

his/her domicile at .................................................................,, ....................................................................................... ................

Havingread this affidavit they do approve and affum that they concur.

Annotations. . ........................................................................................................................................... ................................... .....

*The rex of the infant is indicated only by the word used for “child”; i.e., nifio = male child, rdiia = female child.

52
Reproduction of Medical Certification of Death (Translated)

FRONT

SECRETARIAT OF HEALTH AND WELFARE OF THE

STATES OF MEXICO

MEDICAL CERTIFICATE OF DEATH

UNITED

prior to completing the certflcate read the instructions on the back.

A. DATA OF THE DECEASED.

Name.–

Place and date of death.–

Sex,– Age.- Marital Status,–

Nationality.– Habitual occupation.–

Habitual Residence.–

Father’s name Living?

Mother’s name Living?

Spouse’s name Living?

B. DATA OF THE DEATH:

place, date and hour occurred:

CAUSES Approximate interval

, between the onset of

I

Ithe sic~ess ad cleat]

Sickness or other cause directly producing the death (a) I

Sickness or other cause underlying the direct cause (b) I

Other previous pathological conditions related to the (c)

sickness producing death I

H

I

Other pathological conditions that were I

not related to the principal or basic sickness I

C. DATA ON THE DEATH FROM VIOLENT OR ACCIDENTAL CAUSES

place, date and hour in which occurred

Suicide

Homicide

Accident

Did it occur during a work situation?

D. DATA ON THE CERTIFYING DOCTOR

Name

Health and Welfare Secretariat registration number

Department of Professions I.D. card number

Residence and telephone number

Did the certifying doctor attend the deceased during the last illness?

Place and date certified

Signature of certifying doctor

E, DATA ON THE DECLARANT GIVING NON-MEDICAL INFORMATION

Name

Residence

Signature or finger prints
Chapter Ill

Civil Registration and the

Collection of Vital Statistics

in the Philippines

Dr. Joan Lingner, Adriaaa C. Regudo, and Dr. Alain Vessereau

World Health Organization Study Mission to the Philippines

February 21-March 13, 1977
CONTENTS

Introduction ............................................................................................................................................. 59

Gcnerd Information ............................................................................................................................ 59

Mstoricfl Bac&ound ......................................................................................................................... 60

Or@nization ............................................................................................................................................. 62

National hvel ..................................................................................................................................... 62

Locaf Level ........................................................................................................................... ............... 63

Registration ..............................................................................................................................................

Forms for Registration and Certification ............................i................................................................

Witnesses .............................................................................................................................................

Delayed Registration ...........................................................................................................................

Fees for Registration of Events .........................................................................................................

Certified Copies ...................................................................................................................................

Burial Petits ......................................................................................................................................

Special Problems ..................................................................................................................................

Locaf Registers ....................................................................................................................................

Local CM Registrar ............................................................................................................................

Vital Records .......................................................................................................................................

64

64

65

66

66

67

67

68

68

69

71

72

Utifimtion of Statistics Denvedfiom tie~til Re@stmtion System ........................................................ 74

Depmtment of Hedfi.;.{ ..................................................................................................................... 74

Poptiation Projections ......................................................................................................................... 75

Utilization oftiti Re@st~Records ......................................................................................................... 76

Certificate of Live Birth ...................................................................................................................... 76

Certificate of Death ............................................................................................................................. 76

Certificate of Fetaf Death or Stillbirth ................................................................................................. 76

Marriage Contract ................................................................................................................................ 76

Ev&uation ................................................................................................................................................. 77

Re@stmtion Completeness ................................................................................................................... 77

Assessment of Vlti Rates .................................................................................................................... 77

The POPCOM/NCSO Project ............................................................................................................... 77

Cause-of-Death Statistics ..................................................................................................................... 78

Factors of Underregistration ............................................................................................................... 78

Remedies of Underregistration ................................................................................................................. 79

.

The Administration ............................................................................................................................. 79

LOcaf Level ..................................................................................................................................... ..... 79

population kveI .................................................................................................................................. 80

References ................................................................................................................................................ 80

Appendix: Fores ..................................................................................................................................... 81

9

57
CHAPTER Ill

CIVIL REGISTRATIONAND THE COLLECTION

I VITAL STATISTICS IN THE PHILIPPINES

Dr. Joan Lingner, Adriana C. Regudo, and Dr. Alain Vessereau

INTRODUCTION

General Information

The Philippine Islands, consisting of about

1,100 islands and islets, extend about 1,100

miles north to south along the southeastern rim

of Asia. The Philippines are scpatated from the

Republic of Chini- (Taiwan) on the north and

Malaysia and Indonesia o,n the south by straits a

few miles wide and from Vi@-Nam and mainland China on the west by the 600-mile breadth

of the South China Sea. The total land area is

about 115,707 square miles. Quezon City, near

Manila, was declared the capital in 1948, but

most govcrnmtmt activities remain in Manila.

The Philippine Islands lie within the tropics.

T.hc lowland areas have a year-round warm and

humid climate with only slight variations in the

average mean temperature of 80° F. Rainfall is

generally adequate, but varies from place to

place bccausc of wind directions and the shielding effects of the mountains, The average annual

rainfall in Manila is 82 inches, The wet season in

the Manila area begins in June and ends in November. The country lies astride the typhoon

belt and an averam if 15 of these storms hit the

Philippines annu~ly. A number of active volcanoes exist, and the islands arc subject to destructive earthquakes.

In the Iatc 1960’s about 40,000 miles of

roads existed, about half of them were firstgrade. The railways, of the narrow-gauge type,

tie over 700 miles in length. More th-m 240,000

telephones were in use in the late 1960’s; of

these, about 60 percent were in Manila. Telegrams usually replace long-distance telephone

calls. The islands have a network of 160 radio

and 7 television stations. In 1965, 1.5 million

radio sets and nearly 100,000 television sets

were in operation. Local interiskmd trade to

more than 200 ports is handled by over 6,000

vessels.

The population of the Philippines is about

46.2 million (1979 estimate). Manila has over 3

million and Quezon City has over Y2 million

people.

The population is predomin~tly of Malay

stock, descended from Indonesians and Malays

who migrated to the islands centuries ‘ago. The

most significant alien ethnic group is the

Chinese, who have played an import~t role in

commerce at least since the ninth centtu-y when

they first came to the islands to trade, As a result of intermarriage, many Filipinos have partial

Chinese ancestry. Americans and Spaniards constitute the next largest alien minorities.

Eighty-seven native languages and dialects,

all belonging to the Malayo-Polynesian linguistic

family, are spoken, but eight of these are the

mother tongue of more than 86 percent of the

‘population. Filipino, English, and Spanish are

the official languages. Since 1939, in an effort

to develop national unity, the Government has

59
promoted the use of the national language–

Filipino. Filipino is taught in all schools and is

...... . .

gammg increasing acceptance, particularly as a

second language. English, the most important

non-native language in the Philippines, is used as

a second language by about 40 percent of the

population and is the universal language of professional people, education, and government.

Spanish is spoken by less than one million

people, largely of the social elite, and its use

appears to be decreasing. Despite the multiplicity of languages, the Filipinos have one of the

highest literacy rates in the East Asian and

Pacific areas.

Historical Background

The earliest systematic recording of births

and deaths in the Philippines was that in church

registers of baptisms, marriages, and burials.

l%ese records, which were required by the

Catholic Church, have largely disappeared except for the period 1876-98. Although geographic coverage of the registers is fragmentary,

birth reporting within the areas for which

records exist must have been rather complete .

judging from the relatively high birth rates that

have been estimated from these data. Birth rates

ranged from 51.7 per thousand population

(1887) to 43.2 in 1890 and death rates from

58.2 in 1889 to 26.2 in 1887.

Civil registration was briefly established in

1889 when the Civil Code of Spain was effectuated in the Philippines, only to be rescinded

within a month by order of the GovernorGeneral.

“However, at about the same time, the

Centr6 Estadistica (Central Office of Statistics) was created as a dependency-of the Direccfon General de Administracfon Civil

(Bureau of Civil Administration). Under this

new setup, the parish priests were required

to send to the Central Office of Statistics in

Manila, a detailed statement of the births,

marriages, and deaths that had occurred in

their respective parishes during the year immediately preceding their reports. Registration of births included the name and sex

of the child and the place of birth. The marriage register covered the full names of the

contracting parties, their ages, sexes, races,

and birthplaces, and any remarks pertinent

to the information given. Death records indicated the name, age, sex, and place of birth

of the decedent. Thus, the organization of

this Central Office of Statistics marked the

beginning of the scientific treatment of vital

statistics in the Philippines.” (p. 11)

The first central statistics office was staffed

by one chief, one chief clerk, and three assistants.

Beginning in 1898, a decree of the revolutionary government established a completely

secularized civil registration system in towns

under the control of the independent government. “Vital events were then registered under

the Office of the Justice and Civil Registration.

The Chief of this office was assisted by an

elected delegate of the people, who in turn prepared the record book of births, deaths and marriages and the census.” (p. 1592 ) During the era

of American colonial government, the Philippine

Commission’s Act. No. 82 (1901) provided that

each municipal secretary maintain civil registers.

The Bureau of Archives, also created in 1901,

was given “care and custody” of certain public

records. In 1922, the Bureau of Archives was

incorporated as a division of the National

Library (Act No. 3022). At that time, municipal

secretaries were required to submit quarterly reports on registration matters to the Chief of the

Division of Archives. These regulations marked

the beginning of centralization of civil registration. The 1930 Civil Registry Law (Act No.

3753 ), which continues in force as the basis for

civil registration, orginally named the Director

of the National Library as Civil RegistrarGeneral, although this has since been amended.

The Bureau of Census and Statistics was

created by Commonwealth Act No. 591 in

1940. The functions of the Division of Archives

(National Library) and of the Vital Statistics

Section (Bureau of Health) were transferred to

the Bureau of Statistics, now known as the

National Census and Statistics Office. At present, the Executive Director of the National Census and Statistics Office is ex-officio Civil

&l
Registrar-General. Outside of chartered cities’

local civil registrars are the municipal treasurers,

who are civil service employees responsible to

the Department of Finance, or their duly appointed assistants. Within chartered cities, city

health officers or city secretaries serve in this

capacity. Both groups of officials serve the civil

registry in an ex-officio capacity, without extra

compensation for the addition to their ordinary

duties.

Until 1974, the Department of Health also

collected information on natalit y and mortality,

as well as morbidity, through the national network of city and municipal health officers. In

recent years, however, the National Census and

Statistics Office has assumed exclusive responsibility for the collection of birth and death statistics; analysis of these data, as well as collection

of morbidity data and other types of morbidity

studies, continues to be a responsibility of the

Department of Health.

The legal basis for civil rep>tration.–As previously noted, the 1930 Civil Registry Law (Act

No. 3753 ) continues in force as the basic legislation pertaining to civil registration. This law lists

the types of events and changes in status which

are to be included in the civil registers; specifies

the information to be collected about each

event; and designates responsibilities for declarations, registrations, and certificates. The Civil

Registry Law also contains provisions for fees

for registration and for copies of certificates and

for penalties for violation of the Act.

The general provisions of the Civil Registry

Law are reiterated in the New Civil Code of the

\

a“Cities” are corporate political bodies endowed

with the attributes of perpetual succession and possessed

with powers which pertain to municipal corporation to

be exercised by them in conformity with the provisions

of their respective charter. Each city, unlike municipalities which are created under a general law, is created by

a special law known as the city’s charter passed by the

National Assembly.

As of 197.3, there were 61 chartered cities in the

Philippines (pp. 57-621 ).

b“Municipalities” are subdivisions of provinces.

These units of local government are political ‘corporate

bodies and as such they are endowed with the faculties

of municipal corporations. The municipal treasureris appointed by the provincial treasurer.

Philippines. Book I, Title III of the Code specifies the laws pertaining to marriage, including

issuance of marriage licenses, authority to solemnize marriages, and registration of marriage contracts.

More recently (1975) Presidential Decrees

No. 651 and No. 766 were issued. These decrees

were intended to strengthen existing laws on

registration of births and deaths.

Essential features of these decrees are:

The compulsory registration of births and

deaths that occurred from January 1, 1974

and thereafter.

The requirement for proof of birth registration as a prerequisite for school enrollment

and allowance of tax exemption for dependents under the National Internal Revenue

Code.

The responsibility of barrioc captain and

barangayd chairman for assisting in the registration of births and deaths. Presidential Decree No. 651 specifically provides for the

registration of all births and deaths occurring

after January 1, 1974, within a period of 60

days after the date it became effective. Thk

reporting period, extended by Presidential

Decree No. 766 to December 31, 1975, has

subsequently been extended to December

31, 1977.

The legislation concerning civil registration

and vital statistics has been reinforced and

amplified by a series of implementing rules and

regulations (Administrative Order No. 1/1975

and Administrative Order No. 2/1975).

The Civil Registry Law’s penal provisions

state also that failure to report any event that

CJ4B~&” are units of the municipalities or municipal districts in which they are situated. They are quasimunicipal corporations endowed with such powers as are

necessary for the performance of particular governmentalfunctions. The barrio captain is elected at a meeting

of the barrio assembly.

d’%a.mngays” are the citizen assemblies in barrios,

city districts, and wards. They are now the instrumentalities from which statistics and announcements are

coursed through. Thirty-five thousand barangays have

been organized.

61
affects the status of a person is punishable under

the law. Any person who shall knowingly fail to

report or who makes a false statement in the

preparation of certificates presented for registration in the civil registers shall be meted out the

corresponding punishment for such acts.

ORGANIZATION

National Level

As noted previously, the Civil RegistrarGeneral is an ex-officio position of the Executive Director of the National Census and Statistics Office. The Director also serves as Deputy

Director General of the National Economic and

Development Authority for the Statistical Coordination Office.

The Statistical Advisory Board, the committee charged with the responsiblity for recommending statistical policy, is also attached to the

National Economic and Development Authority.

This Board which is chaired by the Director of

the National Census and Statistics Office coordinates the activities of 18 interagency committees for coordination of statistical activities in

specific areas. Formerly, vital statistics fell in the

province of the Interagency Committee on

Health and Social Service. However, because the

National Census and Statistics Office presently

has sole authority to collect vital statistics data,

and because vital records and statistics have implications broader than health and social services, it appears likely that one of the other interagency committees, possibly that of population

and housing, will assume responsibility for vital

statistics in the future.

Responsibilities -of the Civil Regi>tra&Gen- ,

eral.–The duties and responsibilities of the Civil

Registrar-General are embodied in the Civil

Registry Law (Act No. 3753) of 1930 as follows:

“SECTION 2. Civil Registrar-General: His

duties and Powers–The Director of the National Library shall be Civil Registrar-General and shall enforce the provisions of this

Act. The Director of the National Library, in

his capacity as Civil Registrar-General, is

hereby authorized to prepare and issue, with

approval of the Secretary of Justice, regulations for carrying out the purposes of this

Act, and to prepare and order printed the

necessary forms for its proper compliance.

In the exercise of his functions as Civil

Registrar-General, the Director of the National Library shall have the power to give

orders and instructions to the local civil

registrars with reference to the performance

of their duties as such. It shall be the duty of

the Director of the National Library to report any violation of the provisions of this

Act and all irregularities, negligence or incompetency on the part of the officers desig

nated as local civil registrars to the (Chief of

the Executive Bureau or the Director of the

Non-Christian Tribes) Secretary of the Interior, as the case may be, who shall take the

proper disciplinary action against the offenders.”

As previously noted, the Office of the Civil

Registrar-General was subsequently transferred

to the Director of the Bureau of the Census and

Statistics and presently to the Executive Director of the National Census and Statistics Office.

Responsibility for the compilation and

analysis of the data from the civil registrarsand

for the production of vital statistics and other

types of analysis does not seem to have an explicit basis in law, but rather appears to fall

within the general provisions of Commonwealth

Act No. 591 which directs the Bureau of the

Census and Statistics to “compile and classify all

such statistical data and information and to publish the same for the use of the Government and

the people.” At present, there appears to be a

working agreement between the National Census

and Statistical Office and the Department of

Health such that the National Census and Statistical Office compiles, tabulates, and publishes

the raw data from the civil registration system,

and further analyses, including rate calculation,

are carried out by the Department of Health.

The Civil Regi>try and Vital Statistics Division of the National Census and Statistical Offlee.-The Civil Registry and Vital Statistics

Division includes 59 regular staff members as

well as 80-100 temporary workers.

Although the Civil Registry is functionally

within the Population and Housing Branch of

the National Census and Household Surveys Department, it is administratively responsible to

the Executive Dkector of the National Census

62
and Statistical Office in his capacity as Civil

Registrar-General.

Training activities of the National Census

and Statistical Office. —The National Census and

Statistical Office has attempted to upgrade registration performance. The recently revised Manual on Civil Registration,1 quoted frequently in

this chapter, has been circulated to local civil

registration offices. The regional-provincial-local

network of National Census and Statistical Office workers has been used to conduct seminars

and workshops on civil registration. Regional officers are responsible for providing training to

provincial National Census and Statistical Office

staff who, in turn, train local civil registrars.

These seminars and workshops are paid for out

of city or municipal funds. Rapid turnover of

personnel at the local level was cited as a problem hampering the effectiveness of these training

efforts.

‘Ihe National Census and Statistical Office

has also sponsored or cosponsored national seminars on civil registration. A recent seminar was

held in Manila on April 17-18, 1975, and was

apparently conducted as a result of a suggestion

made by the City Health Officers Association (p.

183). Approximately 100 local civil registrars

participated in this seminar. .

Local Level

Although the legal basis for civil registration

is established by national law and the production

df vital statistics requires aggregated data, implementation of civil registration is primarily a local

affair. For this reason, the activities undertaken

at the local level will be comprehensively depicted.

Local civil registrars. –Local civil registrars

represent the legal authority of the Government

in the field of vital registration. They are the

treasurers of the regular municipalities and municipal districts and in cases of chartered cities

they are the city health officers or other persons

designated by the city charter.

In some chartered cities, the position of

deputy local civil registrar is provided to assist

the local civil registrar. The local civil registrars

of municipalities and municipal districts are permitted to designate assistant local civil registrars

from among their senior employees or the principal clerk of their offices. Local civil registrars

and their assistantsand deputies serve under the

direction and supervision of the Civil RegistrarGeneral. Altogether there are slightly more than

1,500 local civil registrars.

Duties of local civil registrarsare specified in

Section 12 of the Civil Registry Law (Act No.

3753 ) and described as follows in the Administrative Order No. 1/1975 governing the application and enforcement of the Civil Registry Law::

“Rule 3. Local Civil Registrars shall: (a) ac- “

cept all registrable documents including

judicial decrees affecting the civil status of

persons; (b) transcribe and enter immediately upon receipt all registrable documents and

judicial decrees affecting the civil status of

persons in the appropriate civil register; (c)

send to the Office of the Civil RegistrarGeneral, within the first ten days of each

month, duplicate copies of all documents

registered during the preceding month; (d)

issue certified transcripts or xerox copies of

any certificates or documents registered, upon payment of the prescribed fees; (e) classify and bind all registry certificates or documents; (f) index the registered certificates or

documents to facilitate verification of any

documents; (g) administer oaths free of

charge for civil registration purpose; and (h)

perform such other duties as may be necessary in connection with civil registration.”

Civil Register Books

“Rule 4. Every Local Civil Registrar shall

file, keep and preserve in a secured place in

his office the following” books, in which he

shall make the proper entries affecting the

civil status of persons

(a) Register of births;

(b) Register of deaths;

(c) Register of marriages;

(d) Register of annulment of marriages;

(e) Register of void marriages;

(f) Register of legal separations;

(g) Reg!ster of legitimation;

(h) Regyster of acknowledgements;

(i) Register of adoptions;

(j) Register of changes of names;

(k) Register of naturalizations;

(1) Register of elections of Philippine citizenship;

83
by

64

(m) Register of repatriations;

(n) Re@ter of ci~il interdictions;

(o) Register of judicial determinations of

filiation;

(p) Register of voluntary emancipation of

minors; and other registers which may

be required by law or by the Civil Registrar-General.” (p. 791)

(See also “Local Registers,” this chapter.)

Some amplification of these rules is provided

the text of the Manual of Civil Regz”stration:

“The Local Civil Registrar as a representative

of the Civil Registrar-General is responsible

for the civil registration program in his city/

municipality. He shall be knowledgeable of

the Civil Registry, pertinent Books and

Titles of the New Civil Code, Presidential decree No. 651, Administrative Order No. 1,

Series 1975, and all other pertinent provisions of the Law that has direct bearing on

the civil registration matters.

“He shall routinely carry out the duties and

responsibilities listed in the pertinent laws,

revised rules and regulations governing the

application and enforcement of the Civil

Registry Law, Act No. 3753, in the light of

Presidential decree No. 651 as incorporated

in Administrative Order No. 1, Series 1975.

“He shall publicize his office as well as the

obligations of the public, in such a way as to

obtain complete and prompt registration.

“He must examine the records presented to

him for registration and critically review all

certificates for completeness, legibility and

accuracy.

“Example: Check spelling of names, check

date, and signatures, etc. He shall sign and

date all certificates when he accepts them

for filing. He shall maintain useable file of all

records and keep up-to-date the posting entries in the corresponding Civil Registrars.

“He shall collaborate with regional/provincial/municipal census officers of the NCSO

[National Census and Statistics Office]., as

the case may be in conducting educational

campaign for improving the level of registration to implement fully Presidential decree

No. 651.” (p. 51)

Under Section 18 of the Civil Registry Law

(Act. No. 3753),

“Any local Civil Registrar who fails properly

to perform his duties in accordance with the

provisions of this Act and of the regulation

issued hereunder, shall be punished, for the

first offense, by an administrative fine in a

sum equal to his salary for not less than fifteen days nor more than three months, and

for a second or repeated offense, by removal

from the service.”

It should perhaps be reemphasized here that

all local civil registrars serve in an ex-officio

capacity and receive no compensation for their

registration responsibilities. Municipal treasurers

are administratively responsible to the Secretary

of Finance and Health, officers to the Secretary

of Health. The requests for sanction have to be

addressed to the appropriate authorities and are

practically never implemented.

REGISTRATION

Forms for Registration and Certification

Forms for certifying and registering births,

deaths, fetal deaths, and marriage contracts

(municipal Forms No. 102; 103; p. 31, 103-A;

and 97) are printed by the Bureau of Printing.

The responsibility for acquiring and maintaining

these forms is as follows:

“It is the responsibility of the Local Civil

Registrar to have sufficient supply of printed

forms available; namely, Municipal Form

No. 102, Certificate of Livebirth; No. 103,

Certificate of Death; No. 103-A, Certificate

of Foetal Death; and No. 97, Marriage Contract. Public hospitals, since they do not

charge extra cost for providing blank certificates, are to be supplied by the local government where the hospital is located. Private

hospitals/clinics should provide their own

forms.

“Purchase of these standard forms is the

function of the provincial treasurer and

requisitions may be coursed through the Office of the Provincial Treasurer. However,

direct orders to the Bureau of Printing may

be done provided a money order covering

the requisition is attached to the Requisition
Issue Voucher (RIV). Funds for such ‘purchase are paid by the Local/City Government conceme”d.

“The purchase of these standard forms’ from

private printers is prohibited by law (Circular No. 3, Series 1973, dated February 12,

1973*” (p. 431 )

Although local governments are expected to

pay for these forms from local funds, recent

National Census and Statistical Office policy has

been to supply forms (specially marked “Not for

%lc”) to localities that are unable to purchase

them. The cost of the standard forms is approximately 10-12 centavos per copy (about

$0.13-$0,16); because each ‘certifiable event

must be reported in triplicate ,e the forms for

each registration cost approximately 35 centavos

(about $0.48).

Standard forms for other types of civil registrations are not printed centrally. However,

model forms for certifying and registering

foundlings, and registration of repatriations,

election of Philippines citizenship, naturalization, legitimation, adoption, acknowledgments

of natural children, and changes of names are

movided to serve as exarrmles for forms ~ro-

~uced locally. (p. 431) A

.

Informant

As a general rule, every vital event should be

registered in the office of the local civil registrar

of the city or municipality where the event occurred.

The requirements for informants differ according to the type of event, place of occurrence,

and other contingencies. These may be briefly

summarized as follows:

Bz’rth.-Presidential Decree No. 651 states:

“Babies born after the effectivity of this decree must be registered in the office of the

local civil registrar of the Rlace of birth within thirty (30~ davs after b{rth, bv the attend-

,. .,

ing phy’si~ian, nurse, midwife, hilot,f or hoscAlthough the forms are marked “Complete in

duplicate,” triplicate forms seem to be completed in

practice.Theoriginal copy goes to the parents, survivors,

or married couple; one copy is retained for the local

register; the other is forwarded to the office of the Civil

Registrar-General.

fA hilot is the t~adition~ fid~f~.

pit~ or clinic administrator or, in default of

the same, by either parent or a responsible

member of the family or any person who has

knowledge of the birth.

“The parents or the responsible member of

the family and the attendant at birth or the

hospital or clinic administrator referred to

above shall be jointly liable in case they fail

to register the new born child. If there was

no attendant at birth, or if the child was not

born in hospital or maternity clinic, then the

parents or the responsible member of the

family alone shall be primarily liable in case

of failure to register the new born child.”

A slightly different formation of liability is

given in the Administrative Order No. 2/1975

governing the application and enforcement of

Presidential Decree No. 651:

“Rule 8. The physician, nurse, midwife or

hilot in attendant at birth, the administrator

of the hospital or clinic where the child was

born, the parents or a responsible member of

the family are jointly liable for failure to

register the child as required by this decree.

In default of any person in attendance, the

parents shall be primarily liable for such failure.”

Thus it appears clear that the responsibility

for births in hospitals or clinics is jointly shared

by birth attendants, hospital administrators, parents, and other family members. In 1974, 23.7

percent of reported births occurred in hospitals.

The unattended home deliveries must be reported by parents or others having knowledge of

the birth. Approximately 13.3 percent of registered birth certificates indicated that the birth

attendant was other than a physician, nurse,

midwife, or traditional midwife (hilot) or failed

to state an attendant at birth. Some ambiguity

occurs, however, fixing the responsibilityy for

birth registration in the case of attended home

deliveries, which appear to contribute nearly

three-quarters of all deliveries. This ambiguity is

further compounded by the anomalous status of

hilots. A few Provinces have established Iicensure procedures for hilots and this was

thought to have beneficial effects on the completeness of registration.

65
Deaths. –Referring to deaths occurring after

its effective date,’ Presidential Decree No. 651

states:

““Deaths occurring after the effectivity of

this decree must be reported by the nearest

responsible relative or apy person who has

knowledge of the death within 48 hours

after death to the Local Health Officer of

the place of death; who shall then issue the

corresponding certificate of death and order

its registration in the office of the local civil

registrar within thirty (30) days after death.

In case the deceased was attended by a

physician the latter must issue the necessary

certificate of death within 48 hours after

death and submit the same to the local

health officer of the place of death, who

shall order its registration in the office of the

local civil registrar within the said period of

thirty (30) days after death.”

Perhaps the most important point to be

noted regarding death is that certification is the

responsibility of the attending physician or local

health officer; the local civil registrar is responsible for registration, but not certification, of

deaths. Slightly more than one-third of reported

deaths in 1974 were either not medically attended or attendance was not stated. Both the

Civil Registry Act and the implementing rules

and regulations prohibit burial in the absence of

a death certificate.

Fetal and infant deaths.–

Fetus born dead at any stage of gestation–a

Certificate of Fetal Death is issued for statistical purpose.

Liveborn fetus of less than 7 months’ gestation who dies within 24 hours of birth-a

Certificate of I-he Birth and a Certificate of

Death are issued, each of them bearing the

mention “for statistical purposes only.”

.The Civil-Registry Law does not provide for

a register for fetal deaths.

A4amiages.-L0cal civil registrars ire responsible for issuing marriage licenses as well as for

registering marriage contracts. Applications for

marriage licenses require that the contracting

parties swear that they have the necessary quahfications for contracting marriage. Additional requirements are proof of age through birth or

baptismal certificates or testimony of parents or

by affidavit. Males under age 20 and females under age 18 must further furnish proof of consent

of parents. Males between the ages of 20 and 25

and females between the ages of 18 and 23 are

required to ask parents or guardians for advice

upon the marriage; in the event such advice is

not given or is unfavorable, the marriage must be

delayed for 3 months after the application for

license. Widowed and divorced persons are required to present death certificates of the deceased spouse or divorce decrees. If the birth

certificate cannot be found, an affidavit is accepted. Notice of the application for a marriage

license must be posted for 10 days before the

license is issued. Licenses can be issued by the

local registrar of the municipality where either

party resides. Marriage licenses can be waived for

“marriages of exceptional character” which are

defined on the basis of distance between the

bride’s house and the municipal building or if

one of the contracting parties is on point of

death, or in solemnization of common law

unions of 5 or more years’ duration.

The marriage contract requires signature by

the contracting parties, the person solemnizing

the marriage, and two witnesses. The contract is

completed in triplicate. The person authorized

to solemnize the marriage is required to submit

two copies to the loc~ civil registrar within 15

days of the celebration of ordinary marriages

and within 30 days of the solemnization of marriages of exceptional character.

Witnesses

For timely registration no additional witnesses are required other than those just described in connection with the Marriage Contract. However, collaborative testimony is required in delayed registrations as will be

described.

Delayed Registration

Chapter VII of the Manual of Civil Regirtmtion is directed to issues concerning delayed

registration.1

If an event is registered late it is entered in

the civil register in red ink and whenever a certified copy or transcript is issued, the words “late

registration” are written or typed in the upper

right hand comer of the certificate.

ae
Registration of birth, death, or marriage, of

6 months’ delay, becomes a case for investigation and possible penalty.

Should a birth be registered more than 30

days after it occurs, other requirements must be

met, depending on the length of the delay.

Should the delay extend to 18 years or more, a

police investigation may be authorized and the

approval of the Civil Registrar-General is required to register the birth.

Delayed registration of deaths requires that

the local civil registrar be convinced (after presentation of an affidavit reporting place, date,

and cause of death, and an’investigation into the

death) of the truth of the facts of death.

Delayed registration of marriages requires a

‘statement of the reasons for delay, and, in case

of doubt, an investigation into the marriage contract. If the local civil registrar is convinced of

the truth of the facts, he may register the marriage.

If a report of delayed registration is denied

by the local civil registrar, it may be appealed to

the Office of the Civil Registrar-General to be

reconsidered,

Feesfor Registration of Events

Presidential Decree No. 651 requires that

births and deaths that occurred from January 1,

1974 up to March 15, 1975 be registered in the

office of the local civil registrar c~ncerned up to

May 18, 1975 without fine or fee of any kind.

Presidential Decree No. 766 is an amendment to

Presidential Decree No. 651 extending the

period of registration up to December 31, 1975

without fine or fee of any kind; it was again

further extended by Administrative Order No. 1,

Series of 1975 up to December 31, 1977.

Fees for the registration of other vital events

are stipulated in the local tax code as follows:

Us.

Peso dollars

Marriage fees:

Application fee ....... ~10.00 $1.35

License fee ............. 2.00 0.27

Solemnization fee... 3.00 0.41

Burial permit fee .......... 1.00 0.14

Fee for exhumation ...... 1.00 0.14

Fee for removal of

cadaver .,,.................... 3.00 0.41

Registration fees on the civil status of persons—for the registration of documents and for

certified copies of documents on file in the office of the local civil registrar:

Us:

Peso dollars

Per registration of

legitimation ....................... F5.00 $0.68

Fer registration of an

adoption ............................. 5.00 0.68

Per registration for an snnulment of marriage ................ 15.00 2.03

Per registration of divorce ..... 15.00 2.03

Per registration of a

naturalization .................... 30.00 4.06

For certified copies of any

document in the registrar,

for each 100 words ............ 1.00 0.14

(p. 441)

Cettified Copies

Request for certified copies of civil registry

records may be made from the office of the

local civil registrar or Civil Registrar-General

upon payment of the required fee. Anyone can

make such a request except for birth records

which is subject to the limitation imposed by

Article 7 of Presidential Decree 603 which

provides:

“(1)

“(2)

“(3)

“(4)

the person himself, or any person

authorized by him;

his spouse, his parent. or parents, his

direct descendants, or the guardian or

institution legally in charge of him if

he is a minor;

the court or proper public official

whenever absolutely necessary in administrative, judicial or other official

proceedings to determine the identity

of the child’s parents or other circumstances surrounding his birth; and

in case of the person’s death, the

nearest of kin.”

Fees.–Fees for issuance of copies of records

and documents are set forth as follows:

Us.

Peso dollars

For every 100 words or

fraction thereof, typewritten (not including the

67
certificates and any

notation) ............................... P1.oo $0.14 ‘

Where the copy to be furnished in a printed form,

in whole or in part, for

each page (double this fee

if there are two pages in

a sheet) .................................. 2.00 .0.27

For each certificate of

correctness (with seal of

office) written on the copy

or attached thereto ................ 2.00 0.27

For copies furnished other

bureaus, offices and

branches of the government

for official business (except those copies required

by the court at the request

of litigants, in which case

charges should be made in

accordance with the above

schedule ) ................................ Free

For certifying the official

act of a municipal judge or

other certificate (judicial),

with seal................................ 2.00 0.27

For certified copies of any

paper, record decree, judgment

or entry of which any person

is entitled to demand and

receive a copy (in connection

with judicial proceedings,

for each 100 words) .............. 1.00 0.14

Xerox or any other copy

produced by copying machine,

per page................................. 2.00 0.27

Photocopy, per page.............. 5.OO 0.68

However,

“The Civil Registrar may issue certified

copies of a competent court or other government agency. The issuance of certified

copies of birth certificates of children reaching school age when such certificates are required for admission to the primary grades ~

of the public schools shall be considered official and given free of charge.” (p. 441)

It appears that local practice regarding

charges for copies of certificates varies considerably.

Burial Permits

Rule 19 of Administrative Order No. 1,

Series of 1975 governing the application and enforcement of the Civil Registry Laws stipulates

that “No human body shall be buried without a

certificate of death issued either by the local

health officer or attending physician within 48

hours after death.” A copy of the Certificate of

Death shall be attached to the transfer permit

issued for burial to another place other than the

place of death. LocaI civil registrars have no

jurisdiction over matters relative to the issuance

of burial, transfer, and conveyance permits, The

permits for burial, transfer, or conveyance are

issued only by the city or municipal secretary,

upon presentation of a proper Certificate of

Death. The city or municipal secretary does not

issue a ‘permit without a proper Certificate of

Death. However, the registration of the Certificate of Death shall be made in the place of death

and not at the place of the burial (except if the

exact place of death cannot be determined).

Special Problems

The special cases probably have only a minimal impact on the effectiveness of the registration system.

llle~”timate child-h the case of an illegitimate child, the birth certificate is signed and

sworn to jointly by both parents, or the mother

alone, if the father refuses. In the latter case the

certificate must not contain any information by

which the father could be identified.

FozmcZling.-The person who finds a child is

responsible for reporting that fact to the local

civil registrar. The finder has to execute an affidavit giving the place, date, and hour of finding

and other attendant circumstances.

A Certificate of a Foundling (Civil Registrar-General Form No. 101) is registered in the

office of the local civil registrar of the place

where the infant or child was found, if the place

of birth is not known.

A child who is taken from acharitable institution or orphanage for registration is considered

a foundling if the parents and the facts and

circumstances of birth are unknown. In this

case, the Certificate of a Foundling is registered
in the office of the local civil registrar of the

place where the charitable institution or orphanage is located.

Other cases.-Administrative Order No. 1,

Series of 1975 states the procedures to be followed for:

Birth of a child in a vehicle, vessel, or airplane in transit within Philippine territory

(Rule 9).

Death of a person in a vehicle, vessel, or airplane in transit within Philippine territory

(Rules 22 and 23).

Death of a Filipino in a vessel in the high

seas (Rule 24).

Local Registers

The New Civil Code of the Philippines prescribes (Article 407, Book I, Title XVI) that

“Acts, events and judicial decrees concerning the

civil status of persons shall be recorded in the

civil register.” (See also “Local Civil Registrars,”

this chapter.)

All register books of births and deaths; including all supporting Municipal Forms Nos.

102, 103, and 103-A should be in the custody of

the local civil registrar.

Procedures for maintaining local registers are

described in the Manual of Civil Registration as

“follows:

“The receipt, entry in the civil register, binding and filing of the various types of civil

registry records, like the certificates of births

and deaths, marriage contracts, marriage licenses and other refistrable documents shall

I be done separately . ~or each document and in

accordance with the following instructions:

“Before receiving any document for registration, examine the document and see whether

all the items thereof are completely filled

and signed by the informant. Documents

with items not sufficiently filled out or with

any error have to be returned to the applicant who has to fill a new certificate.

“If you are satisfied that the requirements

have been fully complied with, accept the

document for registration. Stamp the date of

receipt or write it on the upper right hand

corner of the document. This is to be initialed by the Local Civil Registrar or his

authorized clerk.

“Record the date of receipt in a logbook or

record book. This is especially important

when the office of the Local Civil Registrar

receives large numbers of documents everyday. This will enable tracing misplaced or

lost documents during the posting of the entries in the civil registers. Responsibility for

such losses can easily be pinpointed.

“File documents as they are received, face

up, the latest report on top, for facility in

determining the next number to be assigned

to the incoming document.

“Enter the registry number of the document

in the space provided in the certificate.

Numbering of the civil registry, documents

begin with “1” at the start of the year. Thus,

the first birth document received shall be

numbered: 1 (a-75). This means the certificate is the first registered for the month of

January (a) and the year 1975 (75). Number

the documents consecutively, whether the

report is a regular or a delayed report of

birth, death or marriage.

“When the report for each event exceeds

1000 certificates a month, the numbering

can start with “1” for each month.

“The pertinent registration procedures are

discussed fully in succeeding chapters VI and

VII. It must be stressed here that the Local

Civil Registrar shall see to it that the posting

of information from the certificates of vital

events is to be done in an up-to-date manner.

“After a document has been given a registry

number, enter immediately the information

required in the civil register following the

sequence of the registry number. Do not

skip or repeat any number. The delayed reports should be entered- in ‘red ink. Any

necessary remarks should be written in the

“remark” column. Each item to be entered

in the register should be copied exactly and

as accurately as possible to avoid any mistakes which might inconve-tience the party at

a future date.

“List the death documents received daily.

This must be prepared in duplicate; one

copy shall accompany the death documents

forwarded to the Local Health Officer and

m
the other copy shallbe retained in the Office

of the Local Civil Registrar.

“Death certificates shall be given a registry

number after they are returned from the

office of the Local Health Officer (LHO).

Always check the certificates ~qtuming from

the Local Health Officer against the transmittal list that went with the documents.

See to it that all the documents forwarded

are accounted for.

“Where there is a large number of documents received for registration, the” documents may be accumulated and entries in

the appropriate civil register may be made

before the close of office hours everyday. It

is also advisable to assign a specific person

the task of posting the entries in the registers

as soon as they are received.

“Sorting is the physical arrangement of file

materials with the aid of some device to

facilitate and systematize arrangement. In

the local level, civil registry documents are

sorted by subject, that is, either birth, death

or marriage, then by the month and year. At

the national level, it is sorted by subject,

province, municipality, month and year.

“At the end of each month, detach the duplicate from the original copies of each type ,

of certificates received and registered during

the month. Sort both sets, originals and duplicates, by registry number.

“Bundle each set of original and duplicate

copies separately by type of document.

Label each set properly by month and ye&,

with the beginning and ending register numbers indicated.

“Example: Births, January 1974 Reg. Nos.

1-109.

“The set containing the duplicate copies of

the certificates registered during the subject

month shall be forwarded with the proper

letter of transmittal to the Office of the Civil

Registrar-General. Record during the first

ten (10) days of each month, pursuant to

Sec. 12 of the Civil Registry Law.

“The set of original copies which are the

supporting documents of the entries in the

register, shallbe retained in the Office of the

Local Civil Registrar for binding and filing

and for the preparation of indexes to facilitate reference.

“The documents which had been sorted by

month and year shall be fastened or held

together in folder or book form, one folder

to contain about 500 documents. Number

the folder consecutively starting with “1”

for the first folder in January, etc., up to the

end of the year. One folder may contain the

documents for more than one month, depending on the number of vital events registered.

“Label each folder or book form designating

its contents. Lettering shall be in uniform

style, using India or any black unfading ink.

“Example:

1974

January to March

Reg. Nos. 1-500

Pages 1-500

“The documents shall be

1974

April to June

Reg. Nos. 501-800

Pages 1-300

indexed to facilitate search and verification. Subjected to too

much handling, the records on file may become tom and defaced and indexing minimizes such handling and keeps the records in

good order. Indexing may be done manually

on index cards, listing and arranging in

alphabetical order names of the parties in

order to facilitate reference. For voluminous

records, IBM indexed print outs are preferable.

“Arrange folders in consecutive order from

January to December in filing shelves, filing

racks, or cabinets, by year and by registry

number. The test in the efficiency of a filing

system is the ease by which any desired

record can be located.

“The Marriage Registers, Birth Registers,

Death Registers and Register for Applications of Marriage License and supporting

documents shall be open to the public

during office hours. Precaution and close

supervision should be exercised to avoid

tampering, loss or destruction of these records. These records shall not be removed

from office, except by order of a court, in

which case proper receipt shall be taken and

a certified copy retained in the office files.

70
“h-r locating the certificates of vital events

being requested for, see that a duly designated person shall attend to the verification.

No verification is to be made without

authority from the Local Civil Registrar who

is in-charge of all records and who has close

supervision in this regard. The Local Civil

Register must be informed of results of any

verification work done and such releases of

information must be recorded in a proper

logbook for future references.

“All vital documents are for public information which may be released only upon

proper request on an individual basis. Beyond this, all records are confidential and

information may be released only to those

with a direct and tangible interest in a record

and this generally include next of kln and

legal representatives, such as attorneys, insurance companies and banks. Information

or certified copies should not be released to

other persons unless they can show their

need for the information.

“MI births, deaths, foetal deaths and marriage certificates and all registrable documents should be filed in the Local Civil

Registrar Office. It is his duty to keep all

these documents safely and maintain them

orderly at all times, being responsible for

their safekeeping and preservation and liable

for negligence, tampering, loss or damage of

any of those documents. He may be charged

with infidelity in the custody of public

documents, if any record is lost or destroyed

through his own fault or negligence.” (pp.

9-111 )

It must be underlined that “The books

making up the Civil Register and all documents

relating thereto shall be considered public documents and shall be prima facie evidence of the

truth of the facts therein contained” (Section

13, Act No. 3753 and Act No. 410, Book I,

Title XVI, New Civil Code of the Philippines) (p.

591 ).

Local Civil Registrar

One of the main duties of the local civil

registrar is to disseminate information on civil

registration and to keep the public well informed on revision, amendments, and innovations on the registration procedures. To fulfill

this mission, the local civil registrar is advised to

maintain close contacts with all collaborating

agencies and local authorities present in his

city/municipality who can help him:

The religious leaders who must be enjoined

to inquire whether the birth or death had

been registered before baptism or performance of religious death rites.

The school teachers who have to request a

birth certificate when a child first enters

school.

The local revenue officer, as the birth certificate is a legal prerequisite for allowance of

tax exemption for additional dependents.

The rural health units and the health centers

which are aware of events occurring in the

community.

The hospital administrator who is the key

person for the local civil registrar to contact.

The local census officer when an educational

campaign for improving the level of registration is conducted.

In addition, the assistance of all barrio captains and barangay chairmen is explicitly enlisted in the registration of birth and death

within their respective areas of responsibility.

Presidential Decree No. 651 stipulates that

“all barrio captain and barangay chairmen shall

have responsibility for disseminating the decree

among their constituents and for assistingin the

registration of births and deaths occurring within their respective jurisdictions to insure complete coverage of these events.”

Administrative Order No. 2, Series of 1975,,

instructs all barrio captains and barangay chairmen “to determine whether all births and deaths

occurring within their respective jurisdictions,

from January 1, 1974 onwards have been registered and, if not, to take appropriate steps to

cause registration. . . .” It is underscored that

“on the performance of their duties and responsibilities relative to Civil Registration they shall

be under the direction and supervision of the

71
Civil Registrar-General or his authorized repretentative. ”

To implement these regulations, the Manual

of Civil Registration delineates the role of these

elected but uncompensated officials as follows:

“The barrio captain or barangay chairman

shall visit periodically every household within the barrio or barangay or as often as possible for the purpose of checking whether”a

birth or death occurred.

“Should there be a new baby born, he shall

inquire whether or not the birth has been

registered. He shall cause a Certificate of

Live Birth (Mun. Form 102) to be accomplished and registered in the Office of the

Local Civil Registrar within 30 days after

birth. In filling up the certificate, the mother

or any other informant should be asked to

supply the correct answer or information in

the personal items of the certificate and sign

in Item 17.

“Should there be a death and where no

death certificate had been prepared, he shall

cause the reporting of the death to the Local

Health Officer for the issuance of a death

certificate within 48 hours after death, although such accomplished certificate of

death shall be registered in the office of

Local Civil Registrar of the city/municipality

within 30 days after death.

“He shall request for his supply of certificates of birth and certificate of death forms

(Mun. Form Nos. 102 and 103) from the

Office of the Local Civil Registrar.”

Discussion with civil registration officials

seemed to indicate that barrio captains and

barangay chairmen varied considerably in their

fulfillment of these responsibilities.

An important recent development likely to

have a bearing on registration completeness is

the establishment of an extensive network of

field employees of the National Census and Statistics Office. In particular, current efforts are

being expended to provide a municipal census

officer or a municipal census assistant for each

municipality. These persons are expected to

assume a number of registration responsibilities,

including corroboration of total number of

events registered and for coding certificates prior

to forwarding them to the Manila office of the

National Census and Statistics Office.

As previously noted, the local health officer

‘hnd the local civil registrar collaborate on death

certifications and registrations. Until 1974, the

Department of Health collected vital statistics information directly through the monthly reports

of the local health officers. These officials in

turn secured their information on births from

the local registers. Although the data provided

through this system are no longer being analyzed, the data are apparently still being collected.

Vital Records

Routing. –Under Section 12(e), Civil Registry Law (Act No. 3753), it is the duty of the

local civil registrar to send the Office of the Civil

Registrar-General, within the first 10 days of the

month, duplicate copies of the entries made

during the previous month, with the proper registry numbers.

The local civil registrars are instructed to

send these monthly reports to reach the Office

of the Civil Registrar-General before the end of

the month or (for far-away municipalities and

cities) during the first week of the following

month.

The set containing the duplicate copies is

mailed, exempted from the payment of ordinary

postage.

A letter of transmittal showing the number

of records in each category is also forwarded.

As they are received, records are sorted by

municipality and province. The number of

records in each registration category is checked

against the number indicated in the transmittal

letter and inquiries are initiated in case of discrepancies. As noted earlier, an additional check

may soon be available from the reports of the

municipal census officers/census assistants.

The requirement to submit registration

documents promptly is not always met. In part,

this is apparently due to difficulties in transportation and communication; but in part, delays

appear to be caused by the need to compile statistics locally. Thus, for example, the City of

Manila is substantially in arrears because the

72
copy submitted to the National Census and Statistics Office is keypunched locally before submission.

Editing and coding. –Editing and coding is

carried out by the editing and coding staff.

Codes are supplied for 17 items on the birth certificate, 13 items on the death certificate, 16 items

on the fetal death certificate, and 12 items on me

marriage certificate. New coders’ work is verified; the error rate is said to be small. Codes are

entered along the right margin of each certificate. The coding of information in box 16 of the

birth certificate calling for information on previous deliveries, total live births, and total children currently alive was mentioned as a special

problem owing to discrepancies and/or omissions. An explicit set of rules dealing with these

problems has been developed, but these rules are

not felt to be entirely satisfactory. Some problems with the cause-of-death codes were also

mentioned, but appear to arise from erroneous

information on the death certificate rather than

from errors in coding as such.

As previously noted, field editing and coding

by the municipal census officers/census assistants in the field is contemplated and is expected

to take effect by the end of calendar year 1977.

As this plan becomes operational, a 100 percent

coding verification in the central office will be

initiated. Although it would appear that field

editing and coding might offer some advantages

in terms of detection and correction of errors,

this potential advantage is offset by the fact that

information on the certificates cannot be

changed except under court order.

When coding is completed, registration certificates are bound into folders each containing

400 records. The records are assigned consecutive page numbers. The book number of the

bound volume and the page number are subsequently keypunched as part of the encoded

record. The book and page references are subsequently used in record searches.

Keypunching and processing. –Books of encoded records are routed to the National Census

and Statistical Office data processing units,

where key to tape machines are used to record

the data. The bound volumes are then returned

to the Civil Registry for permanent storage.

Problems with processing of vital records

appear to be mainly in the areas of breakdowns

of machinery and competition with other projects for machine time. With respect to the

former, it appears that intensive use is made Gf

the available equipment. Keypunchers work 24

hours a day, 6 days a week in 3 shifts; the computer operates on a 3-shift, 7-day schedule.

However, overheating problems are frequent and

up to 6 hours a day are spent in allowing machines to cool down.. The present air-conditioning arrangements are reported to be inadequate.

Competition with other responsibilities is

currently reflected in the priority given to completion of tabulation from the 1975 census,

which is somewhat behind schedule. The most

recent published report on vital statistics is for

the year 1974. Results for 1972 were published

in 1974 and results for 1973 were published in

1975. This publication must be viewed as rather

timely, since the official date for “closing the

books” on a calendar year of registration reports

is presently July of the following year. Presently, consideration is being given to establish an

earlier closure dates. Such a practice would

probably speed up production, but might decrease coverage due to exclusion of registrations

received late. At present, delayed registrations of

vital events (those received after the statutory

period for registration has ended) are not keypunched and no attempt to update tabulations

on the basis of delayed registrations has been

made.

Storage.–The National Census and Statistics

Office maintains files of all vital records received. Recently, experimental trials of microfilming equipment have been conducted. Results

indicate that one unit could about keep pace

with the volume of records currently received at

approximately F200,000 per year (about

$27,082). If an additional machine were acquired, it would take about 9 years to microfilm

the backlog of records on file. The main advantage of microfilm is space saving. This is

being weighed against the additional costs of instal~ng a microfilm system.

The Civil Registry records presen~y filed m

the Archives of the National Census and Statistics Office are all records of births, deaths, and

marriages all over the Philippines covering the

late part of 1945 to date. These include court

decrees and legal instruments. All Civil Registry

records filed in the Bureau of the Census and

73
Statistics prior to the late part of 1945 were

totally destroyed during the Second World War.

UTILIZATION OF STATISTICS

DERIVED FROM THE CIVIL

REGISTRATION SYSTEM

Civil registry records have a wide variety of

legal, protective, administrative, and statistical

uses. The legal and protective functions of civil

records derive mainly from use of the individual

records; administrative and statistical uses, for

the most part, require that the records be aggregated and analyzed. In the present section, some

of the administrative and statistical uses of civil

registration data will be considered. In the next

section, uses of individual records will be discussed.

Department of Health

Perhaps the most extensive traditional use

made of vital statistics’ is in identification of

health problems and the planning and delivery

of health care systems. As previously indicated,

the local health officer plays an important role

in the certification of deaths and links directly

to the local civil registrar. At the national level,

the Health Department was, until 1974, engaged

in the compilation of vital records. Although, at

present, the Department of Health receives its

information on the numbers of vital events in

tabulated form from the National Census and

Statistics Office, it continues to be a major user

of these data through its analysis of vital and

health statistics from the civil registration

records and through its dissemination of information to the various divisions of the Department of Health, including the regional, provincial, and local health offices.

It should be noted that the Department of

Health, like any organization, undergoes considerable change over time. At the time of this

writing, several developments which are likely to

lead to reorganization of certain Health Department functions could be identified. ‘These include current plans to eventually extend Medicare coverage to all citizens (presently, only government workers and employees covered by the

social security system are covered under Medicare ), and the projected development of a

Healih Management Information System which

would embody data on vital and health statistics, health service statistics, health manpower,

and other information needed for administrative

purposes. The implications of these developments for the organization of the Department of

Health have not yet been fully worked out.

Hence the present discussion refers to the current organization of the Health Department and

current utilization of vital statistics.

The Disease Intelligence Center is the main

source and depository of data and information

in the Department of Health on disease occurrence and distribution in the Philippines. It is,

therefore, the health statistical office at the national level. The Disease Intelligence Center is

organizationally set up to consist of two divisions, namely, the Division of Epidemiology

and the Division of Health Statistics, which is

comprised by the vital and morbidity statistics

section and the research and service statistics

section.

Both divisions utilize the regional, provincial, and local network of health officers in collecting data on morbidity and infectious

diseases. Three more or less district reporting

systems are in current use: the index area system, the weekly notification of communicable

diseases, and the monthly reports of natality,

mortality, and morbidity.

The index area system at one time covered

approximately 200 areas. Criteria for inclusion

in the index area system included a population

of 50,000 or over, presence of a health officer

with formal public health training, and telegraph

facilities. The latter was a necessary requirement

because the system depends on telegraphed reports of total deaths, infant deaths, and unusual

deaths. Apparently, the system has fallen into

disuse, since only about 10 percent of the units

originally included in the system continue to

submit reports. However, there are apparently

some plans to revive the system.

The communicable disease reporting system

consists of weekly reports submitted by city and

municipal health officers simultaneously to the

provincial health departments and to the Disease

Intelligence Center. This system covers, in

theory, 28 communicable diseases, including 4

quarantinable diseases. However, since only one

74
of the quarantinable diseases, cholera, is actually endemic in the Philippines, the system, in

practice, reduces to 25 diseases.

The monthly reporting system covers births,

deaths, infant deaths, and morbidity as reported

by local health officers. Prior to 1973, the

Health Department operated its own systems for

processing birth and death data and compiled

vital statistics based on its own tabulations. Although, in theory, counts of births and deaths in

the Disease Intelligence Center should have been

identical to those reported by the National Census and Statistics Office (since both derive from

birth and death certificates), in practice totals

differed somewhat; with the Health Department’s figures usually being somewhat higher.

There are at least two possible explanations for

the dkcrepancies. First, some events certified by

local health officials may not actually have been

registered by the local civil registrar, or if registered, may not have been forwarded to the National Census and Statistics Office. Second, as

previously noted, the National Census and Statistics Office excludes delayed registrations from

its tabulation system; it appears likely that delayed registrations were, at least, to a certain

extent, included in the Disease Intelligence Center system.

Starting March 1, 1973, the Disease Intelligence Center stopped renting IBM key punch

and tabulating equipment and made arrangements with the National Census and Statistics

Office for the mechanical processing of data on

birth and deaths. However, it does continue,

under the same agreement with the National

Census and Statistics Office, to produce analyses

of vital and health statistics. -

Since it is recognized that both birth and

death registration are incomplete, little emphasis

is given to the absolute level of vital rates. Reports published by the Disease Intelligence Center do discuss trends in vital statistics, specifically in crude death rates, infant mortality rates,

and maternal mortality rates. More attention is

given to such basic indicators of health and

health system operation as cause-of-death statistics, proportions of births and deaths medically

attended, proportions of births and deaths occurring in hospitals, and similar indicators.

Mortality statistics are also used by the

Disease Intelligence Center as a means of correcting morbidity statistics. Thus if the number

of reported deaths resulting from a particular

disease category exceeds the incidence of the reported cases in the same category, the morbidity

figures are adjusted upward.

Population Projections

A fundamental use of vital statistics,

whether calculated from registration data or estimated from other sources, is in the preparation

of population projections. Such projects are

often used as the framework for social and economic planning and, therefore, have wide ramifications for development.

Two different sets of population projection

havebeen prepared in the Philippines.The first was

carried out by the National Census and Statistics

Office with funding assistance from the United

Nations Fund for Population Activities. The

methodology employed was the component projection method which uses sets of age-specific

fertility, mortality, and migration rates to carry

each age-sex group population forward in time.

The initial population was based on the adjusted

1970 census age distribution. The age distributions of successive censuses and the “South”

family of regional model life tables were used to

derive age-specific mortality rates rather than

the incomplete data from the vital registration

system. The level of fertility was estimated from

application of reverse survival ratios to the 1970

age distribution; the age pattern of fertility from

vital registration data was accepted, however, for

the national projections.

In these projections, expectation of life at

birth was assumed to increase from a level of

53.5 years for males and 56.8 for females in the

period 1995-2000. Three assumptions regarding

fertility were introduced: the high assumption

was based on an unchanging tot~l fertilit~ rate

of 5.8 children per woman, the low assumption

implied a decline in total fertility rate to 2.6 for

1995-2000 period, and the medium assumption

assumed a decline to 4.2.

Provincial projections were also carried out

using for lack of better information, the same

mortality assumptions as were used in the national projections, but varying initial levels of

fertility in accordance with results from the

1973 National Demographic Survey.

75
A more ambitious population projection

project is currently under way at the University

of the Philippines Population Institute. This

undertaking is part of the collaborative project

on population, resources, environment, and the

Philippine future by the University of the

Philippines.

UTILIZATION OF CIVIL

REGISTRY RECORDS

Certificate of Live Birth

A Certificate of Live Birth is needed to

prove the fact, of birth:

For establishing identity.

For proving parentage.

For tracing ancestry.

For determining legal dependency.

For application for marriage and examination.

For proving inheritance of property.

For settlement of insurance.

As a basis for public health programs.

The birth certificate is also needed to prove

the date of birth:

For enrollment in school and educationalbenefits.

For right to vote.

For right to enter civil service.

For proof of legal age for marriage.

For automobile license.

For issuance of professional license.

For settlement of pensions.

For enlistment in the Armed Forces.

For social security benefits.

For request of additional tax exemption.

In addition it is needed to prove the place of

birth:

For establishing citizenship.

For obtaining passports.

For determining basis for immigration and

naturalization.

Certificate of Death

A Certificate of Death is needed to prove the

fact of death:

For life of insurance claims.

For settlement of estates.

The death certificate also is used to prove

facts about the deceased:

For circumstances of death.

For time and date of death.

For nativity.

For establishing inheritance rights.

For application for second or another marriage.

Certificate of Fetal Death or Stillbirth

A Certificate of Fetal Death or Stillbirth is

needed:

To establish certain questions contingent

upon family composition and birth order,

questions which may deal with rights of inheritance.

To prove the fact, the date, and the place of

occurrence for statistical purposes.

Marriage Contract

A Marriage Contract is needed to prove the

fact of occurrence of a marriage:

To establish civil status.

To ensure legal responsibilities for family

support.

To establish next of kin and rights to inheritance and other legal claims.

76
To confer legitimacy.

To establish emancipation of a minor.

It is ako needed to prove date of marriage in

order to:

Prove date of birth of offspring.

Prove legitimacy of the children to qualify

for pension, social security privileges, and

legal rights.

The marriage contract is also important to

prove place of marriage.

EVALUATION

Registration Completeness

Some demographers had estimated the level

of registration of vital events to be as low as 60

percent of actual occurrences. This was also the

finding in a study made by the National Census

and Statistics Office in 1965 which showed the

lCVC1of registration of vital events at 60.3 percent for birth and 70.0 percent for death. This

study demonstrated that birth registration is

more deficient than death registration.

During the last decade, registration of births

on the nationaI ievel rose from 60 to 79 percent,

while that of deaths rose from 70 to 77 percent.

Greater increases have even been noted in some

regions. Increases from 61 to 97 percent for

births and from 60 to 92 percent for deaths have

been attained, but the aim oflattaining at least a

90 percent leveI for the country may stilI be in

the future.

For the year 1973, a total number of

1,049,290 birth certificates and 283,475 death

certificates have been received. For the year

1974 the numbers were 1,081,073 and 283,975,

respectively. When one takes into consideration

the annual population growth, one can evaluate

the extent of the present coverage of civil registration in the Philippines.

Assessment of Vital Rates

The direct measurement of vital rates from

the civil registry records is not feasible due to

the incompleteness of registration, and the already serious problem is aggravated because the

extent of underregistration cannot be readily

ascertained. In any case, the vital rates derived

from the legal registration system are considered

very low compared with the estimated rates

from different independent investigations.

As derived from the legal registration system, the historical trend of vital rates in the

Philippines after the Second World War declined.

The average birth rate during the period from

1948 to 1973 was 28.8 births per thousand

population; the average death rate was 8.9

deaths per thousand population. These rates are

low when compared with those that could be

anticipated given the age distribution of the

population.

The national estimates from various studies

show that the crude birth rate is approximately

between 41 and 50 per thousand population for

the period between 1950 and 1970 and the

crude death rate between 11 and 18 per thousand population during the same period.4

The POPCOM/NCSO Project

Realizing the need for reliable, if not accurate, vital crude rates, the Bureau of Census,

now known as the National Census and Statistics

Office, undertook a nationwide project under

Population Commission/National Economic and

Development Authority/U.S. Agency for International Development/National Census and Statistics Office subagreement (POPCOM/NCSO

project) to develop a sample registration system

from which estimates of vital crude rates, both

at the national level and regional levels, may be

reliably obtained.

Considering further that vital registration

figures for the country, but particularly for

lesser developed regions of the country, cannot

be correct, and that the regional differences in

rates reflect more variations in underregistration

than in fertility and mortality, the POPCOM/

NCSO sample vital registration project was

started also to improve the level of registration

and to estimate the level of national and regional

underregistration.

The relevant documents describe both technical and administrative difficulties experienced

and present the conclusions which can be drawn

from the results achieved by the project.

77
There is no doubt that, in the sample areas,

the project has made the people atvare that vital

registration is an important event. Data collected

between 1971 and 1974 show that registration

in vital registration improved which confirms

that people are now more acquainted with the

duty to register vital events than they were before. However, the amount of effort that needs

to be exerted to overcome the difficulties underscores the magnitude of the problems to be

solved before a fully satisfactory civil registration system can be implemented throughout the

Philippines.

Cause-of-Death Statistics

Diagnoses of causes of death present a number of problems. First, as previously indicated, a

substantial fraction of deaths are not medically

attended. Hence diagnosis must be made after

death on the basis of symptoms reported by

family members. Second, even in the case of

medically attended deaths, diagnosis is often

made clinically on the basis of presenting

symptoms, rather than on the basis of results

from laboratory tests. Ambiguity of diagnosis

plus difficulties in obtaining followup information has led the Disease Intelligence Center to

edit the reported diagnosis.

The statistics related to the causes of fetal

death are still to be improved as the information

on the disease or condition causing fetal death is

frequently lacking. The Certificate of Fetal

Death was introduced more than 20 years ago in

replacement of the stillbirth certificate where

the cause dld not appear. Shce that time, it is

pointed out that the cause of fetal death must

be properly assigned by using the classification

of causes of stillbirth as a guide. However, it was

noted during the field visit that “stillbirth” without any indication of cause sometimes appears

as one of the 10 leading causes of mortality. As

stillbirth is not mentioned in the tables published by the Disease Intelligence Center, one

can wonder how it is dealt with.

Factorsof Underre&tration

The causes of underregistration have been

made evident by those who are responsible for

the system and they are indicated in several

documents signed by Dr. Tito Mijares, Civil

Registrar-General; Mr. Eugenio Venal, Civil Registry Coordinator of the Civil Registry and Vital

Statistics Division, National Census and Statistics Office; and Francisco Nazaret, Supervising

Census Statistical Coordinator, Population and

Research Branch, National Census and Statistics

Office.

These causes may be split into four categories according to the factors liable for the deficiencies.

The administration. –Deficiencies mainly

originate because financial resources are too

small. Even if the Civil Registry Law (Act No.

3753) provides that “all expenses in connection

with the establishment of local registers shall be

paid out of municipal funds,” most often the

city or municipal council does not provide the

necessary logistics. The consequences are:

Lack of personnel: The local civil registrars

complain about the lack of necessary personnel to handle civil registry work resulting in

the backlog of posting entries on the pertinent registries.

Lack of office equipment and supplies: This

makes preservation and safekeeping of civil

registry documents unsatisfactory.

Inadequate supply of registration forms: The

usual reason given is that no fees are being

collected for the registration of births,

deaths, and marriages and that the city/

municipality cannot afford to give municipal

forms free of charge to the public. To have

available funds, some cities/municipalities

impose fees for the registration of these

events, contrary to the rules in the Civil Reg

istry Law.

As noted previously, the National Census

and_ Statistics_Office supplies forms (specially

marked “not for sale’~ to localities that are unable to purchase them.

More generally, the lack of funds keeps the

Government from improving the level of civil

registration on a nationwide scale.

Local oficiak.-Some local officials do their

jobs poorly; they are negligent and deficient in

their duties. Municipal forms are improperly

78
filled out; documents are submitted late to the

Office of the Civil Registrar-General. Because of

the ex-officio nature of the civil registry work, it

is very difficult to prosecute these local officials

or to punish them for their poor performance.

The population. –Many Filipinos are unaware of the importance of civil registration and

of their responsibilities as set forth in the civil

registration laws. Some, believing that baptism

equals birth registration, do not fulfill the

parental obligation to register the birth. Death is

accompanied by similar negligence. Attendants

at births and deaths are no better informed of

their obligations.

External constraints.–Often the place of registration is a great distance to travel, made more

difficult by lack of roads and poor transportation facilities. Approximately 15 percent of the

total barrios can be reached only by walking.

Only about 25 percent of the barrios have transportation within distances of 10 kilometers.

In addition, by tradition and custom, cultural minorities are intolerant of civil registration practices.

REMEDIES TO UNDERREGISTRATION

Several recommendations have been made

for improving the completeness of registration.

The Administration

‘ Local officials are required to appropriate

funds for civil registry work.

Municipal and city councils are requested to

revoke ordinances imposing fees for delayed registration of births, deaths, and marriages. They

have to strictly adhere to the repealing clause of

Presidential Decree 651 which provides for the

repeal of city/municipal ordinances imposing

fees and fines on civil registration even when

made within the prescribed period.

Certificates of birth, death, and fetal death

are distributed free of charge to needy municipalities.

Local Level

Efforts are made to enforce a uniform interpretation of the laws pertaining to civil registration, as it is the only way to obtain complete,

comparable, current, and accurate records of

vital events.

Provincial censu: officers, municipal census

officers, and census assistants are to follow up

those monthly civil registry reports that are delinquent.

As long as the local civil registrars are officials acting in ex-officio capacity, a closer link

between municipal officers and the Civil Registrar-General should be established for closer

supervision of local civil registrars. Furthermore,

local civil registrars should be given incentives in

the form of some remuneration.

As soon as possible, regular or special local

civil registrars should be appointed. The office

of the local civil registrar should be converted

into a full-time job and not be occupied by a

person holding another office (municipal treasurer or city health officer) who has no time for

the job. The separation of duties and responsibilities of the local civil registrars from those of the

municipal treasurers or city health officers

would allow the former not only to do their

duties accurately but also to institute their own

investigation and registration campaign in outlying barrios.

The barrio captains must be fully involved in

the development and maintenance of a civil registration system, in conformity with Section 7

of Presidential Decree 651 enlisting their assistance in the registration of births and deaths.

The assistance of qualified residents of the

barrio should also be sought. In this respect, the

“volunteers” envisaged in the frame of the Restructure Health Care Delivery System could

play a useful role which should be discussed

with the Project Management Staff Unit. However, experience has shown that, to obtain the

services of efficient collaborators, wages or incentives have to be paid for services rendered.

Close supervision through frequent field inspection by members of the central staff and

extensive communication between field and office are required to ensure quality of collected

information. Supervision will help to clarify

problem situations immediately or to discover

incomplete or unclear information. To remedy

mistakes or omission committed in the field is

difficult; to do so from the central office is almost impossible.

79
Population Level

Presidential Decree 651 must be well publicized and reminders of this Decree should be

regularly made so that the public will know its

responsibilities, duties, and liabilities for failure

to register births.

Posters, pamphlets, and brochures on civil

registration are to be printed and distributed.

A sustained educational campaign should be

conducted through seminars on civil registration

with the collaboration of regional/

provincial/municipal census officers and municipal assistants, local civil registrars and their

assistants, with medical personnel, hospital

clerks, nurses, midwives, teachers, parents,

barangay chairmen/barrio captains and hilots as

participants.

The Government and private hospitals, maternity clinics, and health centers are earnestly

requested to help and cooperate in the registration of births and deaths they attend.

Church leaders are requested to help and

cooperate in informing those concerned to register unregistered births of children baptized and

marriages solemnized in their churches.

REFERENCES

I National cen~u~ and statistics Office: Manual of

Civil Re@”stration. Manila. Office of the Civil RegistrarGeneral, 1975.

2Nationa1 Economic and Development Authority

and National Census and Statistics Office: Philippine

Yearbook, 1975. Manila. National Economic and Development Authority and National Census and Statistics

Office, 1976.

3Nat.ional Census and Statistics Office: Proceedings

of the CSvil Registration Seminar. Manila. Commission

on Population, Population Center Foundation, 1976.

4Mijaes, T. A.: Development and Maintenance of a

Sample Vital Regktration System in the Philippines. Internal Program of Laboratories for Population Statistics.

Reprint Series No. 19. Chapel Hill, N.C. The University

of North Carolina at Chapel Hill, Nov. 1977.

so
APPENDIX

CONTENTS

Forms

Reproduction of Certificate of Live Birth ............................................................................................ 82

Reproduction of Certificate of Death .................................................................................................. 83

Reproduction of Certificate of Feti Death ......................................................................................... 84

Reproduction of Certificate ofa Foundlkg ......................................................................................... 85

Reproduction of Mmiage Con&act ..................................................................................................... 86

81
APPENDIX

Reproduction of Certificate of Live Birth

MUNICIPAL FORM No. 102-(Revised Dec. 1, 1958) (TO BE ACCOMPLISHEDINDUPLICATE)

REPUBLIC OF THE PHILIPPINES

CERTIFICATE OF LIVE BIRTH

(FILL OUT COMPLETELY,ACCURATELY,LEGIBLYININKOR TYPEWRITER)

Register Number:

Province: .......................................................................................................... (a) CivifRegistrar-GenerdlN<>...,,.,...,,.........,,,,,.,.....,.,,......,.,.,,,..

City OrAiutlicipulity : ........................................................................................ (b) Local Civil Registrar No . ......................................................

1. Place of Birth 2, usual Residence of Mother (where dots mother live?)

a. Province a. Province

b. City or Municipality b. City or Municipality

I

c. Name of Hospital or Institution (If not in hospital, give street c. Number and Street

address)

cf. is Placcof Birth hrsidc City Limits? I d.ls Residcncelmidc City Limits? lc, IsResidcnccona Farm?

Yes ❑ No ❑ Yes •l No ❑ I Yes•1 No ❑

CJ 3. Namc(Typc of print) Fkst Middle Last

~ j 4. Sex I 5~. This Birth ISb. lfTwinor TripJct, was Child I 6. Datcof Birth

Single •l Twin ❑ Triplet ❑ I

1st •1 2nd-”U 3rd •l IMonth

~ 7.Name 1 First Middle Last Religion 8. Nationality

d ‘y +

ia I I I

x

1

9, Age(Attimcof 10. Birthplace lld, Usual Occupation 116. Kindof Busincssorhrdustry

~ this birth)

_{ Years I I

.+ ~1’2. MaidcnName F!rst h4ddlc Last Religion 13. Nationality 13,!. Rscc

1

~ 14. Agc(At timeof 1s. Bkthplacc 16, Previous DelivcriesofMorhcr

2

this birth) (Donol includethis birth)

Years

a. How many b. Howmanyothcr c. Howmanyfctal

17a. Informant’s Signature: children are children were deaths (fetuses

b, Namcin Print: now living? born alive but born dead any

arc now dead? time after cOnC. Address: I I

ccption)?

18. Mother’s Mailiig Address: (Number, Street, City or Municipality, Province)

.19. ATTENDANT AT BIRTH

I HEREBY CERTIFY that 1attended the buth of this child who was

born alive at o’clock _.M. on the date above indicated.

a. S18nature:

b, Name in Pcirrt:

c. Address:

20. Received in the Office of the Local Civil Registrar by:

d. Date Signed by Attendant at Birth:

e. I@ of Attendant at Birth:

❑ M.D. ❑ Mldwifc

❑ Nurse Cl Others (Specify)

21. ‘I. Given Name Added from Supplemental Report:

a, Signature:

b. Name in Print: b. Date When Given Name was Supplied:

c. Tide or Position:

d. Date:

22cs. Length of Pregnancy 22b. Weight at Birth 23, Legitimate

Completed Weeks. Lbs. oz. 0 Yes a Nn

24. Date and Place of Marriage of Parents (For legitimate birth) I

25. This Certitkatc is Prepared by:

Signature:

(Month) (Date) (Year) Name in Print:

Title or Position:

City or Municipality , Province _ I mtc:

18—2S9 (SPACE”FORMEDICAL AND-HEALTH ITEMS FOR-SPECIAL puRPOSEs)

NOT FOR SALE

FROM THE CIVIL REGISTRAR GENERAL

.
Reproductionof Certificateof Death

h@dCipd Form No. 103-(RtdsedJarmmy, 1959) (To be accomphhed in duplicate)

RSPUBLfC OF THB PHIUPPINES

CERTIFICATE OF DEATH

FILL OUT COMPLBTRLY, ACCURATELY, AND LEGIBLY WITH INK OR TYPEWRITER

RcgfrtcrNumber:

R&nc& ..........................................................................................."..... (.) CM1RegMrar-GencralNo. .......................................................

Cftj or Municlpdky ................................................................................ (b) Local Cid RegfctrarNo. ..........................................................

10 Place of Death 2. Usuaf Reai&nce (Wb@gncd lived. If institution: reddmce btfore

& Province a Rovfnce

b. CiLYor Town c. Length of Stay b. City or Town

d, Ftd Name of Hoapkaf or Institution [Ifin ho:pkd or tnctitution) c. Ad&eu Street or Barrio

I

3. Name of Deceawad a First b, Middle e. Ln$t

(2ypaOrprfnt)

4. Date of Death:

(Month) (Day) (Year)

5. sax 6. flaw 7. Married; Never Mamiad; 8. Date of Birth 9. ASe If Undm 1 Year If Undm 24 Hours

Wfdowed; Divorced or (Yea) (Months) (Days) (Hours) (Minutes)

Separated (Spccffy)

10. a, Uwl 02cupaH0n 10. b. GiveSpecific Businen 11. Birthplace (Phflfppines or foreign counuy) 12. Citizen of What Country

(Stat6 nature -d or Industry a. City or Town

chatacter) b. province

13. Father’s Name (Wcftepltfnly io fufl) 14, Mother’tMaf&n Name (Write plaidy in fd)

15, If Mudtd, Name ad Ad&mc of Surviving SpouJC 16. Infornww ~ \~e~~t)

,.

17, C2wa of DA

Bnter only one causepar line

(a), @) and (c).

l$b does not mean the mode

of dyfo~ sorb w hew fdfuce, aathenia; etc. It mat

the dfwae, injury, or compffcatfon W&b caused. death.

I& Data of Operatfon

‘w, My:: (spccf@)

Homfclde

2(M+Time of Injury (Month)

c. (Addrcu) “

d. (Relation to demaaed)

MEDICAL CER’ITFICATE I Intcrvaf Between

L &ease or Cadidon Directly Ledingto Death:*

ANTECEDENT CAUSES (a)

Morbid conditions, ff any, .giviug

dat to the Am cause (a) stating

DIMto (b)

the underlying cauze last. Dlm to (c)

IL Other Signihnt CaWiOnsConditiom contributing to the

&di but not dated to the

dkcaae or condftfon +wing

I

onsetand wth

I

19. Autopsy

Yes 13 No❑

(Findings st the back)

&atb. I

18b. Msjor Findings of Opration

20b. Placeof Injury 20c. (Town or Street) (city) (Rovince)

(e.g. in or about home,

facm, fwtocy, Stteet,

oftlce, bddfng, etc.)

—M I Work •l at Work •l I

21.1 hereby certify that the foregoing pattkcuk are comect u near as the same can be aatertaincd, and I further ctrtify that I bawinot attended the

dacmmd from .......................................... ...................................., 19......... to ............................................................................. ................ ,

19 ............

that +atb occurred at .....................................................

from the cawes and on the &te stattd above.

22@) CC&f$ed comtct by; 22@)

•l RI-to Physkfan (signature) ...................................................................................................................................................

❑ Publfc Hedtb Offfmr

(Fdf name in printed letters) ...............................................................................................................................

(Add+ .............................................................................................................................................................

•l Hotpkaf authotidet (Date) .,,,,,,.!!........0............................................................ ...............................................................................

23cr. Budal, (k.rmation, 23b. Date 2%. Name of Cemetery or Crematory

[

23d. I.ucufon Province (City,town)

Rtmoval(Specffy)

1

,

24 Date Rccchd by 240. R@stru’s Sfgnature (N811Kin pdnt) 24b. Bud Pemdt No. Issued on

Lmxl CfvIIRegis- Tmndr Permit No. Issued on

*U

By

l*22a NOT FOR SALE

FROM THS CML REGISTRAR GRNE~

Ss
Reproduction of Certificate of Fetal Death

MUNICIPAL FORM NO. 103-A-(Revised Jmsuary, 1958)

REPUBLIC OF THEPHILIPPINES

CERTIFICATE OF FETAL DEATH

(To be accomplished in Duplicate)

Register number:

Provillcc: (u) Civi/RegiwmGr?nerdNo.

City or Mutticipdity: (b) Locdf Civi/Rcgisttar No.

1. Pkaceof Delivery 2. Usuid Residence of Mothcr(Where doesmothcr live?)

a. Province d. Province

b. Cityor Town b. Cttyot Town

c. Full Namcof Hospital or Institution (lfnotin hospital orinstituticm, c. Street Address

give street address or location).

3. Namcof Fetus (Ifeivcri) 4. Sexof Fetus

.“.

., Male~ Female Cl Undetermined Ill

5m This Delivery 5b. lfTwinor Triplec, wasthis Fetus 6, Dateof Delivery (Month) (Day) (Year)

Delivered

Single Cl . Twin ❑ Triplet ~ 1st •1 2nd •l 3rd •l I

7. Name d, (Pirst) b. (Middle) d, (Last) % Nationality b. Race

Father 1

9, Age (At time 10. Birthphtcc llIs. Usual Occupation Ilb. Kindof Busiriess orlndustry

of delivery)

I— Years I

12. Maiden ,1. (First) b. (Mtddle) e. (Last) 13tr. Natiomdity b. Race

I

Mother 14. Age(Attimc 15. Bhthplace 16. Previous Deliveries roMother (DO NOTinclude this fetus)

. ofdclivery) a. How many I b. How manY I c. How many Previous

I---.-L Years childretr are now children were born fetal deaths ~fetutes

17. Informants Signature “ living? alive but ate now born dead at Any time

Name in Print dearl? after conception ?)_ /

18u, Length of Preg- 18b, Weight of Fetus 19. Legitimate 20. When Did Fetus Dle 21, Autopsy

nancy Compleccd Before During bbor Un-

— Weeks _ Lb. _Oz. Yes ❑ No ❑ Labor •l or Dehvery El known Cl Yes ❑ No ❑

22.

Cause

of

Fc.tai

1. Direct and Antecedent Causes

Diect Cause

State fecal or maternal condition directly

causing fetal death (do not use such terms

as stillbirth or prematurity) I

Antecedent Cau*es

State fetal and/or maternal condition, if

any Giving Rise to the Above Cause

(ta)stating the Underlying Cause I

(enter cmly one cause pet line)

(a)

Due to

(b)

Due to

Last. . 1 [c)

11. Other significant Ccmditions of fetus or mother which may hwe Contributed to fetal death, but, in so far is known, were not related

to dir~kt causeof’fetal death.

I

7

I hereby certify that 23a, Attendant’s Sigrtarure 23d. Dme Signed

this delivery occurred on”

the date stated above and

the fetus was born dead (Name in Print) (Specify if M.D., Nurse, midwife, or other)

at _ o’clock—m. 23C, Attendants Addre$s II If not attended I 24. Signature of City or Municipal Health Officer

by physician

Name and Tide in Print

25a. Busia\, Cremation 25b. Date 25c. Name of Cemetery or Crematory 25d. Location (City, town or street) (Province)

I I I

26, Funeral Director Address Date Received by Registrar’s Signature

Local Regfstrai

(Name in Psint)

a4
Reproduction of Certificate of a Foundling

CRG FORM NO. 101 (New Form ~evised November, 1959)

CERTIFICATE OF A FOUNDLING

(To be accomplished in duplicate)

Province ! CRG Registry No.

City/Municipality: LCR Registry No.

1.

3.

4.

6.

7.

9.

Name of the child: 2. Sex:

Approximate Age of the Child when found:

Color of Hair of the Child: 5. Color of the Eyes of Child

Place the Child was found: ,.

Date the Child was found: 8. Time the Child was found:

Distinguishing features and/or marks in the child:

10. THIS 1STO CERTIFY; that the information given above are true and correct to my own knowledge and belief.

a. Informant’s signature:

b. Informant’s name in print:

c. Informant’s address:

11. Name of Notary Public or officer who administered the oath to the affiant in the sworn statement declaring the finding of the chdd:

12. Notarial identification of the sworn statement declaring the Finding of the child: Docket No. Page No. _

Book No. _ Series of 19 _

13. Date reported to the local civil registrar:

14. a. Signature of the local civil registrar:

b, Signature of the local civil registrar in print:

NOTE: THIS CERTIFICATE MUST BE FILED WITH THE SWORN DECLARATION OF THE FINDING OF THE CHILD.

llce

85
Reproduction of Marriage Certificate

MUNICIPAL FORM No. 97-(FOm No. 13)

REGISTER NO. ..............................

MARRIAGE CONTRACT

HUSBAND

Contracting Parties ....................................................................................... ........................................................

(u) Age ................................................................................................. .......................................................4

(b) Nationality .#........................................................t.......................... ........................................................

(c) Residence ...............4....................................................................... ........................................................

Single, widowed or divorced ........................................................................ ........................................................

Father .......................................................................................................... ........................................................

Nationality ............................................................................................ ........................................................

Mother ......................................................................................................... .......................................................

Nationabty ............................................................................................ ........................................................

Wltncsses ...................................................................................................... ........................................................

Residence .............................................................................................. .......................................................

Persons who gave consent or advice ............................................................. .......................................................

(rI) Residence ..................i.................................................................... .......................................................

(b) Relation to contracting party ......................................................... .......................................................

4

WIFE

.......................................................

........................................................

........................................................

........................................................

........................................................

.................................. .....................

, Officeof fhc )

‘kceofmarriag’! :~:f1"""""""""""""""""""""""""""""""""""""""

(a) .............................................iFi.K..r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (b) ............................................7Aii.kr.................................................

THIS IS TO CERTIFY: Thatr, .................................................................................................................................................. .................... .. and

I., .................................................................................................................................... on the dute and at the place above given, of our own free will

and accord, and in the presence of the person solemnizing this marriage and of the tivv witnesses named beb w, both of age, take ●ach other ai

husband and wfc,

And I,... . .............................................................................................................. . ...................... .................... .................... .................... ................

(Position)

CERTIFY: That on thedate artdatthe place above writterc the aforesaid ..............................o...................................................................................

and .......................................................................................................................................... werewith theirmuttmfconsentbcwfullyjoinedtcyether

in holy matrimony by me in thepresence ofsaid witnesses, both ofage; and Ifurther certify that the Marriage Licercse No. .........................................,

issccedat ..............................................................................................................................

on . . .. . .. .. . .. .. . .. .. . .. . ... . . . .. .. . .. .. . . ... . .. . . .. .. . .. . .. . . .. .. .. . .. .. . 19..........

in favor of said parties, wm exhibited to me or no man-kge license was exhibited to me, this mwriage being ofanexceptional character performed

under Art. .............................. of Rep. Act 386; and that consent or advice to such marriage was duly giveri, as required by law, by the person or

persons above mentioned.

IN WITNESS WHEREOF, we si@aed, (or marked with our fingerprirct) this certificate in triphcate this ................. d~y of ....................................

19........ .

.............................................................................................

..............................................................................................

(Contracting Party) (Contracting Party)

.............................................................................................

(Judge, Justice of the Peace, Mayor, Vrie$t, Mini%t.r, etc.)

WITNESSES
Analysisof Vital Statistics

Services in Thailand

Dr. Fredhold and MS Kuhner

World Health Organization Study Mission to Thailand

March 7-27, 1977
CONTENTS

Introduction ............................................................................................................................................. 91

General kfomation ............................................................................................................................ 91

Organization of Civil Registration and Vital Statistics ............................................................................... 92

Ministry of the Intefior ........................................................................................................................ 92

Nationaf Statistical Office .................................................................................................................... 92

Ministry of Public Health ..................................................................................................................... 92

Re@stition @rtificates ............................................................................................................................ 93

Routing .............................0................................................................................................................. 93

Birth Certificate ................................................................................................................................... 95

Death Cetiificate ................................................................................................................................. 97

Stillbirth Certificate ............................................................................................................................. 99

Processing, Tabuktion, ad Pubhcation of Wtilmd Hedti Statistics ...................................................... 99

Evacuation ................................................................................................................................................. 99

Early Surveys....................................................................................................................................... 99

National Statisticrd Office Surveys....................................................................................................... 100

b&viduA Items ................................................................................................................................... 101

hproving the System ............................................................................................................................... 101

The Wpmg Health Development Project .......................................................................................... 101

Community Self-Reliance .................................................................................................................... 102

Health Planning and Management Information System ........................................................................ 103

Recommendations ..............................~..................................................................................................... 105

References ................................................................................................................................................ 106

Appendix: Forms ..................................................................................................................................... 107

LIST OF FIGURES

IV-1. Organization of health services in Thailand ..................................................................................... 93

IV-2. The vital registration reporting system in Thailand-births and deaths ............................................ 94

LIST OF TABLES

IV-1. Comparison between items included on Thai birth certificates and intemationaf standards ............ 96

IV-2. Comparison between items included on Thai death certificates and international standards ........... 97

IV-3. Comparison between items included on Thai fetal death certificates and international standards ... 98

IV-4. Estimated completeness rates of bwth and death registration by 5-year groups, 1961-69 ................ 100

IV-5. Estimated completeness rates of death registration, by sex and age ................................................ 100

89
CHAPTER IV

ANALYSIS OF VITAL STATISTICS

SERVICES IN THAILAND

Dr. Fred Arnold and Alois Kfiner

INTRODUCTION

General Information

The Kingdom of Thailand, formerly known

as Siam, is located in Southeast Asia. It has an

area of about 200,000 square miles. Thailand

has common boundaries with Burma on the west

and northwest, Laos on the north and east,

Cambodia on the southeast, and Malaysia on the

south.

Thailand’s topography is diversified with

four main geographic regions-central, northeast,

north, and south. The central region is dominated by Thailand’s most important river, the

Chao Phaya. The land is rich in alluvium and

watered by an extensive network of canals and

irrigation projects. The northeast region, a large

plateau rising about 1,000 feet above the central

plain, comprises roughly one-third of the country. Most of this land is poor and suffers either

from occasional droughts or floods depending

on the season. The topography of the plateau

makes irrigation difficult, but planned irrigation

and flood control projects on the Mekong River

should improve agricultural potential.

Northern Thailand, a region primarily of

mountains and valleys, comprises about onequarter of the Nation, The mountains, extending

north and south, are forested; the valleys between them are narrow but fertile.

The southern region, along fragment of land

stretching from ,central Thailand southward to

Malaysia, is greatly covered by rain forest.

Thailand is a tropical land, high in temperature and humidity. The climate of much of the

country is dominated by monsoons. In most

regions three seasons prevail: rainy (JuneOctober), cool (November-February), and hot

(March-May). Rainfall varies, but is generally

heaviest in the south and lightest in the northeast.

Thailand’s most important administrative

divisions are the 71 Provinces. Each Province is

headed by a Governor, who is an appointed

official responsible to the Minister of Interior.

Elected provincial assemblies enact local governmentordinances.

T’he 71 Provinces (changwats), including the

Bangkok Metropolitan Area, are further subdivided into over 530 districts (amphoes), 5,000

communes (tambols), and about 50,000 villages.

The head of the district (district officer) is

an appointed Government official who is responsible to the Governor. The village headman

is elected by the population. The village headmen of one commune elect the tambol headman

who, in turn, is responsible to the district

officer.

Waterways carry more than half of Thailand’s freight. The waterways are supplemented

by a state railway system.

In the mid-1960’s there were approximately

6,500 miles of highway. Well-built roads exist.

Most roads serve as connections between the

railways and waterways. Domestic airline service

is maintained by the Government’s Thai Airways

91
Co., Ltd., with airports at most provincial

centers. Internal mail service uses railroads and

airplanes to serve the country. Telegraph service

reaches only principal commercial and railway

centers. Radiotelegraphy is used largely for Government messages; the Government owns and

operates the radio network. Two television stations exist, one is operated by the Ministry of

.Defense and the other is operated by a semigovernmental cofioration. Telephones are

scarce.

Thailand’s population of about 46,200,000

(1979 estimate) is composed primarily of people

of Thai stock. The principal minority groups are

about 2 million ethnic Chinese located mainly in

the larger urban areas, most of whom have integrated into the Thai society; over 800,000

Malay-speaking Moslems in the southernmost

provinces; about 300,000 various hill tribes in

the north; and over 50,000 Vietnamese, mostly

in the northeast.

Thai society is predominantly rural and is

heavily concentrated in the valleys and plains of

the north, northeast, and central regions.

ORGANIZATION OF CIVIL

REGISTRATION AND

VITAL STATISTICS

Three major Government agencies are involved in civil registration and in the production

and use of vital statistics: the Ministry of the

Interior, the National Statistical Office, and the

Ministry of Public Health.

Ministry of the Interior

The People’s Registration Act of 1956 stipulates the establishment and maintenance of

population registers in all amphoes and tambols. ~

The tambol registrar, generally called the

“kamnan,” and the municipal registrar work

under the authority of the Ministry of the Interior. The kamnan keeps the original register; a

copy of all birth, death, and fetal death certificates is kept by the amphoe registrar.

According to the Registration Act, the head

of the household is required to notify the

kamnan of any vital event occurring in his household; the kamnan then issues the various certificates, after he verifies the vital event.

The district and provincial offices send to

the Ministry of the Interior summaries of information on population size according to sex once

every month. This information is kept by the

Ministry and is not further analyzed. At the end

of each year the population figures are published

by the Ministry, with a delay of only about 3

months.

National Statistical Office

In the area of civil registration and vital statistics, the work of the National Statistical Office is limited to conducting population censuses, speciaI population surveys, and analyses.

In this regard, the National Statistical Office is a

most important user of primary vital statistics—

not a producer.

This Office is also responsible for the overall

coordination and, improvement of statistics in

Thailand. Within the scope of this objective, the

National Statistical Office has conducted two

major national surveys to estimate vital rates and

evaluate the completeness of vital registration

and statistics. The results of these surveys will be

discussed later in this chapter.

Ministry of Public Health

The health services of Thailand at all levels

perform very significant functions in the registration of vital events and in the analysis and

publication of vitaI statistics.

The structure of the health services differs in

only minor aspects from the general administrative organization of the country.

The organization chart (figure IV-1 ) shows

that the overall responsibility for public health,

inchding preventive health services, lies with the

Ministry of Public Health. Each of the Provinces

as well as the Bangkok Metropolis an Area is

under the jurisdiction of a provincial chief medical officer who generally supervises:

6 The provincial hospital (with a large outpatient capacity).

. The district health offices and rural and

me&lcal health centers (MD’s, nurses, midwives, sanitarians).

92
cepts the responsibility of registration. In the

I

PROVINCIAL Office of the provincial Provincial

(CHANGWATI LEVEL chief mwflcd officer hospital

I

——J———— “—

DISTRICT I h-~h.ffi.,r ~ ~f$:::::s I

Office of the district

(AMPHOE) LEVEL

I 1

(TAMBOL) CoMM”NE LEVEL w

VILLAGE

LEVEL I

Midwifery

cmters I , 1

Figure IV-I. Organization of health services in Thailand

The health subcenters at the tambol level

(one midwife, one sanitaria).

The midwifery centers at the village level

staffed by a m“idwife prov@ing m~ly maternal and child health (MCH) services.

REGISTRATION CERTIFICATES

!’

In 1909, the registration of live births and

deaths was started in the Bangkok area; and in

1916, birth and death registration was made

mandatory throughout” Thailand. Fetal deaths

(stillbirths) were included in the registration

system in 1936. Until recently, fetal deaths were

registered by attaching a birth and death certificate together and marking them as a fetal death,

but a special fetal death (stillbirth) form is now

in use for the registration of stillbirths. The current procedures for registering vital events are

governed by the People’s Registration Act of

1956 which has been expanded since that time.

By law, births must be registered within 15

days of their occurrence, and deaths and still- ‘

births within 24 hours. The head of a household

or the mother of a baby “isresponsible for seeing -

that a birth——— is registered. For stillbirths, the reZponsibility lies with the head of the household

except when the delivery occurs outside of any

house or hospital, in which case the mother acc&e of death:, registration is‘the responsibility

of the head of the household or of the person

who finds the body.

Registration of births, deaths, and stillbirths

is on a de facto basis, that is, according to the

place of occurrence of the event rather than the

usual place of residence of the mother or the

decedent.

Routing

Registration forms for births, deaths, and

stillbirths consist of three parts for each type of

form (see appendix, “Forms”). In each case,

parts 1, 2, and 3 are identical except that part 3

contains additional information. On registration,

part 1 is given to the person who registers the

event; it constitutes the official certificate of the

event. The disposition of parts 2 and 3 depends

on the place in which the event occurs. The detailed routing of the certificates is shown in the

flowchart in figure IV-2.

There is no charge for registering a birth,

death, or stillbirth if it is registered within the

legal registration period. In the case of late registration, the registrar may assessa fine of up to

200 baht (approximately U.S. $10); the fines,

however, are often of nominal amount or else

waived completely.

Births and deaths that are reported to the

registrarare recorded as additions or deletions to

the household register as well as being recorded I

on the birth and death certificate forms. A copy

of the household register is kept by each family.

The House Registration Form used for this purpose is shown in the appendix.

Rural areas.–In nonmunicipal areas, where

85 percent of the population lives, vital events

are registered at the tambol level “with the

kamnan. The average commune comprises about

10 villages. The kamnan serves as the official

registrar for the commune, but he has many

other duties as the government’s commune representative. He returns part 1 of the certificate

to the informant and sends parts 2 and 3 plus a

summary report to the arnphoe on the 5th of

every month. In special cases, such as when the

informant cannot contact the kamnan within

the legal time limits, vital events may be registered directly at the district office. Part 2 of the

93
NONMUNICIPAL AREAS MUNICIPAL AREAS OUTSIDE BANGKOK METROPOLIS BANGKOK METROFULIS

Nonhwpital events HospiM events Nonhospifd e’mnts Hospital events

PI Event regimered

imwm!r%d-mrn)

PA 1

Parts 2&d3and

I

com mum, mmmcry

Pat 3 and dl~ct summary

p~,+q

Part 3 and munbipd summary

Notifhion P&1

form and change

I of addres$

Part ~ and

district symmary

P.m + ,. Bangkok

Metropolitan

Administmtion

Part 3 and

summary wmmary rewrt

Ministry of

the Interior

t

rpam3a””mmawr”””

Summary

reDOl-t

Figure IV-2. The vitel registration reporting system in Thailend-births and deaths
certificate is stored at the arnphoe and part 3 is

sent to the provincial chief medical officer

through the Governor, and a district summary is

passed along to the provincial office on the 15th

of each month. Up to this point, the registration

process is entirely under the control of the Ministry of the Interior. At the provincial level, the

Governor’s office makes a summary report to

the Ministry of the Interior in Bangkok, but the

Mh-iistry of the Interior does not receive the actual certificates. Once part 3 of the certificate is

turned over to the provincial chief medical officer, control of the certificates shifts to the

Ministry of Public Health. The provincial chief

medical officer checks the certificates for completeness and accuracy, paying special attention

to the cause of death on death and stillbirth

certificates. On the 25th of the month following

receipt of the forms, the provincial chief medical

‘ officer is required to send a summary report plus

part 3 of all certificates received to the Ministry

of Public Health in Bangkok for processing and

publication. This is the general procedure for

registration, although the practice may differ

slightly from one area to another and delays are

often encountered in meeting the schedule.

Municipal areas.–Registration procedures

are similar in municipal areas except that events

are initially registered at a slightly higher administrative level. In municipal areas outside of

the Bangkok Metropolis, births, deaths, and stillbirths are registered directly at the municipality

office. As always, part 1 of the certificate is returned to the informant. Part 2 is stored at the

municipality office and part 3 plus a municipal

summary is sent to the provincial office changwat. From there the documents follow the same

course discussed earlier.

In the Bangkok Metropolis, events are registered at the district office. Part 1 is returned to

the informant; part 2 is retained at the district

office; part 3 is sent to the Bangkok Metropolitan Administration. From there, part 3 plus a

summary report goes directly to the Ministry of

Public Health, and a separate summary report

goes to the Ministry of the Interior.

For events that occur in a hospital, a notification form is filled out and sent to the district

office or the municipality office. These forms

are the responsibility of the medical records officer or other hospital personnel. In the larger

hospitals, the forms are normally delivered by

hospital personnel on a daily basis. The notification forms contain most of the same information as the certificates of events, but there are

minor differences. The registrar issues a certificate for the event, returns part 1 to the informant, and, in the case of births, also issues a form

for changing the baby’s address from the hospi’-

tal to the usual place of residence. In some cases,

hospital personnel will receive these forms for

transmittal to the mother or a relative at the

hospital. In other cases, the mother of a newborn child will also be given a separate card advising her to take the card to the district or

municipality office in order to obtain the birth

certificate and the change of address form to

change the baby’s address from the hospital to

the place of usual residence. An example of the

card used for this purpose by Chukdongkorn

Hospital in Bangkok is shown in the appendix.

Detailed information collected on birth,

death, and stillbirth certificates basically conforms to first-priority international standards

and includes many items from the second-priority international recommendations as well (see

tables IV-1, IV-2, and IV-3). In addition, the

Thai certificates include a large number of country-specific items that do not appear in the international recommendations.

Birth Certificate

The birth certificate contains items characteristic of the event itself (e.g., date and place of

occurrence); demographic and physical characteristics of the child; fairly detailed characteristics of the parents; and information about the

informant and the attendant at birth. Information is also collected on any illness the mother

may have suffered due to pregnancy, delivery, or

other factors. In alI cases, the baby’s name must

be recorded at the time of registration no matter

who registers the birth. The name may then be

changed at any time within 6 months of the

registration date without charge. The birth cerfi~e consists of three parts. Parts 1 and 2 are

half a page long and contain identical information. Part 3 is a full page with the same

information as the previous parts on the top half

plus more detailed information on the bottom

half. Carbon paper is used so that parts 1 and 2

plus the top half of part 3 need to be filled out

95
Table IV-1. Comparison betwean items included on Thai birth certificates and international standards

Characteristic

Event

Date of occurrence ..................................................................................................................

Date of registration .................................................................................................................

Place of acurrence .................................................................................................................

Type of birth (single or multiple issue)....................................................................................

Type of attendent at titih .......................................................................................................

Name and address of attendant at birth ...................................................................................

Hospitalization ........................................................................................................................

Child

sex ..........................................................................................................................................

Legitimacy status ....................................................................................................................

Weight at birth ........................................................................................................................

Height at birth .........................................................................................................................

Gestational aga ........................................................................................................................

Nationality ..............................................................................................................................

Injurad dua to delivary? ..........................................................................................................

Abnormal body .......................................................................................................................

Mother

Age ..........................................................................................................................................

Children born alive during mothar’s Iifatime ...........................................................................

Children still living ..................................................................................................................

Fetak deaths during mother’s lifetime ......................................................................................

Number of children born alive who died .................................................................................

Birth order ..............................................................................................................................

Interval since last pravious live Mrth ...................................................... ..................................

Duration of marriage ...............................................................................................................

Education attainment ..............................................................................................................

Literacy status .........................................................................................................................

Ethnic group ...........................................................................................................................

Religion ...................................................................................................................................

Citizenship ..............................................................................................................................

Type of economic activity .......................................................................................................

Occupation ..............................................................................................................................

Placa of usual residence ...........................................................................................................

Duration of residence in usual (prasent) Place ........................................................................-

Place of residence at a specified time in the pest .....................................................................

Place of ti~h ...........................................................................................................................

Illness of mother due to pregnancy .........................................................................................

Illness of mother not due to pregnancy ................................................................. ..................

Illness of mother due to delivery .............................................................................................

Special delivery .......................................................................................................................

Father

Age ..........................................................................................................................................

Educational attainment ...........................................................................................................

Literwy status .........................................................................................................................

Ethnic group .................... .......................................................................................................

Religion ...................................................................................................................................

Citizenship ..............................................................................................................................

Type of economic activity .......................................................................................................

Occupation ..............................................................................................................................

Place of usual residanca ...........................................................................................................

Duration of residence in usual place ........................................................................................

Place of residence at a specified time in the past .....................................................................

Place of Mrth ...........................................................................................................................

Thailand

certificate

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

‘irst priority

nternational

standerds

x

x

x

x

x

x

x

x

x

x

x

x

x

Expanded

international

commendations

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

1

x

x

x

x

x

NOTE: The international standards do not include information on registration number, place of registration, characteristics of the registrar,

characteristic of the informant, or names of the principal people invoIved. Therefore, these items have not been included in the table.

Source of international standards: Reference 1.

96
Table IV-2. Comparison between items included on Thai death certificates and international standards

Characteristic

Event

Date of occurrence .......o.............o.............o.........o...........................o........................................

Date of registration .................................................................................................................

Plaoa of occurrence .........................................................$.......................................................

CaUstrof death .,,,,,.,.,.,,..., ,.,,,,,.,,.,..,.,.,!,. ,,.,.,!!.,.! ......!......,,.. ,...:.,,.,.,,.,., ,,...,,. ...........................!

Tvpe of certifier .0.,,.................................................................................................................

Name and address of certifiar ,,.,,!,,,.,,,,,...,., ,,..,.,!,..,,,,,.,,, ,.,,,.,.,,.,,,,,.,.! ,,,..,, ,,.,,..,,.,.,., .......!!..,,..

Attendant at birth (for daeths under 1 year of age) ................................................................

Ilospitallzation ....o.....................o..o..ot..e...................................................................................

Major symptoms of illness .......................................................................................................

Duration of illness ...................................................................................................................

Disposal of the corpse ,,,,,..,,,.,.,,,,,,,,.,,..,,.,,,,,,.,,,,,..,...,,.,....,.....,.,,,,,,.,,..,...,,..,,..,,,,.,,.,,.,..,,......,

Performance of autopsy ......................................+........o.............f.............................o..........$...

Decedent

Age.,,...!.,,,,.,.,,,,,.,..,.,,.,,,,, ... ,.,.,.,,,,,,,,.,,..................,.......0....!.!,.............. .................................

Age of surviving spouse (for married) ......................................................................................

sex ,,,.,,.,.,.,,,,,,,,.,,,,,,..!...!,,,,,.,,. ,..!.,.,,..,!,,..,,, .,..!..,,.,,,.,,,,,, ,,..,...,,.!,... !,,.., .,,,,,..,,.,.!,..,.,.. !..........!

Merital status...........................................................................................................................

Duratirrn of marriage ...............................................................................................................

Children born alive (for females of childbearing age and over) ................................................

Children still living (for females of childbearing age and over) .................................................

Educational attainment ...........................................................................................................

Literacy status ...................1........o...................................o.......oo...............................................

Ethnic wou~ ...........................................................................................................................

Rellgio; ...................................................................................................................................

Citizenship ..............................................................................................................................

Was birth registered? (for deaths undar 1 year of age).............................................................

Legitimacy status (for deaths under 1 year of age)..................................................................

Type of economic activity .......................................................................................................

~cupation .............................................. ................................................................................

Place of usuel residence ...........................................................................................................

Place of residence at a spacified tima in the past .....................................................................

Plaoa of birth .................................................................................................................!.........

Duration of stay at place of death ..................................,..!...............................,...!...?.,,.... ,...,,

Decedent’s parents

Father’s citizenship .................................................................................................................

Mother’s citizenship ................................................................................................................

Fathsk’s plaae of birth ........................................................................................O....................

Mother’s pleoe of birth .................!....!.,.,.,..,.. ...............................!.! ........................................

Father'$ occupation,,,,,,,,.,,.,.,,.,.,..,.,,....,.,,.,,,..,.,,..,,,.,...,,....,,,,,,,,..,.,....,...,,......,.......,......,...,,...

Mother’s uoupation ................................................................................................................

Thailand

death

certificate

.x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

First Rriority

international

etandar&’

x

x

x

x

x

x

x

x

x

Expanded

international

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

NOTE: The brternntirrnal standards do not include information on registration number, place of registration, characteristics of the registrar,

characteristics of the informtmt, or names of the principal people involved. Therefore, the= item$ have not been included in the table,

Source of international stondards: Reference 1.

only once, The detailed information in part 3 is

likely to be less completely filled out than the

other parts, particularly if the birth occurs

outside of a hospital or if the informant is not

the baby’s mother or father.

Death Certificate

The death certificate contains items charao

teristic of the event itself, detailed characteristics of the decedent, some characteristics of the

decedent’s parents, and information about the

informant and the certifier of the death. The

cause of death is recorded and coded according

to the International Classification of Diseases,

1965 Revision. The death certificate also contains information about whether an autopsy was

performed and how the body was disposed of.

The three.part format is similar to that just described for birth certificates.

97
Table IV-3. Comparisonbetween items included on Thai fetal deeth certificates and international standards

Characteristic

Event

Dete of occurrence (of fetel &livery )......................................................................................

Date of registration .................................................................................................................

Piece of occurrence .................................................................................................................

Type of birth (singleor multiple i~ue) ....................................................................................

Attendent at birth ...................................................................................................................

Type of certifier ......................................................................................................................

Neme and address of certifier ..................................................................................................

Cause of fetal &ath .................................................................................................................

Time of death (in relation to delivery) ....................................................................................

Hospitalization ........................................................................................................................

Method of delivery ..................................................................................................................

Autopsy performed? ...............................................................................................................

Important symptoms (of mother and stillborn child) ..............................................................

Disposal of corpse ...................................................................................................................

Fetus

Legitimwy status ,!..................................................................................................................

Weight at &liveW ....................................................................................................................

Height at delivary ....................................................................................................................

Gestational age ........................................................................................................................

Abnormal at tirth? ..................................................................................................................

Wounded due to &livery ?.......................................................................................................

Mother

AW ..........................................................................................................................................

Children born alive during entire lifetime of mother ...............................................................

Children still living ..................................................................................................................

Fetal deaths during entire lifetime of mother ..........................................................................

Total number of pregnancies ...................................................................................................

Number of children born alive who died .................................................................................

Number of childran who died before 28 weeks .......................................................................

Duration of marria@ ...............................................................................................................

Educational attainment ...........................................................................................................

Literacy stitus .........................................................................................................................

Ethnic group ...........................................................................................................................

Religion ...................................................................................................................................

Gtizanship ..............................................................................................................................

Type of economic wtivity .......................................................................................................

Placa.of usual residenca ...........................................................................................................

Type of last pravious deiivery (singla or multiple) ...................................................................

Outcoma of last previous delivery ...........................................................................................

Date of last previous delivery ..................................................................................................

Oelivery order .........................................................................................................................

Fathar

E~ucational attiinmmt ...........................................................................................................

Literacy smtus .........................................................................................................................

Ethnic group ...........................................................................................................................

Religim ...................................................................................................................................

Citizenship ..............................................................................................................................

Type of aconomic ectiviW .......................................................................................................

Ocwpation ............................................................................................................................. .

Place of usual r~i&nca ...........................................................................................................

Plwa of birth ................................................................................................. ........................,

Thailand

‘etel death

certificate

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

First priority

international

standards

x

x

x

x

x

x

x

x

x

x

x

x

Exoended

international

racommandatlons

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

NOTE: The international standards do not include information on registration number, place of registration, characteristics of the registrar,

characteristics of the informant, or names of the principal people involved. Therefore, these items have not been included in the tuble.

Source of international standards: Reference 1.
Stillbirth Certificate

The stillbirth certificate contains many’ of

the same items that appear on the birth certificate and the death certificate. The certificate is

divided into only two parts, because no copy is

kept at the district or municipality office.

PROCESSING, TABULATION, AND

PUBLICATION OF VITAL AND

HEALTH STATISTICS

In a previous section, it was pointed out that

vital registration data are collected by the

Ministry of the Interior and the vital and health

statistics division of the Ministry of Public

Health. However, only the latter makes use of

the information for further analysis, processing,

and publication. This information is received at

the national level in the form of provincial

summaries by sex and age mid individual certificates of birth, death, and stillbirth. These

information sources are supplemented by

monthly reports on communicable diseases from

the Division of Communicable Disease Control

of the Ministry of Public Health and the

Bangkok Metropolitan Area.

Although the individual certificates are used

only to spot check the summary reports and for

special studies mostly for’ internal dktribution

within the Ministry of Public Health, the summary reports serve as a basis for the preparation

of numerous tables. The processing equipment

at present available to the Ministry of Public

Health for these purposes, and rented from

International Business Machines (IBM), includes

“ three numeric card punchers (IBM-029), two

immeric card verifiers (IBM-059), and one card

sorter (IBM-083).

Tabulation is done for a variety of purposes

but only a set of minimum standard tables is

published in the annual Public Health Statistics

volume. Unfortunately, there is at present a

delay of about 3 years in publication of data.

The importance of vital statistics as a basis

for the statistics published in this volume is

clearly shown; over 90 percent of the information published is based on data of vital events:

number and rates of live births, infant deaths,

maternal deaths, and stillbirths, and deaths by

age and sex. Stillbirths are tabulated by sex,,

region, and age of mother. The causes of death

are presented as numbers and rates by sex and

age according to the A-list of the International

Classification of Diseases. The number and rates

of perinatal deaths are calculated from stillbirths

plus deaths during the first week of life. Four

main groups of causes of maternal deaths are

indicated: Complications of pregnancy (International Classification of Diseases numbers

630-639), Abortion (640-645), Complications of

delivery (650-662), and Complications of the

puerperium (670-678). All birth, death, stillbirth, and perinatal death rates are shown ‘as””

reported and as adjusted for underregistration;

the adjustment methods are clearly explained.

In addition, the National Statistical Office is

an important user of primary vital statistics

because its work is limited to conducting population censuses; special population surveys, and

analyses.

EVALUATION

Of the 36 countries in the Asian and Pacific

region, only 9 countries (or 25 percent) can be

considered to maintii.in “reasonably complete”

ti~al statistics. Although Thailand is among the

27 countries with inadequate vital statistics, its

vital registration system must be regarded as

relatively well developed. Several attempts have

been made to estimate the completeness of

Thailand’s vital statistics by comparing the

registered rates with independent estimates or

through special surveys conducted by the National Statistical Office.

Early Surveys

Das Gupta et al.z estimated that in 1960

birth registration was “75-76 percent complete

and death registration was 57-61 percent complete. A more recent study presents estimates of

the completeness of birth and death registration

in Thailand from the early days of registration

until 1970 (table IV-4).3 The estimated number

of births, on which the completeness rate of the
Tabla IV4. Estimated completeness ratas of births and death

registration by 5-year groups, 1919-69

8irth registration

Registration

pariod

1920-24

1925-28

1930-34

1935-39

194044

1845-49

1950-54

1955-58

1660-64

1865-69

ParCant

53.6

57.4

69.2

75.9

87.3

60.6

63.7

70.3

“82.9

63.7

Death registration

Registration

period

1918-28

1926-36

183746

1847-58

1%0-69

Percent

completion

47.1

58.3

74.7

62.0

70.1

NOTE: The comuleteneas rates have been calculated from

estimated and registered buths and deaths obtained from a

monograph on the population of Thailand to be published b

the Economic and Social CommiAon for Ada and the Pacific.3

birth registration k based, was calculated by

applying the reverse survival method to various

censuses in Thailand. Deaths were then estimated using the balancing equation. The results

show a steady increase in the completeness of

birth registration from a level of 54 percent in

1920-24 to 87 percent in 1940-44. This was

followed by a sharp drop in the following

decade, possibly due in part to disruptions

during World War II and the postwar period.

Thereafter, birth registration improved to a

completeness rate of 83-84 percent between

1960 and 1969. Death registration followed the

same general pattern of improvement over time

(except in the postwar years); underregistration

was always higher for deaths than for births. In

the initial period, 1919-29, it was estimated that

fewer than half of all deaths were registered, but

by 1960-70 it was estimated that over 70

percent of deaths were registered.

National Statistical Office Surveys

The National Statistical Office has conducted two major nationwide studies (Surveys

of Population Change) with the dual purpose of

estimating vital rates for Thailand and evaluating

the completeness of vital registration. The first

of theseA was conducted in 1964-67, in cooperation with the Ministry of the Interior and the

Ministry of Public Health. A sample of 302

villages and 17 municipal blocks was chosen

from the whole country excluding BangkokThonburi. Every household in the sample area

was visited four times a year, and interviewers

recorded all changes in household composition

between interviews that were due to births,

deaths, or migration. Births and deaths found in

the survey were matched with births and deaths

that were registered in the same sample areas. In

this way it was possible to see what percent of

events found in the survey had been reported

and duly registered.

First Suwey of Population Change.–Results

for all 3 years of the first Survey of Population

Change have been published,4 but the first-year

results (1964-65) are generally considered to be

the most reliable. The first-year findings have

been widely cited, and it is these results that

will’ be” discussed. The Survey estimated that

about 15 percent of births and 30 percent of

deaths had not been registered in the official

system, based on crude birth and death rates

from the Survey and the official registration.

However, when the actual number of ‘registered

events was compared with those estimated by

the Survey, the underregistration rates were

somewhat higher—16 percent for births and 37

percent for deaths. Among births there was little

variation in the proportion registered according

to the age of the mother or the sex of the baby.

However, deaths of males were more completely

registered than deaths of females; and the

proportion registered varied substantially by the

age of the decedent. Underregistration of deaths

was particularly severe for deaths under 1 year

of age as shown in table IV-5.

Second Survey of Population Change.–The

Survey was repeated in 1974-75 using a sample

drawn from the entire country including

Tabla IV-5. Estimatad completeness rates of death registration,

sex

Male........................

Female ....................

by sex and age

IITotal Under 1-9

1 year years

60

10-59 yaars

years and

over

PerCant

69.6 78.8 76.7

60.0 58.8 69.1 68.6

100
Bangkok-Thonburi. Prelim-maryresults fkom the

first year of the Survey indicate that registration

is substantially more complete in municipal

areas than in nonmunicipal areas.b For municipal and nonmunicipal areas together, birth registration was estimated to be 70 percent complete

and death registration was estimated to be 59

percent complete. These estimates of completeness are considerably lower than those made 10

years earlier in the first Survey, particularly in

the case of births.

Although the new figures suggest some

deterioration in completeness of vital registration in Thailand between 1964-65 and 1974-75,

that conclusion may not be entirely warranted

for a number of reasons. First of all, the new

estimates are preliminary and they represent the

results from only the first year of the Survey.

Second, both Surveys are subject to some degree

of sampling error &d, there~ore, small chdges

in the completeness rates may not indicate any

real change in the adequacy of the vital registration system. Nevertheless, even a cautious interpretation of the results would suggest that there

was probably no significant improvement in the

completeness of vital statistics during the decade

following 1964-65.

Supplementary Survey. -In 1966, as a supplement to the first Survey of Population

Change, a special survey was conducted to

obtain information about knowledge of, attitudes toward, and practice concerning registration of vital events, as weli & reasons why

people did not register events.G A major goal of

the survey was to make use of the results to

improve the registration system. The survey

found that the legal regulations for registering

births and deaths were generzdly understood by

the respondents. Over 90 percent correctly

answered that events must be reported to the

kamnan or at the municipality offices. The

majority also knew whose responsibility it is to

register,, events and approximately within what

time period events——should be registered. The

majority” also knew that no fee is charged for

registration and that no- documents have to be

taken to the registrar. However, there was

considerable misunderstanding of the correct

procedure for registering events that occur outside the tambol of usual residence. Only onethird of respondents knew that such events

should be reported to the registration office

where the event occurred. Failure to register

events was evidently due to a lack of motivation

on the part of the informant rather than to a

lack of understanding or because registering the

event was inconvenient. The registrars sometimes underestimated the need to record all

events within the specified period of time. The

supplementary Survey showed that the maintenance of vital registration records was often

given low priority because registrars were overburdened with a variety of other tasks.

Individual Items

Although a good deal of attention has been

given to the completeness of registering vital

events, somewhat less attention has been paid to

the completeness or accuracy of individual items

on the registration certificates. It should be

recognized that the registration certificates are

lengthy and that the informant may not know

aIl the detailed information that is requested.

Therefore, various items are often Ieft bkmk,

particularly on part 3 of the certificate. In

addition, the recording of cause of death is

paiticularIy problematic because most deaths are

not certified “by a qualified doctor. The 1972

figures show that 35.4 percent of deaths are

caused by iII-defined and unknown causes and

another 17.7 percent are caused by senility.

Because only 16.2 percent of all deaths in 1972

occurred in a hospitaI, it is unlikeIy that the

overall figures can be improved substantially in

the near future.

IMPROVING THE SYSTEM

The Lampang Health Development Project

One major geographically limited project–

the Lampang Health Development Project–

deserves to be described briefly because one of

its principal objectives is to develop the information bases for health services development and

evaluation:

“The Lampang Project aims to improve the

general level of health of the rural population through the innovative development

and evaluation of a low-cost integrated

101
health delivery system which will effectively

reach and serve at least two-thirds of the

target population within the resources available to the Royal Thai Government.”7

In this Project the following approaches have

been emphasized:

(a) Integration of all provincial medical/

health care infrastructure for improved

efficiency and effectiveness.

(b) Training and development of large

cadres of volunteer health workers:

health communicators, health post

volunteers, and traditional midwives.

(c) Training and deployment of intermediate level medical health care providers,

paraphysicians called “wechakorn.”

(d) Promotion of community involvement

through village adjunct committees and

health committees at every administrative level, and other features.

The Project is a pilot project because its

expected outcome is that the key features and

innovations that are”tested and found effective

will be adopted by the Ministry of Public Health

and the Royal Thai Government for replication

throughout the Kingdom of Thailand.

The approaches just cited suggest the creation of innovative, information-collecting mechanisms and the strengthening of the existing

ones. Particularly in the case of vital statistics

(i.e., indicator data based on vital events and

population figures), collection of information

has become an end in itself, rather than a

support to more effective planning and management of social services, among which are the

health services. Incidentally, much information

is collected at present, but little analysis or

effective use is made of it especially at the

provincial level.

If there are many unmet needs of the users

of vital statistics and health information, this is

due to shortcomings mainly at the primary local

data collection or registration level. Furthermore, ~ was explained earlier in this chapter,

the information collected and made available is

often unreliable. This is particularly true of the

number of deaths and even more of the causes

of death. If death registration is unsatisfactory,

the causes of death, which constitute essential

information for health planning and evaluation

of the health services, are often not shown, not

certified, and ill defined.

Considering the small amount of analysis

made at the provincial level and the lack of

feedback in some adequate form to the producers/users of the information, the provinces

are faced with a relative information overload.

Because the Lampang Project is a project of

development at the rural provincial level, where

operational management and planning decisions

should be made, its objective is to concentrate

most of the information activities at this provincial level, particularly the analytical functions, in support of planning and management.

It is, of course, only legitimate to speak of

“information overload” or of “the inadequacy

of the data for planning and decisionmaking” if

one has clearly defined the scope of the decisions to be taken and the expected results of

such decisionmaking; in other words, if the

information requirements are known in detail.

Increased analytical activity at the provincial

level does not necessarily mean information

processing by electronic computer. Such equip- -

ment is generally not available at the provincial

levels; it may also be inappropriate at present.

Vital statistics for use in the health information

system would have to be analyzed and tabulated

at this level. This will create a number of

additional statistical activities at the provincial

level; the understaffed provincial statistical offices cannot cope at present with additional

activities.

Community Self-Reliance

At present, one Project approach focuses on

community self-reliance and an increased social

motivation of the population. The creation and

training of three types of community health

volunteers—health communicators, traditional

midwives, and health post volunteers–may be

expected to improve the registration of births,

stillbirths, and deaths. The health communicators are the most important addition to the

vital and health information system, because

their primary function is to collect and disseminate information in the village. The role of the

102
traditional midwife as a motivator for registration and informant of vital events, however,

cannot be rated too highly, especially if we

consider that approximately 60 percent of all

deliveries are attended by these midwives. The

health post volunteer who provides first aid and

treatment of simple illnesses, health education,

and family planning supplies cooperates with the

communicators and viIIage midwives and reports

monthly to the district health officer who in

turn sends consolidated reports to the provincial

chief medical officer.

Because the officizd registration system of

reporting births, stillbirths, and deaths to the

Ministry of the Interior does not meet the

requirements of the Project in respect to reliability of the information registered and reported,

the Project’s own “parallel” network of village

volunteers is gathering vital events data. These

data were already compared with the official

registration data, and some significant differences were noted. These differences could be

due to events, such as births and deaths,

occurring in districts other than the usual place

of residence and for which the address was not

changed and the household register card not

brought up to date. That means that for a

certain commune, the official registration data

may be lower or higher than the events entered

on the household register card or which were

reported by the health communicators.

The village volunteers probably cannot be

asked to be responsible for routine reporting

because they normaIly will be ordy part-time

workers. This might prove a major shortcoming.

Another drawback might be the illiteracy of

many of the traditional midwives who generally

report verb~Iy to the Government midwife who,

in turn, puts the information into written form.

Every month, the reports on vital events

collected by the volunteers are sent to the

district offices and from there to the provincial

office. At this level, information is supposed to

be fed back to the various divisions of the

provincial office where it may be used for

planning and evaluation purposes. At the village

level there is no such feedback mechanism to the

volunteers. For the volunteer, however, the

regular visit of the Government health worker

may be sufficient to discuss the work and solve

problems that arise.

Training of alI workers at all levels of the

vital and health statistics system is one of the

crucial tasks that has to be planned caxefully and

carried out systematically.

The question of whether the prototype

information system can be replicated in any

other Province is difficult to answer at this stage.

However, if we assume that in other Provinces

the information needs are similar to the needs in

the Lampang Province, that the same standardized information documents are used, and the

information flows are identical, then the principles developed for the Lampang information

system can easily be applied to other Provinces,

with certain adjustments. Taking into account

the user orientation of modern information

systems, it is the planners, administrators, and

decisionmakers who will determine for each

Province the most urgent information requirements.

Health Planning and Management Information

System

The new health planning and management

information system started in 1975 is designed

to support all planning, management, monitoring, and evaluation efforts undertaken within

the framework of the Fourth Five-Year National

Economic and Social Development Plan (1977-

81). In this report, ondy a concise description

can be provided, outlining the main features of a

system that will at the same time generate and

use vital statistics information. The main objectives of this project that, in its first phase, is

being introduced in 20 Provinces, are as follows:

To coordinate the collection and processing

of aU health and health-related information

in order to make the system as effective and

efficient as possible.

To provide information support for

planning, management, monitoring, and evaluation efforts of National Health”Development Projects within the framework of the

Fourth Five-Year Development Plan and to

cooperate closely with development project

teams.

To encourage training of various categories

of health personnel at all levels, including

village health volunteers and communicators.

103
To improve the existing statistical information in terms of quality, reliability, promptness, completeness, timeliness, and specificity. The project particularly emphasizes the

need for more complete and reliable vital

registration data and vital statistics and aims

to improve the registration of births and

deaths. The project also intends to accelerate

and improve the reporting system of all

health institutions in respect to morbidity.

To develop the epidemiological surveillance

network and its reporting system from the

village level to the national level and accelerate the notification of communicable

diseases so that prompt action can be taken.

To suggest revisions in the legislation concerning vital statistics according to the

recommendations of the proposed Advisory

Committee for Vital Statistics. ,

To recommend revision of thd design of

recording and reporting systems as proposed

by the Advisory Committee for Vkl Statistics.

GoaZs.-The first goal of the proposed

project is to increase completeness of vital

registration from 85 percent to 95 percent. for

births and from 70 percent to 80 percent for

deaths.

Other goals include complete reporting of

communicable diseases, especially notifiable

diseases, and of resource utilization.

Structural changes.–Some important structural changes are suggested:

Establishment in the Ministry of Public

Health of a central information center that

would assume the functions of the Health

Statistics Division and be placed under the

direct responsibility of the Undersecretary

of State for Public Health.

Establishment of an advisory committee for

vital statistics.

Coordination of the functions of the Central

Information Center with the activities of the

Health Planning Division and the Epidemiological Surveillance Division.

Training of a--large number of health

personnel.

Operational measures.–The innovation in

the proposed system is the decentralization from

the Ministry of Public Health to the provincial

health offices of statistical processing and analysis of information received by the district

health office. This conforms to the suggestion to

bring the entire planning and management system “closer” to the population. The advantages

of such decentralization are obvious:

Better contact with the information sources

and easier verification and rectification of

data.

A possible gain in specificity, completeness,

and quality of information.

The cost of such decentralization and the

intensive training efforts might prove a major

drawback.

The provincial information center, previously

the statistics unit, will collect all information

from the district offices, provincial hospitals,

district hospitals, medical and health service

centers, and other health units in the Province,

municipality, and the private sector. The decentralization of the information processing and

analysis functions to the Provinces follows the

decentralization of planning at the provincial

level which the information system has to

support.

Summaries of the processed and analyzed

information will be sent to the Central Information Center, and feedback distribution of the

processed and analyzed information to the

provincial services will be secured.

At the central level, the Central Information

Center will still be carrying out its functions of

processing and analysis. However, in the future,

this analysis will be based on information

already processed, analyzed, and verified by the

20 Provinces included in the project. In addition

to the provincial information, the Central Information Center will receive information from

other central health institutions, public health

services, state enterprises, and the private sector.

The Center will verify the information and store

it for annual publication. At this stage, the

information can then be used for health

plannirig, monitoring,

‘health development

and evaluation of the

projects. Furthermore,

104
essential parts of the information can be fed

back to the services that have provided the basic

data.

Another feature and responsibility of the

Central Information Center is to cooperate

closely in information exchange with other

information producers and users, such as the

National Statistical Office and the National

Economic and Social Development Board.

RECOMMENDATIONS

According to the current 5-year plan, discussgd earlier in this chapter, the goals for

completeness rates for vital statistics by 1981

are 95 percent for births and 80 percent for

deaths. If these goals are to be achieved, a

concerted effort toward improvement will have

to be launched by all agencies concerned with

vital statistics collection and processing. Several

efforts along these Iines are currently being

initiated or are planned for the near future.

Among these are:

An intensive newspaper, radio, and television

publicity campaign by the Ministry of the

Interior to explain the importance of registering vital events.

Refresher courses for civil registrars at the

,district (amphoe) and commune (tarnbol)

levels that emphasize the importance of vital

registration, demonstrate methods of filling

@ certificates, and discuss problems encountered in registration (such courses were

conducted by the Ministry of the Interior in

1973-75 and might be conducted again by

the Ministry of Public Health).

Development of a system by the Ministry of

the Interior for grading registrars on the

basis of their promptness in turning in forms

and the completeness of the forms.

The system of health post volunteers and

communic-ators discussed earlier.

Various innovative programs on the local

level such as door-to-door campaigns to

register vital events

ernment services.

and provide other govIn addition to these very worthwhile efforts,

a number of other activities are suggested for

improving vital statistics in Thailand. As it was

not possible for the study team to understand

fully some of the features of Thailand’s complex

vital registration system during its short stay in

Thailand, no specific recommendations were

formulated. Rather the items that follow are

proposed as possible topics for discussion among

personnel in Thailand who are concerned with

vital registration and vital statistics:

The present considerable delays in the collection, processing, and publication of vital

statistics might be shortened by applying the

following procedures:

Strict observation of reporting schedules

at all levels of the system including

cutoff dates in order not to delay publication of the information.

Publication of preliminary data on

births, deaths, and stillbirths on an annual or even a quarterly basis. Final

results would be published in subsequent

reports.

A selection of only the most useful items

of information. It may not be necessary

or useful to code and key punch all

items from the registration certificates

every year, particularly items not currently analyzed and published.

By applying scientific sampling methods,

less than 50 percent of the birth certificates may be included in the sample.

Sampling of death certificates should

ako be explored.

Separate analytical studies based on the vital

statistics information should be encouraged.

The proposed information system for health

planning, management, monitoring, and evaluation should provide a mechanism for

establishing regidar contacts between information producers and users (such as planners

and administrators) so that the information

available will meet the planning and management requirements.

105
The proposed decentralization of theamdysis and processing functions from the na- .

tional to the provincial level would have

many advantages, as discussed earlier. However, the successful implementation of this

proposal depends on the thorough training

of provincial staff and close supervision by

the Ministry of Public Health. For the

purpose of standardization, guidelines for

training the staff should be prepared.

Continued evaluation of the completeness

and accuracy of vital statistics is necessarj.

A repetition of the Survey of Population

Change by the National Statistical Office

after the 1980 census is recommended. It

would also be worthwhile for the Ministry of

Public Health to conduct specific evaluation

studies.

The proposed information system for health

planning, management, monitoring, and evaluation recommends the introduction of a lay

reporting system, particularly for use by

village volunteers. This system is based on a

classification of symptoms and is designed to

facilitate the reporting of causes of death

and to improve the cause-of-death statistics.

In order to ensure the successful application

of the system, village volunteers and local

health workers would be trained in the

appropriate use of the lay classification.

Training manuals and guidelines will have to

be developed.

REFERENCES

lDepartment of Economic and Social Affairs:

l%inci@es and Recommen&tions for a Vital Statistics.

System. Statisticalpapers,SeriesM, No. 19, Rev. 1. New

York. United Nations, 197%

2Ds+s Gupta, A., Choteehanapibal, S., Chalothorn,

T., and Siripak, W.: Population perspective of Thailand.

Sankya: Indian J. Stat. Series B. 27 (1 and 2): 1-46,

1965.

3Economic ~d so~~l Commiggion for Asia ad the

Pacific:’ Popukztion of Thaikand ESCAP Country Monograph. Series No. 3. Bangkok. United Nations. 1976.

4National Statistical Office: The Survey of Population Change, 1964.67. Bangkok. Office of the Prime

Minister, 1969.

5National Statistical Office: 2%e Suroey of Po@dation Change, 1974-75. Preliminary report. Bangkok.

Office of the PrimeMinister,1977.

6Natiqnal Statistical Office: The Survey of Population Changes. Supplementary Survey on Knowledge of,

Attitude Toward, and .?%ctice Concerning Official Reg.

istration of Births and Deaths, Mar. 21-Apr. 22, 1966.

Bangkok. Office of the ~lme Minister, 1969. I

7~is@ of pubfic Health: Development and

Evaluation of an Integrated Health Delivery System in

Thailand. Lampang Project, Provincial Chief Medical

Officer, Lampang, Thailand, 1976.

106
APPENDIX

CONTENTS

Forms

Reproduction of Birth Certificate-Parts 1,2, and 3............................................................................ 108

Reproduction of Death Certificate-Parts 1,2, and 3 .......................................................................... 109

Reproduction of Stillbirth Ccrtitkate-Parts 1 and 2............................................................................ 110

Reproduction of Medical Certificate of Cause of Deati ....................................................................... 111

107
of Birth Certificate-Parts

Note: Parts 1 & 2 are identical to this

Office of the registrar -------

APPENDIX

1, 2, and 3

B1RTH CERTI FICATE

Part 3

No. 1

. . . . . . . .

1. 1.1 First Name Family Name 1.2 sex 1.3 Nationality

MaIc Female

❑ ID

1.4 Date of birth (Day, month, year) Time Month Year

why Lunar calendar

‘“c’c& ‘&

1.5 Place of birth (house No., village No.. lane, scrcct) Comm.nc, district, province Country

2. 2.1 First Name Maiden Name 2.2 Agc 2.3 Nationality

Mother

Years

2.4 Place of rcsidencc House No. village No, Commune, District, Province

mm. as place of lane. street

birth of baby ❑

3< 3.1 First Name Family Name 3.2 Agc 3.3 Nationality

Father Years

4. 4.1 First Name 4.2 Address (House No, village No. Ian., street, commune, district,

province)

Informant 4.3 Relationship 4.4 signature of informant

Household

Father Mother Official

Attendant other

head at delivery

•1 ❑ 0 ❑ ❑ ❑

5. Date of registration (day. month, year) 6. Date of change of name (day, month, year)

7. Signature of registrar 8. Si8nature of registrar for chan8c of name

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( ) ( )

Registrar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Registrar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. 9.1 Place of birch 9.2 Reli$on

Mother Provinm. countrg

9“3 ‘~::dc •1 ‘“”C %4 Occupation

10. 10.1 Place of birth 10.2 Religion

Father Province. country

10’3 ~;;;, ❑ ‘“”C

10,4 Occupation

11. Father’s usual place of residence Ad&ess (House No., village No., lane, street. cormnu”c. district. province)

Same as Baby’s place

Mother’s •1 of birth •1 11.1111

12. 12.1 Single birth 12.2 Multifdc birth 12.3 Birth order

•1 Twins ❑ Three ❑ Four ❑ OncaTwoD Threen Fo”rn

12.4 Parity 12.5 Duration of Gestation 12.6 Wci8ht 12.7 Height

Months H Weeks ❑ Grams

[Ill Centimeters

12,8 Injury due to delivery 12.9 Abnormal body

❑ Yes ❑ No r No❑ Y,,❑ r

13. 13.1 Illness d“. m pregnancy 13.2 Illness “m due toprcg”ancy

❑ Yes ❑ No r No❑ Y..❑ r

Illness 13.3 Illness duc to dciivcry 13.4 Spccid delivery

of ❑ Yes ❑ No

r

No ❑ Y., ❑

motbcr r

13.5 Marriage registration 13.6 Duration of maniagc 13.7 Total No. of cbildrcn including ncwbor” and any

H Y., ❑ No ❑ Yc.rs who dlcd

r

No. living No. dead No. stillborn

n1111

14, 14,1 . Traditional

By herself Ncigbbour midwife Midtifc Nuke midwife Junior sanitaria. Medical doctor

Attcn- n ❑ •1 ❑ ❑ ❑ •1

dant at

r

birth 14.2 First Nmnc Last Name 14.3 Address (ho.sc No, til12gc No, hme, street,

comm””c, district, province) I

I II I II

15. Si8naturc of attendant at birtb 16. Signature of doctor

I

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( ) ( )

108
Reproduction of Death Certificate-Parts 1,2, and 3

DEATH CERTIFICATE

Note: Parts 1 & 2 arc identical to this

Part 3

] No. I

(Wire . ..... of.. ,h. .... .,,+.,.,. ........ . . . . . ..-

1. 1.1 First Name Last Name 1.2 Sex 1.3 Age 1.4 Nationality

Male Femafe Years

Decedent nm

1.5 Date of death (day, month, year) 1.6 Cause of death

2. Place 2.1 Address (house No, village No, lane, street, district, province, comury)

of

Death

3. 3.1 Father’s first name Last Name 3.2 Nationality

Parents

of

decedent

3.3 Mother’s name 3.4 Nationality

4. 4.1 First Name Last Name 4.2 Relationship

Household Father Mother Husband Wife Health Official Othej

Informant ~ncl EICIEI CID

4.3 Address (house No, village No, Ianc, street, commune, district, province)

5. 5.1 Disposal of body 5.2 Place (commune, district, province)

Corpse saved Cremated Buried

❑ ❑ 0

6. Date of rcgktration (day, month, year) 8. Signature of registrar

7. Siinature of informant

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( )

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Registrar . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. 9.1 Father’s place of birth 9.2 Father’s occupation 9.3 Mother’s place of birtb 9.4 Mother’s occupation

Parents (country, province) (country, province)

10. 10.1 Religion 10.2 Marital Status

Decedent 103 ‘d~Gn de ❑ None

10.4 Ckcupation

single married ieparated divorced widowed

r n n n n ra

11. Decedent’s place of birth, Address {house No, village No, lane, street, commune, district, province)

..

12. Usual place of rcsideri~c Address (house No, village No, lane, street, commune, district, province)

of decedent same as place

of death

r 111111

13. Major symptoms of illness 13.1 Duration of stay at place of death (years, months, &ys)

14. 14.1 Certified by

Traditional Midwife Traditional doctor Midwife

o

Nurse midwife Junior sanatarian Medical doctor

~ c1 a ❑

Cause

14.2 First Name Last Name 14.3 Address (house No, Village No, lane, street, commune, district, province)

of [Ill I I

death 14.4 Cause of death

from Duration of illness

certified Years Months Days Hours

card

(1) Nameofdisease A. Duectantecedent cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

B.lntermediate antccedentcause. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. Underlying cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2) other important cause

14.5 Autopsy performed

❑ No •1 Ye,

15. Signature of doctor

. . . . . . ------ . . . . . . . . . . . . . . . . . . . . . . . . -

( )
Reproduction of Stillbirth Certificate-Parts 1 and 2

STILLBIRTH CERTIFICATE Part 2

1

Note: Parts 1 & 2 are identical

nfc.. ,.C.l.. ..-%... . . . . . . . . . . r I I 1 i 1 I t 1 I . ..... -. .... ..&... -. I I I I I I I I I I

1. 1.1 Date of delivery (day, month, year) Time 1.2 sex

Male Female

n

Notfitain

0 r

Stillbirth

1.3 Place of delivery (house No, village No, lane, street, commune, district, province)

1.4 Important symptoms (of mother and stillborn baby) 1.4 cause of death

llll_

2. 2.1 First Name Maiden Name 2.2 Age 2.3 Nationality

Years r

Mother 2.4 Place of retidence same as place of Addrest (house No, village No, lane, street, commune, district, province)

delivery ❑

.——cuut

3. 3.1 First Name Last Name 3.2 AST 3.3 Nationality

Father Years r

4. 4.1 First Name Last Name 4.2 Address (house No, village No, lane, street, commune, district, province)

InfOr- 4.3 Relationship 5. Date of registration (day, month, year)

mant Household Father Mother Official Deliverer Other

head

•1 ❑ 0 •1 •1 •1

6. 6.1 Disposal of corpse 6.2 Place (commune, district, province)

Corpse Saved Buried Cremated

•1 •1

7. Signature of informant 8. Si@uure of registrar

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(

. . . . . ..- -------- . . . . . . . . . . . . . . . . . . . . . . . . .

) (

Registrar

)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. 9,1 Place of birth (province, country) 9.2 Religion 9.3 Education D Grade

❑ None 9.4 Occupation

9.5 Wasever checked

❑ No , ❑ Yes

9.6 Method of delivery

H Normal ❑ Special

Mother 9.7 Registration of marriage 9.8 Duration of marriage 9.9 Total No. of pregnancies No. living, No. died

❑ Yes H No Year month including this one No. died before 28 weeks

r-r

I

9.10 Last delivery 9.11 Deliveries 9.12 Date of delivery (date, month, year)

SingIe Twins Three Four No. diVC No. stillborn

❑ 000

10. 10.1 Place ofjirth 10.2 Religion 10.3 Education ❑ No;.

Father

10.4 Occupation

(province, country) ❑ Grade

r r

11. Usual place of father’s residence same as 11.1 Address (house No, villagt No., lane, street, commune, district, province)

Mother ❑ Place of stillbirth ❑ I I I I IL

12. 12.1 Mukiple hirtb 12.2 Delivery order 12.3 Parity 12.4 Duration of gestation

Twins Three Four

‘“”& 8 ‘5 ‘d ‘H

Months Weeks

❑ 0 rr

StiU- 12.5 Weight 12.6 Hcjght 12.7 13me of death ❑ D.ring delivery

birth grins II I I

cms U Before delivery ❑ U“knowm r

12.8 Abnormal at birth 12.9 Injured due to delivery

❑ No

12.10 Autopsy performed

❑ Yes ❑ No ❑ Yes a No ❑ Yes r

13. ~rtified by

Traditional midwife Tradition doctor Midwife Nurse midwife

•1

Junior sanitaria Medical doctor

•1 •1 ❑ r Cause 13.1 First name

of

fist name 13.2 Addre& (house No, village No, lane, street, commune, district, province)

death r

from 13,3 Cause of death Duration of illness

certified Years Months Days Hours

card

(1) Namoof&sease ~, Dkccta"tecede"t ca"se..., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

B.lntermediate antecedent cause. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. Underlying cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2) Other important cause

14. Siinature of deliverer 15. Siiature of doctor

. . .. ---- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( )
Reproduction of Medical Certificate of Causeof Death

MEDICAL CERTIFICATE OF CAUSE OF DEATH

DATE OF DEATH

I

Immediste cause

State the disease, injury or complication which

caused death, not the mode of dying such as heart

failure, asthemia, etc.

Antecedent causes

Morbid conditions, if any, giving rise to the above

carqe stating the underlying condition last

II

Other signitkent conditions

Contributing to the death, but not related to the

disease or condition causing it

I I I

AGE (In years last birthday)

w“hours ‘

CAUSE OF DEATH

(a) --------------------------------------------------

due to (or as a consequence of)

(b)--------------------------------------------------

due to (or as a consequence of)

(c) -- ------ ------ --------------------- -------- .------

I

------- --------------- ----------- --------

-------- ------- ------------- -------- ----.-

Accident, Suicide, Homicide How did injury occur?

Minutes I

interval

between onset

and death

,-------- ----

--------- -.. .

------ -------

------------

---------- ---

Attending Approved

physichn -------------------- ----------- by ------------------------- ----------

Signature Siinature

Date ofsignature --------- ----...- Date ofsignature --------- --------

111
ChapterV

Vital Statistics and the

Vital Statistics System

in Jamaica

SamKoilpillai, GraceSbaw, andDr.BogsSbiajar

World Health Organization Study Mission to Jamaica

June 6-24, 1977
CONTENTS

Introduction ........................................................................................................................................ ..... 117

General Infomation ....................................................................................................................... 117

Organization ............................................................................................................................................. 118

Health Sewices............................................................................................................................... 118

The Vital Registration System........................................................................................................ 119

Mechanismsof Registration and Certification of Vital Events

Births

................................................................... 122

........................................................................................................................................ .....

stillbirth 122

...........................................................................................................$.......................$... 123

Deatis ............................................................................................................................................ 124

Additional Procedures.................................................................................................................... 124

Utfization .................................................................................................................................................

Public Use of Vital Recor& .................................................................................................................

Other Uses...........................................................................................................................................

Health Sewices...............................................................................................................................

Research Workers.................................................. .........................................................................

Other Uses......................................................................................................................................

Use of Vital Statistics ..........................................................................................................................

Health Ministry and Local Health Autiotities ................................................................................

Nationsl Planning Agency ..............................................................................................................

Department of Statistics.................................................................................................................

University of the WestIn&es..........................................................................................................

126

126

127

127

127

127

127

128

128

129

129

Evaluation of Vital Statistics..................................................................................................................... 129

Avddih& ..................................................................................................................................... 129

Coverageand Completenem............................................................................................................ 129

Qu&W ........................................................................................................................................... 130

Evahration Mechanism...............................................................................................................!.... 130

General Assessment........................................................................................................................ 130

Education and Training Programs.........................................................!...................................................

Public.............................................................................................................................................

MedicrdDoctors and Other Health Personnel .................................................................................

Registrar General’sOffice Staff......................................................................................................

Local Re@trars ..............................................................................................................................

Statistician ....................................................................................................................................

Information Speciflwti......................................o............................................................................

MedicalRecords Officers,.,,,,.,.!,..,..,,..............................................................................................

131

131

131

132

132

132

133

133

Conclusion............................................................................................................................................ .... 133

Availability of Information ............................................................................................................ 134

Quality of Information ................................................................................................................... 135

Use of Information ......................................................................................................................... 136

Coordination and Co~oration ..................................................................................................... 136

Referencca................................................................................................................................................ 136

Appendix: Forms............................................................!........................................................................ 137

115
LIST OF TABLES

V-1. Population of Jamaica by parkh: 1970”census ................................................................................ 118

V-2. Trends in vital statistics: 1970.76 .................................................................................................... 119

116
CHAPTER V

VITAL REGISTRATION AND THE VITAL STATISTICS

SYSTEMS IN JAMAICA

Sam Koilpillai, Grace Shaw, and Dr. Boga Skrinjar

INTRODUCTION

General information

Jamaica, an independent country since

1962, is the third largest island in the Greater

Antilles and the largest in the Commonwealth

Caribbean. It is 146 miles from east to west and

51 miles from north to south, and covers a total

area of approximately 4,400 square miles. The

topography and vegetation vary from region to

region, and are dependent on the climatic

conditions, which are influenced greatly by the

mountains. The island consists of a narrow

northern coastal plain, a somewhat broader plain

in the south and a limestone plateau in the

interior. The plateau is uneven, broken by many

rivers and streams and numerous upland ranges

with peaks exceeding 4,000 feet (highest peak

7,500 feet) in the Blue Mountains, which extend

laterally in the eastern part of the country. Half

of the island is over 1,000 feet above sea level.

The country has a tropical maritime climate

and lies in the path of the northeast trade winds.

In Kingston (the capital), which is near sea level,

the temperature ranges between 70° and 92° F

(21° and 33” C). Rainfall is moderately heavy on

the northern coast and reaches 200 inches a year

on the northeastern slopes of ““theBlue Mountains. The mountain rain shadow effect, however, reduces precipitation on the southern part

of the island. The &nual average

is 74-77 inches.’ The heaviest

during October and November.

for the country

rainfall occurs

For administrative purposes, Jamaica is divided into 14 parishes, which are grouped into

three counties (Cornwall, Middlesex, and Surrey). (See table V-1. ) Each parish is administered

by a parochial council that has local administrative responsibility but limited power and financing.

Generally reliable telephone and telegraphic

services are available throughout the island, and

a postal service is also provided by the Government. Travel within Jamaica can be undertaken

by road, rail, or air. An extensive road network

totalling over 9,000 miles exists. A Govemmentowned railway operates two lines extending 205

miles. The internal air service connects Kingston,

Montego Bay, Ocho Rios, Port Antonio, and

Mandeville.

In 1976 the population of Jamaica was

estimated to be 2,072,800. According to the

1970 census, 29 percent of the population was

concentrated in the Kingston-St. Andrew area:

41 percent of the population was urban.

Although the population is predominantly

Anglican or Protestant, it also consists of a large

group of Roman Catholics, a small Jewish

community, and a number of other religious

groups.

English is the official language. A local

patois, which is basically English, is also spoken.

According to Demographic Statistics, 1 29.8

births and 7.0 deaths per 1,000 population

occurred in 1976, with an annual population

increase of 1.7 percent in 1975 and 1.2 in 1976.

117
Tabla V-1. Population of Jamaica by parish: .1970 census

County and parish

Total ...................

Cornwall County

Hanover ..............................

St. Elizabeth .......................

St. James ............................

Trelawny ............................

Westmoreland .....................

Middlesex County

Clarandon ...........................

Manchester .........................

St. Ann ...............................

St. Catherine .......................

St. Mary ..............................

Surrey County

Kingston .............................

Portland ..............................

St. Andrew .........................

St. Thcmsas.........................

SOURCE: Reference 1.

Numbar

1,813,594

58,296

125,279

100,528

60,504

112,663

173,823

121,407

120,001

180,404

98,392

111,879

67,497

413,328

69,391

Percent

of

total

100.0

3.3

6.9

5.5

?2

9.6

6.7

6.6

9.9

5.4

6.2

3.7

22.9

3.8

urban

41.4

6.2

5.2

43.5

12.7

14.7

22.5

21.1

19.2

34.il

18.2

100.0

20.5

88.0

21.7

Infant death and stillbirth rates in 1!376 were

20.4 and 11.0 per .1,000 live births, respectively

(table V-2).

ORGANIZATION

HealthServices

Health services are delivered through a network of Government and private institutions

distributed throughout the island.

In Jamaica, the provision of health services is

mainly a Government function and is for the

most part directed by the Ministry of Health and

Environmental Control (hereafter referred to as

the “Ministry” or the “Health Ministry”). The

Ministry operates in collaboration with the

Ministry of Local Government, which provides

environmental health services at the parish level

through a corps of public health inspectors and

other related personnel. The link between the

two Ministries is the medical officer of heahh

who is an employee of the Health Ministry. He

serves as special adviser on health matters to the

Parish Councils, which are part of the local

government system. The Registrar General’s

Office, which is responsible for vital registration

and vital statistics, is a department of the Health

Ministry.

Medical care is provided through a variety of

institutions ranging from hospitals with several

specialties to the small rural health clinics.

Present hospital services are divided, for

administrative purposes, into nine hospital

regions, each with its own hospital management

board. Excluded from this system is University

Hospital, which has its own board, and Bellevue

Hospital, which specializes in mental care. King

George V Memorial Sanatorium, a tuberculosis

hospital, is regarded as a separate region. Each of

the other regions contains a group of three or

four hospitals within a given geographic area.

The central responsibility for the administration of preventive health services lies with the

Principal Medical Officer for HeaIth and the

Principal Medical Officer for Maternal and Child

Health, who are both under the directorship of

the Chief Medical Officer. These services are

managed at the parish level ,by the medical

officer of health who is the foremost health

officer at this level. However, he has no formal

links with the hospital system. This officer is

responsible for all the health services provided

through the health centers and dispensaries in

his parish. The services provided through the

medical officer of health and his staff (public

health nurses, public health inspectors, midwives, community health aides, and others)

include all maternal and child health programs,

family planning services, and immunization.

The concept of the Cornwall County Programme, a demonstration project ~or the other

two counties, is that at the county level, there

would be an almost autonomous administration

which would be responsible for the affairs of the

primary health system. In each of the five

parishes of the county, the medical officer of

health would be the head of all health personnel.

The project provides for the development of

57 new health centers that would be classified

into four types:

A type 1 center is the smallest and approximates the present maternal and child health

118
Table V-2. Trends in vital statistics: 1970-76

1970 ........................................................................

1971 ........................................................................

1972 ........................................................................

1973 ........................................................................

1974 ........................................................................

1975 ........................................................................

1976 ........................................................................

Births

Number

64,375

66,277

66,219

61,857

61,506

61,562

61,675

Rate 1

34.4

34.9

34.3

31.4

30.6

30.1

28.8

Deaths

I

Number Retel

14,352 7.7

14,078 7.4

13,970 7.2

14,157 7.2

14,374 7.2

14,004 6.9

14,635 7.0

Infant deaths

Number

2,071

1,798

2,048

1,622

1,612

1,427

1,256

Rate*

32.2

27.1

30.9

26.2

26.2

23.2

20.4

Stillbitihs

Number

528

744

675

616

622

659

680

Rate*

8.2

11.2

10.2

10.0

10.1

10.7

11.0

lPer 1,000 mean population,

‘2Per 1,000 live births,

SOURCE: Reference 1.

clinic or dispensary. It is staffed by one and disseminating information on births, deaths,

midwife and- two community health aides

who assistin various education, motivation,

and followup activities, such as nutrition

demonstration, food supplements’ distribution, patient referral, and first aid. It operates daily and serves approximately 4,000

persons.

A type H center is slightly larger and

approximates the present health center. Its

staff includes the same type of staff as that

of a type I health center plus a registered

nurse, a public health nurse, and a public

health inspector. A doctor and a pharmacist

visit the type II health center at regular

interwds (about twice a week). It serves

approximately 8,000 persons.

A type 1.1 center is staffed by a full-time

physician and a full-time pharmacist, an

assiatant health educator, and a nutrition

assistant. This center provides a comprehensive health service to patients and receives all referrals from the type I and II

centers. It serves 16,000-20,000persons.

A type W center is located in each parish

and is the parish headquarters of the public

health staff. The staff includes the same

type of staff as that of a type 111center. It

is located in the hospital compound.

The Vital Registration System

The functions of recording, reporting, collecting, collating, tabulating, analyzing, publishing,

and stillbirths and those of training personnel

involved in the vital statistics systems are performed by several governmental agencies. These

include:

Ministry of Health and Environmental Control

Registrar General’s Office

Vital records and registration

District registrars’ offices

Local re@strars

Vital statistics

Health Services Units

Health Statistics Unit

Hospital medical records department

Offices of medical officers of health at

parish maternal and child health /

family planning clinics

Midwives

Rural maternity hospitals

Ministry of Finance

Department of Statistics

National Planning Agency

Central Data Processing Unit

University of the West Indies

Department of sociology

Department of social and preventive

medicine

Others

College of Arts, Science, and Technology

Police (Ministry of National Security)

Coroners (Ministry of Justice)

119
Regitrar General’s Office.-The main Government agency responsible for vital records and

statistics is the Office of the Registrar General,

which is organizationally a part of the Health

Ministry. However, the Registrar General’s Office is located a distance of 13-14 miles from the

Ministry, and day-to-day contact between this

Office and the other units of the Ministry are

not easily or satisfactorily accomplished.

The collection, checking, and indexing of

the registration documents from the local registrars are done at the Registrar General’s Office.

Under the present law (The Registration

[Births and Deaths] Act, 1881) the Minister of

Health has the authority to divide the parishes

of the island into registration districts. He may

also alter the districts by changing the boundaries, by the formation of new districts, or by

the union of existing districts. These changes

have to be officially announced. The boundaries

of these districts do not necessarily have to

correspond to the administrative boundaries of

the district. At present there are about 380

registration districts. Each of these districts has a

registrar who is appointed by the Minister of

Health or by the Registrar General with the

approval of the Minister of Health. The registrar

in turn appoints a deputy registrar with the

approval of the Registrar General. Both must

either live in or have a known office within the

district. Many are postmasters; others are private

individuals who set up offices in their homes.

The registrar must be on duty at his home or

office on the days and hours approved by the

Registrar General for the purpose of registering

births and deaths. A signboard with his name

and title, together with the office days and

hours, must be placed on the outer door of his

home or office.

While functioning as registrars, the registrars

and deputy registrars receive no fixed salaries

and have no status as Government employees.

For each registration, they are paid a small fee,

which is not considered a salary, by the central

Government. These fees, although slightly higher

now, have remained about the same for years.

The fees paid to postmasters are smaller than

those paid to other registrars because the postmasters are also Government officials and they

carry on the task of registration during regular

office hours. A registrar using his dwelling as an

office receives a small rental fee for the use of

his home. The registrar also collects other small

fees, for example, from the mother when the

name of the child has to be changed or added to

the registration form and when she requests a

certificate of registration of the birth, and from

the Government for Supplying the medical officer of health for the parish with lists of births

and deaths registered during the month. The

Registrar General has requested that these fees

paid to registrarsbe increased and that they be

given a retainer for their services, but this has

not yet been approved.

The registration of a vital event must be

done at the registrar’s office nearest to where

the event occurred. Should there temporarily be

no registrar or deputy registrar in a district, the

Registrar General requests the registrar of

another district to undertake the registration.

The Registrar General then places a notice to

this effect on the signboard of the absent

registrar for the information of the public.

Without this permission, a registrar cannot register an event that took place outside of his

registration district.

The Registrar General provides the registrars

with registration books (sometimes in short

supply) for registering live births, stillbirths, and

deaths. The registrars are supervised by the staff

from the Registrar General’s Office whose duty

it is to visit the registrars and clear up any

misunderstanding of the registration process.

Each registrar should be visited at least once a

year, but this has not been happening because

there are only two supervisors for the whole

island who also perform other routine duties in

connection with the routing of the registration

documents within the Registrar General’s Office.

The number of personnel engaged in statistical activities at the Registrar General’s Office is

small. The data processing unit has three keypunch machines, two verifiers, and one sorter;

the personnel assigned to this unit are engaged in

producing alphabetical indexes for the purpose

of records retrieval. There is no programmer

connected with the Registrar General’s Office

who is responsible for producing statistical

tables. Programmers have to be hired from the

outside. The alphabetical indexes probably will

be produced at the Minister of Finance’s Central

Data Processing Unit. At the time of this report,

120
preparatory work was being dorie for 1969 at

the Registrar General’s Office,

Health Services Units.–The majority of

births either occur in the hospitals -or are

delivered by the public health midwives. The

number of deaths that occur in hospitals varies.

Information is recorded, reported, or processed

to a limited degree by: the medical records

departments of hospitals, the rural maternity

hospitals, the maternal and child health/family

planning clinics, the midwives, the parish office

of the medical officer of health, and the Health

Statistics Unit in the Health Ministry to which

the data and summary reports are sent by the

various health service units involved. Moreover,

the Medical Records Officer at University Hospital and the midwife at the rural maternity

hospital in the parish of St. Thomas are also

local registrars for the vital events that occur in

their institutions.

The Health Statistics Unit has two sections.

The first section, which used to be part of the

now defunct family planning board, handles the

data (including those on births and infant

deaths) received from maternal and child

health/family planning clinics. It has 3 keypunch

machines, 2 verifiers, and 1 sorter, and a staff of

15 that includes a statistical officer. The other

section has a staff of six including two statistical

officers. It handles mainly summary tables (including data on births, deaths, and stillbirths)

received from the various institutions and the

offices of the medical officers of health. The

two sections of the Health Statistics Unit are in

the process of being integrated.

With the proposed reorganization of the

health services in the country to be patterned

after the pilot project in Cornwall County, the

health statistical services are also in line to be

reorganized.

Department of Statistics.-The Department

of Statistics, part of the Ministry of Finance, is

the central statistical agency for the country.

According to the law, it is obliged to supply

statistical data to interested agencies. The Department has been engaged in a variety of

activities related to vital statistical systems. For

example, the Department has recently initiated a

comprehensive analysis of the system of civil

registration in general. In 1975, a study on the

completeness of registration was conducted;

final results have not yet been obtained. A

fertility study is also in progress. Furthermore

whenever population estimates, which are

usually computed and published by the Registrar General, are not available, the Department

supplies these estimates.

The Department, for example, also periodically engages in the analysis and publication of

vital statistics in the annual publication Demographic Statistics.

National Planning Agency.–The National

Planning Agency, Ministry of Finance, is involved with the Registrar General’s Office and

the Department of Statistics in arriving at

accurate estimates of population based on

births, deaths, and migration. The Agency also

analyzes and publishes some of the vital statistics in its annual publication Economic and

Social Survey, Jamaica.

Central Data Processing Unit.–The Central

Data Processing Unit, Ministry of Finance, is

responsible for processing data, including data

on births and deaths of infants born to patients

seen at the maternal and child” health/family

planning clinics, received from the Health Statistics Unit. It also compiles alphabetical indexes

for the Registrar General.

University of the West Indies.–The department of sociology and the department of social

and preventive medicine of the University of the

West Indies have been engaged in activities

relating to vital statistics and have conducted

studies in this area. The department of sociology

was responsible for an analysis of fertility in the

West Indies that was based largely on material

from the 1960 census. The results of the study

have been published in Fertility and Mating in

Four West Indizn Populations. 2 Several studies

relating to mortality in Jamaica including the

Inter-American Investigation of Mortality in

Childhood were carried on by the department of

social and preventive medicine. In the early

1960’s the department also conducted another

study on childhood mortality. The results of the

latter study have been published in a paper

“Child Mortality in Jamaica.”3

In addition, the department of sociology was

closely associated with the 1960 and 1970

censuses in the West Indies. During the 1960

census a series of tests were carried out by the

department to match the census information

121
with the records at the Registrar General’s

Office. The department was also involved in the

design of a system for processing (using marksense sheets for the computer) the data on births

and deaths co~ected at the Registrar General’s

Office.

College of Arts, Science, and Technolqgy.-The training of medical records and

health statistics personnel at the intermediate

level, who will be directly or indirectly engaged

in vital statistics systems, is primarily the responsibility of the College of Arts, Science, and

Technolo~

Police and coroners.–The Ministry of National Security (police depatiment) and the

M@istry of Justice (coroners) are also involved

in the vital statistics systems to the extent that

the data relating to deaths due to unnatural

causes or of an indeterminate nature originate

with the police and the coroners.

Coordinating mechanism.–The need for

coordinating the involvement of the various

Government units in activities concerning vital

statistics was recognized, and a National Committee on Vital and Health Statistics was in

operation during 1965-69. The Committee consisted of representatives from the Registrar

General’s Office, the Ministry of Health, the

Department of Statistics, the Central Planning

Unit, the Ministry of Finance, the University of

the West Indies, and the Pan American Health

Organization/World Health Organization. No

stich coordinating mechanism exists at present.

MECHANISMS OF REGISTRATION

AND CERTIFICATION OF

VITAL EVENTS

The registration of births and deaths in

Jamaica was made compulsory in 1878, Prior to

this the Anglican Church, which kept records of

baptisms, marriages, and burials, was authorized

by law to forward quarterly transcripts of these

records to the then Island Secretary in Spanish

Town. These records, some dating back to 1664,

have been preserved in the Archives and are still

available for reference.

Births

Under the present law it is the duty of the

mother and father of the child to give the local

registrar the particulars required for registering

the birth within 42 days of birth and to sign the

registration form (see appendix, “Forms”) in the

presence of the registrar. If either parent fails to

do this, the person in whose house the birth

occurred, any person present at the time of the

birth, or the person in charge of the child is

required to give the particulars to the registrar

and to sign the registration form.

For births occurring in public or private

hospitals or institutions, the person in charge of

the institution is required to send to the

registrar, withii 14 days of birth, the prescribed

certificate signed by the mother (see appendix,

“Forms”). Upon receipt of this notification the

registrar then registers the birth.

This form of notification has three parts:

1.

2.

3.

The counterfoil, which is kept in the

institution for reference.

The body of the form with the information necessarj for registration, which is

sent to the registrar after being completed.

The Certificate of Naming, which is given

to the mother in the case-of a living ;hild

for whom no name has been decided

before leaving the institution. The

mother is instructed to complete this

Certificate and take it to the registrar.

This Certificate of Naming cannot be

used after the child has been baptized. A

Certificate of Name Ghen in Baptism

(see appendix, “Forms”) should be obtained and given to the registrar who

enters the particulars on the registration

form and counterfoil if they are still with

him. However, if more than 12 months

have gone by since the registration, the

name may not be added to the registration entry or altered without the

written authority of the Registrar General.

When a birth does not take place in a

hospital or institution, it is the duty of the

midwife in attendance to notify the registrar of

the birth within 48 hours of its occurrence. The

difficulty here is that all births occurring outside

hospitals or institutions are not attended by a

122
registered midwife. Traditional midwives still do

deliveries, but the number of such deliveries is

not known. In addition, in one district visited it

was stated that the midwives give the notice to

the mother to take to the registrar. This procedure gives rise to the possibility that the event

may not be registered.

In the case of a foundling, it is the duty of

the person who found the child or the person in

whose care the child is placed to give the

registrar within 7 days of finding the child any

information they may have and to sign the

registration form. For every birth or death

occurring on board any ship moored in port or

any water within the limits of the island, it is the

duty of the master or chief officer to report the

information necessary for registration.

The informant is not charged a fee for the

registration of a birth that is completed in the

office of the registrar. However, if the registrar is

requested, in writing, to go to a residence to

register the birth, he is entitled to a fee.

Upon completion of the registration of the

birth, a Certificate of Registry of Birth (see

appendix, “Forms”) is given to the parent, on

demand, and on the payment of a small fee. A

notice to have the child vaccinated within 6

months of the date of birth also is given to the

parent at this time. With the eradication of

smallpox this is no longer mandatory. The

practice, however, is still followed. The Certificate of Registry of Birth does not replace the

birth certificate, which is issued, on request, by

the Registrar General only.

In principle it is the duty of the local

registrar to be aware of births occurring within

his district, Where a birth has not been registered

within 42 days of its occurrence, he should

request any of the persons responsible under the

law to come to his office to give the required

information and to sign the registration form.

The parent or informant has up to 3 months

after the birth of the child to supply the

information necessary for registration to the

qrjstrar so that he can register the birth. At the

expiration of 3 months, but not later than 12

months after the birth, the information necessary for registration must be sworn to and the

registration form and counterfoil must be signed

in the presence of the registrar and a justice or

some other responsible witness by the person

supplying the information. After 12 months, the

birth cannot be registered without written

authorization by the Registrar General, and a

note that this authorization has been given must

be entered on the registration form and counterfoil.

The name of the father of a single woman’s

child may be entered on the registration form

and counterfoil by the registrar if (1) both

parties appear before the registrar and sign the

form and counterfoil, (2) the registrar is furnished with a prescribed declaration of paternity

form signed by both parents of the child and by

a justice or other appointed officer, or (3) one

of the child’s parents appears before the registrar

with a written request to enter the name of the

father and presents a signed declaration of

paternity from the other parent. An extra fee is

paid to the registrar when the name of the father

is registered. The percent of unmarried couples

is high.

With the introduction of the Status of

Children Act, 1976, which is designed to remove

the legal impediments to children born out of

wedlock, many more requests for the father’s

name to be entered on the registration form are

being made.

Stillbirths

The responsibility for registering stillbirths

rests with the person who would have been

required to give the registrar information concerning the birth if the child had been born

alive. The person giving the information to the

nqgistrar should either deliver to the registrar a

written certificate that the child was not born

alive signed by a registered medical practitioner

or certified midwife who was in attendance at

the birth or who examined the body of the child

or make a declaration using the prescribed form

stating that no registered medical practitioner or

certified midwife was present at the birth or

examined the body or that a certificate cannot

be obtained and that the child was not born

alive.

The registration procedure is similar to that

for a live birth (see appendix, “Forms”). Burial

requires the issue of an order for burial, and the

procedure is the same as that for deaths. The

problem here is that stillbirths are not usually

123
buried in a cemetery. (When a stillbirth occurs in

a hospital, the hospital disposes of the body. )

Deaths

When a person dies in any dwelling or is

found dead, it is the duty of a relative, a person

present at the death, the occupant of the house

in which the death took place, or the person

undertaking the disposal of the body to give to

the registrar within 5 days following the death,

information necessary for registration and to

sign the ~egistration form and counterfoil (see

appendix, “Forms”) in the presence of the

regisfrar. If a written notification of the death

accompanied by a Medical Certificate of the

Cause of Death (see appendix, “Forms”) is sent,

to the registrar by the person required to give

information concerning the death, the time

period for giving this, information may be

extended to 14 days.

Upon registering a death or receiving written

notification (accompanied by a medicid certificate) of the occurrence of a death, the registrar

gives the relative or person responsible for burial

a signed certificate that he has registered or

received notice of the death. This certificate

comes in three parts: Part A is the counterfoil,

which is retained by the registrar; part B is the ..—.,.

c~rtlficate; &d pait~.C-is‘a notification of burial.

Parts B and C are &ven to the relatives to pass

on to the cemetery official burying the body.

This official retains part B and returns part C to

the registrar within 96 hours of the burial.

In the event of a sudden or a suspicious

death, a coroner, justice of the peace, or officer

of the constabulary either requests a post

mortem examination under the Coroner’s Act or

an investigation to determine whether the death

was the result of natural causes, in which case a

post mortem examination is not necessary.

In principle, it is the duty of the local

registrar to be aware of the deaths that have

occurred in his district. When a death has not

been registered because the person required to

give information did not do so, the registrar,

after 5 days and withk 12 months from the day

of ,death, may give written notice to any of the

responsible persons to appear before him to

supply him with this information and to sign the

registration form and counterfoil.

After 12 months, a death cannot be registered without the written authorization of the

Registrar General. A note that this authorization

was given must be entered on the registration

form and counterfoil.

A Medical Certificate of the Cause of Death

is required for the registration of all deaths.

However, when no Medical Certificate can be

obtained and no postmortem examination has

been made, the person required to inform the

registrar makes a written declaration stating (1)

that no medical practitioner attended the deceased or (2) where the deceased was so attended, giving the reasons why a Medical Certificate cannot be obtained. The registrar then

registers the death and issues the certificate that

he has received notice of the death. He sends a

notice of uncertified death to the medical

officer of health of the parish in which the death

occurred. If, as a result of investigation, the

medical officer of health sends, within 42 days

of the date of death, a written certificate of the

cause of death, the registrar enters the information on the counterfoil or on the registration

form and counterfoil (if both are still in his

possession) and sends the certificate to the

Registrar Gener+.

Additional Procedures

The birth, death, and stillbirth registration

forms and counterfoils are issued in books that

contain 100 sheets. These forms are preceded

and numbered consecutively so as to be able to

check that all the forms are returned to the

Registrar General at the end of a designated

period. The counterfoil serves as a copy of the

registration document and is used for “backup”

purposes in the event that the original registration form is misfiled, damaged, or destroyed.

Formerly, these forms had to be completed

twice to provide duplicate registration. Since

1957, the counterfoil serves as a carbon copy of

the original registration. This was done to

improve the system and to speed up registration.

Unfortunately, the carbon copy sometimes is

not legible or is missing altogether.

To control the entries on the registration

forms and to facilitate filing of these records,

the registrar sends the Registrar General, within

124
the first 3 days of every calendar month, by

registered mail, all the registration forms for

births, deaths, and stillbirths completed during

the previous month. In addition, he sends all

supporting documents, such as certificates of

births in institutions, medical certificates, and

certificates of naming. All of these documents

have to be listed on an accompanying sheet. The

documents are checked to ensure that all of

those reported on the list have been received.

The registration forms are checked against the

supporting documents to see that all the entries

are correctly written. In theory they should then

be coded and keypunched before being filed,

but in practice only the cause of death is coded

and entered in pencil on the registration form.

Only items necessary for the Registration Index

are being keypunched. (Prior to 1964 this work

was done by hand. ) After being coded and

keypunched, the forms are filed numerically by

year under a code that refers to the parish and

the district within the parish. Over 12 million

certificates are now stored in the vault. Al-

+ough under the Registration [Births and

Deaths] Act, the Registrar General is required to

send to the Minister an annual report on the

births and deaths registered during the year, the

vital statistics processing section has fallen into

arrears. The last printed report refers to 1961.

An abridged report giving totals only is,”however, put out annually.

Data for 1962-64 are ready for printing, and

the data for 1965-68 have been checked and

keypunched to some extent. No report, however, has yet been published for any of these

years. Data for 1969-71, because the year of the

census is included, have been processed with the

assistance of the Agency for International Development (U.S. ), the census research program

of the University of the West Indies, and the

services of a private firm. Printing will be done

by the Department of Statistics as soon as errors

that have been found are corrected.

A great deal of effort on the part of the

Registrar General is being focused on vital

registration procedures, and the resulting documents are considered to be reliable. Most of the

staff at the Registrar General’s Office are involved “in this activity; and very few in th;-

preparation of vital statistics. Of a total of 144

persons, only 29 are in the vital statistics

section. Of these, three are machine operators.

The vital statistics section issues the registration

booksj checks the entries, and also makes

changes, when necessary.

Increased migration and the resulting demand for birth certificates, which began in the

1950’s, continue. Schools now require a birth

certificate for admission. In addition, the number of certified copies of registration documents

required for litigation purposes is high. As a

result, over 600 applications for certified copies

arereceived atthe Registrar General’s Office daily.

When the events are relatively recent, the search

process slows up because there are no final

printouts of the indexes although punched cards

for this purpose are available up to 1968 and

those for 1969 are now being punched. If the

work could be updated—as it might be with

outside assistance only—the preliminary index

could be made available a month after the

occurrences of births or deaths and the final

index a year later, optimally.

Although written instructions for the guidance of local registrars are available, no such

written instructions exist for medical records

clerks in hospitals engaged in notification of

vital events. The procedures practiced were the

same in the hospitals visited. At the University

Hospital of the West Indies, however, the procedure was not much different from that practiced at the Government hospitals; however, the

chief medical records officer is also the local

registrar for births and deaths occurring in the

hospital, and another member of the staff of the

records office is the deputy local registrar.

Re&tration forms are sent directly to the

Registrar General thus eliminating the delay of

passing them through a third party.

Each morning, the hospital clerk in charge of

preparing the notification of births checks the

number of deliveries that have taken place the

day before and that have been entered on the

daily census sheet. In principle, a double check

exists because the delivery book is kept on the

ward and is filled in by the nurse in charge as

soon as possible after delivery.

Medical personnel and medical records clerks

are involved in the production of vital statistics

from the beginning through the registration

process. Medical personnel are also the main

users of the fiiished product.

125
The procedure for notification of stillbirths

occurring in a hospital is the same as that for live

births except that special forms are used (see

ap~endix, “Forms”). Certification of the cause

o}-fetal death is not ‘very reliable.

UTILIZATION

Although it is recognized

registration system in Jamaica

that the vital

depends upon

administrative and legal arrangements, the demands of users did influence and will hopefully

continue to influence vital registration and vital

statistics development in the country. This will

depend on whether the demands on the information system will be expressed strongly or if they

will be justified. The contents of the system

should be tailored to the needs of the potential

users.

The uses of records and vital statistics to be

described are not exhaustive. They will be given

separately for vital records and for vital statistics. Responding to the demand for vital records

occupies the greater part of the time of the staff

of the Registrar General’s Office.

Public Use of Vital Records

The certificate of birth, issued by the Registrar General, is a legal document proving identity and civil status.

A number of legal and social rights depend

on the identity of the person:

Voting (over 18 years).

Entrance into school.

Issuance of passport.

Eligibility for various allowances.

Insurance benefits.

Property ownership.

Inheritance.

Proof of nationality.

For some of the above purposes, a copy of

the notification of birth, issued by the hospital,

is sufficient. Local registrars cannot issue certificates of birth; and certificates given to mothers

as proof of registration of the baby have no legal

value.

Any person, upon applying and upon payment, is entitled to obtain the certified copy of

an entry in the register of births containing all

information that appears on the original entry.

The Registrar General may refuse to issue a

certified copy or certificate where there are

reasonable grounds to suspect unlawful use of

the information released. A fee is prescribed for

either the certified cop y of the entry in the birth

register or for a certificate of birth and for the

time needed to carry on the search.

Over 600 persons apply daily to the Registrar General, either for a certified copy or to

change certain information on the original certificate.

Retrieval is difficult because exact information to identify the person in birth register often

is not provided by the applicant.

Delay of up to a few months can be

expected if the original cannot be found or if

the birth was not entered in the. register of

births.

Registers are kept by parishes and districts

where the birth occurred, by dates of births. If

any information is not available, the search is

time consuming.

Until 1964, indexes were handled manually.

Updating of the index to 1969 has been started

on key-punched cards.

The certificate of death is required”

To issue a burial order.

To provide legal evidence relevant to claims:

For inheritance,

For insurance,

For various allowances,

For pensions.

To prove right of surviving spouse to remarry.

The application procedure to obtain a certificate of death is the same as that to obtain a

certificate of birth. The burial order is issued by

the local registrar or in legal cases by local

police,

126
The certi$cate of cause of death is used in

some instances as the only document for registration of death at the local registrar level. It

also is requested for insurance purposes. The

Registrar General and, in some cases, hospitals

or medical officers of health issue copies of the

certificate of cause of death for this purpose. In

most cases, this certificate is issued by hospitals

to accompany the notification of death.

Cause-of-death certificates are often received

very late at the Registrar General’s Office; and

information provided on them is not accurate or

is even missing:at times.

The cen%ficates of stillbirth have not been

used as vital records by individuals according to

available evidence.

I Health Sarvicas

,

Birth records

vaccination cards

Other Usas

have been used for issuing

to mothers at the time of

registration of the baby. This practice will be

omitted because the smallpox vaccination progmm has been altered.

Birth records are also the basis for public

health programs run at the parish level by the

medical officer of health and his staff. However,

in many instances birth records are received too

late and therefore cannot be used for operational purposes. In the parish visited, the local

regislr& f&wards record; every quarter and not

at the end of each month as expected. Hospital

records sent to medical officers of health, are

also not received regularly enough to be used for

the daily operation of health services.

Death records with cause-of-death certificates are sent by the local registrar to the

medical officer of health for review and for

further inquiry or action. If sent early enough

and if filled out correctly, their use can be

broadened (e.g., investigation of infectious diseases, death of children, maternal deaths).

ResearchWorkers

Birth records have been used for sociological

studies omanized by the University of the West

Indies’ de~artment ‘of sociology

ment of social and preventive

&d its departmedicine. The

Department of Statistics has also undertaken a

fertility study that, however, has not been

completed.

In addition, a study matching births within a

3-year time period prior to the 1960 census with

births during the 1960 census was conducted by

the department of sociology at the University.

In a matching-type survey undertaken at the

beginning of 1977 by the Department of Statistics, Ministry of Finance, birth and death

records were traced from the time of occurrence

of the event in the hospital to the time the

records were received at the Registrar General’s

Office. In the case of births, 75 were matched

easily several months later but 25 were not,

most probably because the births had been

registered under the wrong name.

According to available evidence, research

activity has declined since late 1960.

Other Use

VIM records received from the local registrar by the Registrar General are used as the

basis of payment to the local registrar. Notifications of vital evenlx received by the medical

officer of health at the parish level are also used

for this purpose.

Useof Vital Statistics

VM statistics available in Jamaica since

1964 as a result of the vital registration system

are limited to totals of registered births and

deaths. Reference was made to the use of

information available before 1964. These statis-

$iis, however, at present have no operational

value. Several examples on how statistics were

used before 1964 were cited. These examples

can be considered only to illustrate users’

expectations regarding vital statistics, rather

than as examples of areas in which statistics

were actually used before 1964.

Four national agencies–Ministry of Health

and Environmental Control, National Planning

Agency, Department of Statistics, and the University of the West Indies-are principal users of

vital statistics. They all have manifested interest

in vital statistics, they are aware of what data

they need and for what purpose, and they are

familiar with the existing situation. In addition,

127
they have all attempted to improve the present

situation and to overcome the lack of information.

Problems inter ferz”ng with adequate use of

information. —Available data do not correspond

to the existing needs of the agencies just

mentioned because (1) information on vital

events is presented according to the occurrence

of the event, not according to the residence; (2)

data are based on certificates received and as

such do not necessarily refer to the reporting

period because of numerous late notifications;

(3) registration is often incomplete; (4) registration areas do not necessarily correspond to the

parish boundaries; (5) detailed vital statistics

have not been available since 1964; (6) discrepancies exist between monthly, quarterly, and

annual figures; (7) no adequate estimation of

coverage has been done since the census of

1960; and (8) there has been no recent study

regarding the quality of data.

‘Because the ploblems hindering the use of

information on a national level are well identified and great interest has been displayed in vital

statistics, a solution to these problems might

soon be found if all parties interested in vital

statistics would coordinate their activities. Further analysis of these problems, a development

of a working program, and an assessment of the

needs of all principal users are essential beginnings. The roles to be played by each of the

concerned users will also have to be determined

in order to expedite the efforts.

Health Ministry and

Local Health Authorities

The Department of Statistics (recently

merged with the statistical unit that operated

within the framework of the Family Planning

Board) plays an important role in stimulating

the use of vital statistics data by assisting other

departments of the Ministry. The Maternal and

Child Health Department, the Department of

Epidemiology, the Department for Health Administration, and other agencies base their work

on inadequate data available. They have stressed

the need for detailed information, in particular,

information on causes of death. Mortality- data

by age, sex, and residence are also considered

essential for programming and evaluation purposes, if provided regularly and on time. The

data on births and deaths available at present are

used in a restricted way because data refer to the

place of occurrence of the event and not to the

residence of the newborn or the deceased.

Information on newborn children is of use

to health services at subnational (parish, district)

levels and at the institutional level. Identifying

the target population would be of extreme

importance for the management of maternal and

child health services. A development program

regarding basic health services for which this

information would be of utmost importance has

been started. It is not possible to evaluate the

program on the basis of the parish figures

available quarterly and annually because data

tabulation is based on the occurrence-of-events

principle.

National Planning Agency

Demographic analysis is a prerequisite for

pkmning economic and social development and

is an area for which information is needed

urgently. Knowledge of population structure,

population growth, and geographical distribution is required very often for planning purposes.

The use of information is limited at present

to totals of births and deaths provided by the

Health Ministry, data provided by the Immigration Office, medical officers of health of

parishes, and censuses. The analysis of the

population according to geographic distribution

and internal migration therefore is impossible to

conduct based on the data available. Comprehensive national planning and specific plans

relating to items such as education, welfare, and

health are areas for which the Agency needs

up-to-date and detailed information. At present

the annual evaluation of specific plans is based

on vital statistics and the findings interpreted in

the Annual Public Statktics volumes. A few

surveys have been used to fill in the gaps because

of the lack in the availability of information.

The urgent need for vital statistics was also

mentioned in relation to the preparation of a

5-year plan coordinating activities in various

areas in collaboration with the corresponding

agencies.

128
Department of Statistics

The Department of Statistics uses vital statistics primarily for making projections regarding

population size and structure for various ministries and agencies (e.g., Mini@ries of Agriculture,

Education, and Labour). Estimates of the

number of births and deaths are done by

counting individual records and are used to

compensate for the lack of complete information. Requests are received for the analysis of

mortality and fertility trends. The National

Planning Agency, various institutions, research

workers, and schools were listed as making the

most frequent requests.

University of the West Indies

Vital statistics were used by the University

to conduct sociological studies of the population, fertility studies, and studies of health

problems, and for teaching purposes until 1964.

Since then no significant studies have been

undertaken.

EVALUATION OF VITAL STATISTICS

Availability

Since 1964, vital statistical data for the

entire country, including those related to age,

sex, cause, place of residence (rather than place

of registration), time of occurrence (rather than

time of registration), birth weight, and so forth,

which are urgently needed by various usersboth

within and outside the health sector, have not

been available, although much of the basic data

needed can be obtained from the original

records. The preface to Demographic Statistics

1976 by the Department of Statistics expresses

the feeling of one Government agency:

“The statistics of births and deaths have,

over the years, become progressively less

available in the required form. Thus up-todate detailed tabulations on births and

deaths are not available, the most recent

year for which these details may be obtained

being 1964. Since 1975, the summary tables

on number of births and deaths in the most

recent year have not been provided by the

Registrar General. Accordingly, as was the

case last year, the estimates of births and

deaths and hence of population for 1976

have been derived from tabulations of the

records by the staff of the Department of

Statistics.”1

Basic data are recorded either on certificates

of birth, stillbirth, and death, or on other

individual forms collected by the Health Ministry or through special studies. Some of them

have been summarized and appear in various

annual reports.

Coverageand Completeness

Every vital event in the entire country is

required by law to be registered. Registration,

however, is incomplete, and the degree of

underregistration is higher for deaths than for

births. Among the Government officials interviewed, those within the health sector expressed

a great concern regarding the completeness of

registration.

Although no firm estimates of underregistration are available for the island as a

whole, the following data may give some indication of this problem:

According to the 1975 annual report of the

medical officer of health for the parish of

Portland, there were 440 deaths and 40

infant deaths in the parish during 1975 as

compared with 413 deaths and 31 infant

deaths registered.

Incomplete data on stillbirths reported by

hospitals for 1975 and 1974 totaled 846 and

8444 as compared with 659 and 622 registered in the entire country.s

Skepticism has also been expressed regarding

the relatively low crude death rate (6.9 per

1,000 population in 1975) and infant death

rate (6.9 per 1,000 live births) for the

country and the 1975 infant death rates of

10.6 and 11.3 for the parishes of Hanover

and Trelawny, respectively.

Considerable doubt has also been expressed

regarding the completeness and validity of data

on infants that die ,within a few hours of birth.

129
Because of the bother and possible costs involved in burial, these deaths may not be

included in the number of live births or of infant

deaths. In the rural areas they may not be

reported at all if the babies were delivered at

home. In the latter instances, even if the child is

alive, because the notification of birth is given to

the mother, it may not always reach the local

registrar.

The study by the Inter-American Investigation of Mortality in Childhood deals with the

question of underregistration and showed that in

the Kingston/St. Andrew area infant deaths were

underregistered by 10 percent and deaths in

children 1-4 years of age by 18 percent.6

The proposed reorganization of the structure

of the health services as envisaged under the

Second Population Project financed by the

World Bank should make it possible for a more

complete coverage of health data including those

relating to vitzd events. Because the Government’s program calls for the training of 2,000

community health aides, of which 1,200 have

already been trained, and because one of the

functions of these aides is to periodically visit

each household within a defined geographic

area, it should become possible to obtain more

accurate and complete information on vital

events regardless of type of attendant or place of

occurrence.

Quality

The quality of data is affected at various

points along the vital statistics system. At the

point of origin, the most serious defect is the

identification and/or recording of an event

incorrectly; for example, instead of stillbirths,

abortions; instead of infant deaths, stillbirths.

This results not -only in incompleteness of data

on infant deaths, but also in inferior quality of

data on stillbirths and in an overstatement of the

incidence of the latter.

Other factors affecting quality came to the

attention of the study team.

For example, if a mother comes to the local

registrar to register the birth of her baby several

months after birth without the birth notification

that may have been given to her, the information recorded by the registrar is based on the

mother’s recollection of the event, which may

not be accurate.

Similarly, in some instances of death, burial

may take place before registration, and information given at the time of registration depends on

the informant’s memory.

The certification of cause of death is incomplete and unsatisfactory; for example, in cases

where no Medical Certificate of the Cause of

Death can be obtained and no postmortem

examination under the coroner’s law has been

done. In this case, the parish medical officer of

health who may not have known the deceased or

the circumstances of death is requested to

“investigate” the case and issue a Certificate of

Cause of Death.

Because the facts about the father are not

recorded for many registered births, data on

paternity are probably of doubtful quality and

completeness.

Misspelling or falsification of names is

another factor that may affect the quality of

data.

Evaluation Mechanisms

There is no regular or built-in mechanism for

the ewduation of vital statistics. The evaluation

at present depends on ad hoc surveys such as the

one to be undertaken by the Department of

Statistics and the one taken at the time of the

1960 census by the department of sociology of

the University of the West Indies. In recent

years, however, there has been no evaluation of

the vital statistics system.

General Assessment

Although data on a number of items are

recorded and checked for accuracy, the processing of the data relating to registered births

and deaths needs strengthening. Most of the

personnel at the Registrar General’s Office seem

to be engaged primarily in registration, recording, filing, and retrieval of the original documents and records. Efforts directed toward the

processing of the data and the production of a

comprehensive set of tabulations and the analysis of the data are not effective. The difficulties

irLprocessing the data are apparently related to

the computer system. The system was designed

and operates outside the Registrar General’s

Office because there is a lack of personnel for

data processing and statistical analysis.

130
Although the Registrar General’s Office and

the Health Statistics Unit are in the same

Ministry, little or no coordination of efforts to

determine and meet the needs of health services

and to improve the quality and completeness of

data exists between the two units.

Even at the level of data recording and

reporting, the gaps between the points of origin

of the information (mostly in the health services) and the first points of collection (at the

district registrar’s offices) are too wide and

permit loss of accurate information.

EDUCATION AND TRAINING

PROGRAMS

The mana~ment of a vital registration and

vital statistics system requires the collaboration

of various groups of people. According to the

rde the people involved are to assume, three

main groups have been identified: the producer

of basic data, the mana@r of the registration

and statistics system, and the user of this

system. In order to ensure efficient operation of

the system and to achieve adequate use of the

information, all three groups will have -to be

educated to the level, that will enable them to

fi-dfill their roles. h Jam”aica, the following

people are involved in the vital registration and

statistics system and should be considered when

education, training, and motivation regarding

vital records and vital statistics are discussed:

Public.

Medical doctors and other health personnel.

Registrar General’s Office staff.

Local registrars.

Statisticians (clerks, technicians, professionals). ‘

Information specialists.

Managers of various program

other users of vital records

tistics.

Medical records officers.

Teachers.

activities and

and vital staThe need for education and motivation of all

these categories has ( been pointed out, and

several suggestions have been made regarding an

educational program that is to be developed.

However, financial problems may impede the

development of a systematic educational approach in this area.

Public

Education of the public has taken various

forms. From time to time there have been radio

announcements informing the people of their

duties regarding registration. However, it is felt

that this should be done more systematically

and that informative talks should stress the need

to register vital events.

The education program for adults includes

the disbursement of pamphlets on registration of

births and deaths. Education in this respect,

however, should be more intensive. Local registrars are not very cooperative because they are

not motivated to cooperate nor are they paid for

this function, only for the process of registration.

Community health aides and midwives,

dufig home visits or clinic sessions, could play

an important ‘role in educating the public,

particularly in instructing mothers on the advantages of prompt and correct registration. The

education of a community health aide is not as

great as that of a health worker but she does

receive 3 months’ training to prepare her for

home visitation. The importance of vital records

and registration and of educating the public are

not dealt with specifically during this training.

Medical Doctors and

Other Health Personnel

Medical doctors and other health personnel

working within the medical care delivery system

do not show great interest in providing accurate

and prompt data on vital events. Personnel

involved in statistics are seldom called upon to

motivate them nor is there much encouragement

from the Health Ministry. Correspondence with

treating physicians in order to correct cause-ofdeath certificates is made by the Registrar

General’s staff. Unfortunately, the medical profession has not undertaken the task of training

physicians in the correct way to complete

131
certificates and in the use of the proper terms to

denote causes of death.

Occasionally, medical students are exposed

to lectures on population, demography, and vital

statistics given by the department of sociology

at the University of the West Indies. Similar

arrangements are also made for medical postgraduate students. Statistics as such are taught

by the department for social and preventive

medicine over a period of 20-30 hours. Causeof-death statistics have been given a special place

in the curriculum. A more extensive educational

program is being organized at present at the

University.

The study of vital and health statistics is

included in the postgraduate course leading to a

doctorate in public health that has been organized for Jamaican and foreign students by the

department of social and preventive medicine at

the University. A similar course has been setup

for other health students.

Registrar General’s Office Staff

Very few people working in the Registrar

General’s Office have been trained in statistics,

keeping of medical records, or vital registration,

and management.

Training of registration clerks does not exist.

In 1968, one member of the staff was trained in

the coding of causes of death. The course, based

on the Eighth Revkion International Classification of Diseases,7 ——was organized by the Uni- .r

versity of the West Indies and the World Health

Organization. The Registrar General’s Office has

not been informed of any retraining based on

the Ninth Revisions although coding of causes

of death is being done at the Office.

Other members of this Office also have not

been trained. Consequently, an educational program needs to be developed for the entire staff.

The Registrar General, together with people

from the University of the West Indies, should

consult with professionals from other countries

to setup training and educational programs.

Local Registrars

The work of

for the whole

addition to the

380 local registrars is the basis

vital registration system. In

recording and reporting that

they are already doing, the registrars could help

to educate and motivate the public regarding the

registration of births and deaths.

Until the present, no educational programs

have been developed for local registrars. The

written instructions given to every newly appointed local registrar and the occasional visits

by a Registrar General’s Office supervisor obviously cannot replace an adequate education.

The knowledge, skills, and particularly the attitudes of the local registrars will not improve if

these people are exposed to short training

programs. Money problems, lack of personnel to

run such short term workshops, time, and the

great number of people to be trained prevent the

inauguration of such an intensive educational

program. However, if vital registration and vital

statistics in Jamaica are to be improved, such a

program should be considered as a first step in

the development of the system.

Statisticians

Very few personnel have had formal or

advanced training. The University of the West

Indies organizes an annual course of 14 weeks

for nonprofessional statistics officers from

various Government departments. Attention is

focused on training in elementary statistics and

economics, and specific statistical areas, such as

demography and vital statistics, are only briefly

presented to the students.

No training of professional statisticians

exists in the country. People in senior posts arc

university graduates in another subject (mathematics). Participation in specific problcmsoriented workshops and in internationally organized seminars to study the various aspects of

vital statistics systems would be very valuable

for these people. Progress in the Jamaican

information system, including vital registration,

depends to a great extent upon this group of

professionals and the opportunity for this kind

of training should be provided to a few selected

persons without delay.

Students of sociology in the department of

sociology, the University of the West Indies,

take courses in demography and in statistics.

However, there are not many posts available for

demographers, and they wind up working in

other positions.

132
As far as the intermediate level of statistics

personnel is concerned, the sociology department at the College of Arts, Science, and

Technology started a combined course for medical records and health statistics technicians in

1977. The study of vital statistics is part of the

curriculum. Unfortunately, the Registrar General’s Office was not informed irl time to send

any of its staff for this training.

Information Specialists

Education and training of information

specialists have been neglected. It seems that no

effort has been made to train Jamaican nationals

to take over the work performed until the

present by outside experts in the areas of

computer program design, design of forms, and

so forth. Lack of national experts in programming was repeatedly pointed out to the authors

of this report and mentioned and identified as

an extremely critical one for adequate processing of information.

Medical Records Officers

Great effort has been devoted to the upgrading of medical records personnel working in

hospitals and other institutions. Several training

arrangements have been made with the College

of Arts and Sciences and Technology in Kingston, A national association of medical records

personnel also has played an active role in the

development of educational programs for medical records personnel at all levels. A workshop is

organized every year by the national association

in close cooperation with the Health Ministry.

Because these workshops are frequented by a

large number of medical records people, they

could be useful in initiating discussions on vital

registration. “Mini workshops” are organized

systematically by the Health Ministry to provide

refresher courses for hospital staff.

Since 1974, regular medical record courses

have been organized for medical records officers.

Formal education at a pre-university level or

several years of practice are required for admission. The course is of 1 year’s duration. Vital

statistics and registration of vital events are

included in the practical training. Not much

time is devoted to teaching the subject during

the theoretical part of the course. The implementation of what students are taught in school

is not always possible because of insufficient

staff in the hospitd_s where they practice to

carry through all the procedures such as double

checking.

For medical records officers in leading positions, a training course of an additional year was

started in 1977. Great interest has been shown

among medical records officers in this course.

The extent of emphasis on population and vital

statistics will depend on the teacher because

educational objectives have not been clearly

stated. A great problem in running the educational program is the lack of Jamaican teachers

and tutors. An outside expert can successfully

replace .a national lecturer on a specific subject

temporarily. In the long run, however, a teacher

has to be involved closely in the national

development of a medical records program. Lack

of facilities to train teachers has been emphasized as a great need that must be met. Equipment and visua3 aids to be used in teaching

recording of vital events and statistics would also

be valuable.

A correspondence course for medicaI records

personnel who do not have the opportunity to

participate in formal training is under discussion.

CONCLUSION

Although the vital registration and statistics

system in Jamaica has been in existence for a

long time and has developed, over the years, into

one that could serve the purposes of various

users, it has deteriorated since the early 1960’s.

Problems identified during the present study

relate to:

Institutional and organizational aspects of

the vital registration and statistics system.

Recording, registration, and statistical forms

and procedures.

Availability of information.

Use of vital statistics.

Education and training.

133
AU the aspects of the problems just indicated should be analyzed in greater detail than

was possible during the study mission before

detailed recommendations can be offered for

their solution. The problems are basic and will

not be solved until arrangements are made to

eliminate the factors contributing to their existence. Any other alternative suggestion not

directed toward the elimination of the factors

that provoked the existing situation will not

have any permanent effect on the availability,

quality, and use of information.

Availability of Information

The most striking problem–a consequence

of various other problems in Jamaica-is the

nonexistence of vital statistics since 1964. The

problem is of such magnitude and so obvious

that attempts have been made by various agencies to assistin the processing of information for

the missing years or to obtain the information

by other means.

At first, the study team was inclined to

recommend as a priority that the necessary

resources be sought–personnel, equipment,

money, up-to-date information processing. However, as long as the status quo of 1964 is

tolerated, and the circumstances that hamper

the regular processing and provision of data.in

Jamaica remain unchanged, the problems will

continue to exist. Assistance to get data processed for a number of years, particularly when

performed by outsiders, cannot be considered a

solution to the existing problem, but only a

temporary remedy.

Therefore, it is strongly advised that a more

detailed analysis be made of the factors that, at

present, obstruct the re~lar processing of data

and as a priority assist in their elimination. The

processing of data for the past several years

should take second place.

After discussing the existing situation with a

number of Jamaican nationals, the study team

identified several factors that led to the present

situation. However, after a visit of only a couple

of weeks, it is difficult to judge the importance

of each factor and to make certain that the list is

exhaustive and complete.

On the basis of the information collected

during the visit it is not possible to go into a

detailed analysis of the existing organization of

the Registrar General’s Office and to offer

detailed suggestions as to what should be done.

However, it seems that it is first necessary to:

Establish the need (at all levels) in both

manpower and equipment for bringing the

vital statistics data up to date and keeping it

current.

Design a working program for the systematic

processing of data, including printing, analysis,and flow to various decision areas.

Draft an educational program for personnel

involved in vital registration and statistics.

A small team of nationals, chaired by the

Registrar General, can be charged with the work

mentioned. In the implementation of the program, some outside aid may be needed in the

form of equipment, audiovisual aids, organization of training, financial support for printing,

up-to-date processing of information for missing

years, and initiating ad hoc surveys.

In order to begin the work and conduct it

adequately, the following suggestions are offered:

The Registrar General and one or two more

senior officers involved in vital statistics

should be given the opportunity of attending

a workshop or training seminar to meet

officials from other countries involved in

vital registration and statistics to discuss

their probIems and possible solutions. The

Chief Health Statistician, the Chief Medical

Records Officer, and possibly one of the

Chief Medical Officers from the Ministry of

Health, may also be invited.

A professional health statistician or demographer should be appointed as Deputy

Registrar General and placed in charge of the

vital statistics section.

A programmer who would be responsible for

the programming requirements of both the

vital and health statistics sections of the

Health Ministry should be assigned exclusively to that Ministry.

134
Duties should be reorganized so as to ensure

the optimum use of existing equipment and

personnel. An adequate number of machines

and machine operators, as well as assured

computer time and printing services, should

be provided.

More adequately trained statistical personnel

should be charged with vital statistics work.

It might also be advisable, as an alternative

solution, to integrate all three statistical units in

the Health Mi~istry-the one at the Registrar

General’s Office, the Family Planning Statistical

Unit, and the Health Statistics Unit. A professional statistician should be placed in charge of

all these three units to coordinate, integrate, and

supervise their activities and to meet the needs

of various services, including the needs for

analysis of the data. This statistician together

with the programmer and the Registrar General’s

staff could provide strong leadership in the

development of vital registration and statistics

systems in the country.

Until the present time, vital registration and

statistics have been combined under one Government department. This is, without doubt, a

logical and economical arrangement. However,

the production of vital statistics at the Registrar

General’s Office at present appears to have

received less attention than the needs for accurate and readily retrievable records in order to

meet legal requirements related to registration.

It also seems that in the present setting vital

statistics does not receive the same attention and

support as other statistical areas which are the

responsibility of the Central Statistical Department in the Ministry of Finance.

Quality of Information

No studies have been conducted recently to

assess the completeness of registration and the

quality of data. However, it has been stressed

repeatedly that the situation concerning these

areas still needs to be improved. Various suggestions in this respect have been made.

An evaluation mechanism, covering all levels

of the registration process, should be developed,

and ad hoc studies similar to the ones performed

in the early 1960’s should be repeated on a

regular basis. The design for such an evaluation

procedure might be discussed during the workshop mentioned previously.

At the same time, other activities that would

improve the system should be vigorously pursued. These might include:

Wide publicity and training of the population at all levels regarding:

The need to have vital events registered.

The procedure to be followed to have

these events registered.

The information to be given to the

Registrar General by individuals requiring certified copies of these registration documents.

Training of doctors, nurses, midwives,

records officen, and local registrars in their

specific responsibilities in the registration

process and the value and use of the resulting statistics. This training should be given

while they are preparing for their professions

and again when they are actually working.

Because a large proportion of vital events

occur in hospitals or are attended by health

personnel, it would seem advisable that the

hospitals and the health centers (to which the

health personnel are attached) take over the

supervision of the local registration centers and

be responsible not only for the events (births,

deaths, and stillbirths) occurring in the institutions but for all events occurring in the geographic area served by the institution. This

would obviate the necessity of an intermediate

step (notification) between occurrence and registration of most of the events and would ensure a

greater degree of completeness of registration

and better quality of data. This suggested

system, limited to events occurring in the

institution, is being followed at the University

Hospital.

Moreover, the health centers would be able

to collect more complete vital data and could

serve as local registration and reporting units

after the proposed plan of setting up an islandwide network of community health aides attached to the Government health centers would

135
be implemented. The aides are expected to

periodically visit every household in their assigned areas and to obtain demographic and

health information.

A need for uniformity in recording and

reporting vital events exists. One reason for this

lack of uniformity is the absence of supervision

over local registrars. The supervisory personnel

at the Registrar General’s Office should be

increased to provide adequate and frequent

guidance to all (including institutions} involved

in recording, reporting, and registering vital

events. Another possible means of promoting

uniformity and improvement in vital registration

is periodic meetings of the local registrars. The

responsibilityy for registration and notification is

not understood by all because the obligations

have not been expressed clearly.

Feedback to the local registrars through an

appropriate mechanism, such as the distribution

of a quarterly publication or a newsletter, could

also serve to educate and motivate them.

U36of Information

At present, it is difficult to talk of the use or

nonuse of vital statistics data and to identify the

users. When information becomes available

again, there will be time enough to consider the

adequate transfer of data to those who are

interested at the present time. However, it

would be advisable to consult with potential

users and to define their needs in terms of

frequency, quality, and quantity of data. These

needs should influence the processing program.

The education of the user in the proper use

of vital statistics has also been set forth as a

need. Educational objectives should be determined, and learning materials (audiovisual

aids, learning packages, reading material, illustrations on use of data, etc.) should be deveIoped

to answer the requests of concerned persons.

These needs, however, may have to be met with

outside assistance. At the same time, the training

of teachers should be given a high priority.

Coordination and Collaboration

No overall coordinating mechanism for all

“the Government and non-Government agencies

involved or interested in an effective and efficient vital statistics system e,xistsin the country.

The reestablishment of the National Committee

on Health and Vital Statistics, which existed in

the 1960’s, might be the answer to the urgent

need for the coordination of activities in this

area and for obtaining the collaboration of all

those who are seriously interested in improving

vital statistics in Jamaica.

A mechanism should also be developed that

will ensure effective liaison and dialogue among

workers at the local, parish, and central levels.

REFERENCES

1Dep~~ent of Statistics: Demogra~hic Stati”stks>

1976. Kingston, Jamaica. Department of Statistics,

Ministry of Finance, April 1977.

$?Roberts, G. W.: Fertility and Mating in Four West

Indtin Populations. Kingston, Jaxmdca. University of the

West Indies, Institute of Social and Economic Research,

1975.

3McKenzie, H. I., Lovell, H. G., Standard, K. L.,

and Miall, W. E.: Child mortality in Jamaica. Milbarzk

Mere. Fund Quar. 45 (3, pt. 1): July 1967.

4Health Statistics Unit: Hospital Statistical Tables,

Annual 1975. Kingston, Jamaica. Ministry of Health and

Environmental Control, 1977.

5Registrar General’s Office: Demographic Statistics

of Jamaica, 1975. Kingston, Jamaica. Registrar General’s

0~ice,_1977.

6Puffer, R. R., and Serrano, C. V.: Patterns of

Mortality in Childhood. Report of the Inter-American

Investigation of Mortality in Childhood. Washington.

Pan American Health Organization, 1975.

7National Center for Health Statistics: Eighth Revision International Ckzssification of Diseases, Adapted

for Use in the United States. PHS Pub. No. 1693. Public

Health Service. Washington. U.S. Government Printing

Office, 1967.

8National Center for Health Statistics: Ninth Revision International Classification of Diseases. Vol. 1.

Geneva. World Health Organization, 1977.

136
APPENDIX

CONTENTS

Forms

Reproduction of BKth Registration Form ...........................................................................................

Notification of a Birth in a Public Institution or Private Hospital ........................................................

Certificate of Name Given in Baptism..................................................................................................

Certificate of Naming ..........................................................................................................................

Certificate of Regislay of Birth ............................................................................................................

Reproduction of Still-birth Registration Form ....................................................................................

Certificate of Stillbirth ........................................................................................................................

Reproduction of Death Registration Fom ..........................................................................................

Reproduction of Medical Certificate of the Cause of Death .................................................................

138

139

140

141

141

142

143

144

145

137
APPENDIX

Reproduction of Birth Registration Form

ORIGINAL FORM A (Section 12)

BIRTH REGISTRATION FORM

“1. BIRTH IN THE DISTRICTOF

2. PARISH 3. NO.

Do not write

in this margin

4. Place of Biih

USUAL RESIDENCE OF MOTHER

..............................................

5. Date .of Birth ............................................... 13. (a) Residence

}

................................

.................................................................... (b) Town or Village ................................

6. Sex .............................................................. (C) parish ...................................................

7. Name of Child .............................................

.................................................................... 14. No. of Children (a) Alive .........................

8. Physician or registered

}

............................ previously born

)

midwife in attendance ............................ to mother (b) Still-born ..................

FATHER MOTHER

9. Name and Surname .................................... 15. Name and Maiden Surname ........................

.................................................................... ....................................................................

10. Age at time of birth ........................... years 16, Age at time of birth .......................... years

11. Occupation ................................................. 17. Occupation .................................................

12. Birthplace ................................................... 18. Birthplace ...................................................

INFORMANT

19. Name and Surname ..................................... 21. (a) Residence .............................................

.................................................................... (b) Town or Village

.,

...................................,

ZO. Qudlfication, .............................................. (C) parish ...................................................

........................................................................................................................................ ...........

Signature of Informant

REGISTRAR’S CERTIFICATE

22. (a) Signed in my presence by said informant;

(or)

(b) Entered by me from the particulars on a Certificate received from .....................................

................................................................................................................................... ................

23. Witness .......................................................

24. Date ...........................................................

25. (Signed) .....................................................

Registrar

(7) NAME lF ADDED AFTER REGISTRATION OF BIRTH

26. Name ......................................................... 28. Date added .................................................

27. Authority ...................................................................................................................................

138
Ncrrtt :—Fsum of certifkate to be SEUT to REGISTRAR by Chief Resident 017icer of public institutions

or person in charge of private hospital. (Section 13(1) )

FORM D

Tsta REGISTIWION (BIRTHSANDDEWHS) Acr

NOTIFICATION OF A BIRTH IN A PUBLIC INSTITUTION OR PRIVATE HOSPITAL

To be delivered to Registrar, Births assd Deaths within 14 days of birth::

To the Registrar of Bhths and Deaths for the Dktict of...................................... .............................

in the parish of.. ......................................................................

1 certify that tie .........................................................child for whom particulars required to be

registered arc given below was born in the...................................................................................at

..................................................................... ........................on the date stated.

Dzte ... . . . . . . . . . .. . .. .. .. . . . .. .. . . . . . .. . . . . . . . . .. .. . . .. ...

PARTICULARS F{

(s@d) ...............................................................

(Chief Resident O@cer or Person i/c

Private Hospital)

REGISTRATION

Date of Birth of Clild .......................................

Name.............................................................

&x ................................................................

Physi~ian or Rcgd.

Mldvnfe in attendance ........................................

FATSiSR

Full

Nwc .............................................................

Age last hrthday ..............................................

..............................................................yws

Usual Rmidcncc ...............................................

Towa or Vdlage ........................................... ....

&cu~tion . . .. . .. .. .. . .. . ... . . . . . . . .. . .. . . . . .. .. . . .. .... . . . . . . ..

Bhfrplaca . . . . .. .. ... . . ... .. .. . . . . . .. . . . . . . . . . .. . .. .. .. . . . . . . . . . .

N.B. :—In the case oj the child oj a single woman. i

of the father on the register of birth in occa

Usual Residence of Mother

rown or Wllage ...............................................

Parish..............................................................

N~j&fr3sildren previously born to

{

Alive.........

stillborn. .....

MOTHER

Full

Nme ........................................................ .....

Maidan

Smme .........................................................

Age last Mfi&y ..............................................

..............................................................yas

kuption ......................................................

BirthDlacc.......................................................

I proposed to take immediate steph to enter the name

nce with Sectian 17 of the Act?* . . . . . . .. .. . .. . . . .. . . . . . ... .

...........................................................................

.Vignn:ttre of parent a other person furnishing particulars

●..Yes.” or ““No.”

(TO bcgivasslxdyiac aseofativiwdild *

whom DOssarna has baan decided npn).

Nones m m P~

Atanytime rntltin sixwccka ofthc-birUL you

may have a name for the child registcrcrL free of

charge by delivering the form on the back heraof

to the Registrar of Births and Deaths.

............................................................District

.....................................................................

After six wcaks from the date of bwtb tha name

will no longer be ragistcred frea. A fee of tcsr cants

will then lx payable to the Registrar of Births and

Deaths..........................................Diskict

l%o form on the back lisrcof cumot be used aftar

the chfld has been baptized. To register a name

given in baptism. you must obtain a certi6catc from

the minister who performs the baptism and deliver

it to the Registrar. A fee of ten cents wilf be pay-

●ble.
0

Nm4?orrn of “certificate k be given by minister or person performing rite of bapf%n. (Section 2S(2)).

Mx I

THE ilEGISTRAl!fON (BIRTHS AND DEATHS) LAW

CERTIFICATE OF NAME GIVEN IN BAPTISM

This form is to be completed only by the mi]fister or person who performs the rite Of bapfi~. In c=e of *e da$h, absrmceor rmnovaf of thatminiskr, the minkterar pmwm in c&-

of the ohuroh, chapel or place of worship should use FcmmJ.

.4 fee not exceeding one shiiling is payable to the minister for the issue of this certitk?ak.

A further’fee (see over) is payable to the Registrar of Births and Deaths when thk certificate is delivered to him.

1, . . . . . . . .. .. . . . . . . .. . . . . .. . .. . .. . . . . .. . . .. . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . .. . . . ..of....... .... .. .... ................. ... ........... ......................k tie F’srih of..................,............................~ HRREBY CERTIFY,

(fufl name)

thton the.................................day of...................................................19.......... I hqtized by the Name(s) & ............................................................. ...............s .......................... .

(nt@k .f.alafe)

dild produced tome by.........................................................M the............................of......................................................................................................d dackmd by the nid

(80W or daughter) (XIwlw 0/ pm) (name of Wmkr)

....................................................................................tohsve been horn at......... ........................................................in b P@sh d,... ................................CQ &l... ..................

d~y of................................................19 .......

Witness my hand tti16............................ ...........day ti .................................................19.........

.......................................................O*ting mini,kr

FOR USE ONLY BY THE BFX31SYBAB OF BIRTHS AND DEATHS

I 11

Iq csza where tie Regisbmr stillhas in his pmses&m the book .xmbining the wunfafoif d

the bti MgiStmtbn form.

In-where the bmkconkiuing thacounkcfoil of the birth qistmticmfmaisinfb

pncloka C4the Regidrar &nezaL

D18tcict Entry Month of

ktkm ................................IJO.

Dmtriot Month of

.................registmtion of birth ....................................... letter8................................mgistrati00 Of tiA ..........................................................

Baptkmal name entered in ●form and counterfoil ●counterfoil only Fee ............................ Fro............................................

Data ......................................... .......................................................

&pnatur6 of Ragutrar

I

Date ............. .. . ... ..................... ..

%bb W&h@E dcu -t SPply.

.......................................................

Stgnatnrc of Rqdnr

z

:at
Certificate of Naming

(To be filled up by the Rcgistror only)

District

btters ................o.o..........................

Regn. No .........................................

Dale entered..,..... ............................

Fee ..................................................

(No jee if entered within 42

days oj birth)

Name of Mother ................................

.......................................................

CERTIFICATE OF NAMING

(Not to bc used after the child has been baptized)

1........... ............................................................................hereby certify that the

(nome irr jull)

................... ...............................child born at ...................................................

(male or jernale) (name of institution or hospital)

in the parish of ........ .................................on the ..................day of .....................

(month)

19.......... has without being baptized received the name(s) of .......................................

..............................................................................

............................................................................

Signature of Parent or Guardian

Date .................................................. ......

To the Registrar of Births and Deaths,

.................................. ......District

............................................ P.o.

Certificate of Registry of Birth

Birth Entry No ..........................................

REGISTRATION (BIRTHS AND DEATHS) ACT

CERTIFICATE OF REGISTRY OF BIRTH

I the undersigned, do hereby Certify that the Birth of................................................

................................................male child of........................................................

born on the..................day of....................................19....... has been duly Registered

by me.

Witness my hand, this........................day of.......................................19......

~ Registrar of

. . . .. . . . . . . . .. . .. . . .. . . . . .. . . .. . .. . .. . . .. . .. .. . . . . . .. . . . .. . . J Births and Deaths

. . . .. . .. . .. .. . . . . . . . ... .. . .. . .. . . ... . . . ... . . ... . .. . . . . . .. . .. . . ... . . District

Parish oj . . . . . .. . . .. . . . .. . . .. .. . .. . . . . .. . . . . . .. . . .. . .. . . . . . .. . ..

141
Reproduction

ORIGINAL

Do not write

in this margin

of Still-birth Registration Form

FORM C

STILL-BIRTH REGISTRATION FORM

1. STILL-BIRTH IN THE DISTRICT OF

. Isar, actnm * mln

(Section 32)

L, r~nm-i a. Iwu.

USUAL RESIDENCE OF MOTHER

4. place of Still-birth ....................................... 12. Residence ....................................................

.................................................................... Town or Village ..........................................

5. Date of Still-birth ........................................ parish ..........................................................

....................................................................

6. Sex .............................................................. CAUSE OF STILL-BIRTH

13a. (a) Foetxd cause ......................................,.

7. Certificate or

I

13b. (b) Maternal cause .....................................

Decktion upon .................................... 14. Did child die before

I

..............................

which registered or during Iabour? ..............................

FATHER MOTHER

15. Name and Surname

1

...................0,..........

8. Name and Surname Maiden Surname

.,0.,.......0........,,....,,,,

...............................

....................................................................

9. Age at time of Still-birth .................... years 16. Age at time of Still-birth .................... years

.0. Occupation ......................................e.......... 17. Occupation .................................................

.1, Birthplace ................................................... 18. Birthplace ...................................................

INFORMANT

.9. Name and Surname ..................................... 21. Residence ....................................................

.................................................................... Town or Village ....................................,, ,,.,

!0. Qualification ............................................... parish .......................................................0..

Signed ........................................................................................................................................

Informant

REGISTRAR’S CERTIFICATE

~20 S&ed ~ my presence by the stid informant

(or)

Entered by me from the particulars on a certificate received from ...................................,.,.,.,,,.

...................................................................................................................................................

~3, Witness ........................................................

24. Date ............................................................ 25. Signed .........................................................

Regzstrar

I

142
Certificate of Stillbirth

FORM W

REGISTRATION (BIRTHS AND DEATHS) LAW, CHAPTER 337

CERTIFICATE OF STILLBIRTH

‘ This form may bo used only by u Registered Medical Practitioner or o Certified Midwife

FOR USE BY TIIEREGISTRAR

District Letters . . . . . . . .

Entry No . . . . . . . . . . . . . . .

lHEREBY OERTIFY that................................. ...... . ..................................

(Name of Mother)

vwwcldivored of a . . . . . . . . . . . . . . . . . . . . . . . . ..chikl on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...19....

(Sex)

at. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . that I

*was in attendcmco at the buth andthdthcddd Wru3NOT BORN ALIVE.

*exnmined the body of the clild

Arm I IIEREBY CERTIFY that to the bestofmy knowkdgc nnd beliefthe childdied.........................

(before or durhi ..

Id lonr, n.nd the cmwc of dcnth wns as hereunder written:- -

,.

cAusn OF (a) Foetalcrmse . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . .

13EATII (b) Maternal cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Witness my bond this . . . . . . . . . . . . . . . . . . . . ..(lay Of... . . . . . . . . . . . . . . . . . . . . . . ...19....

Signntmw. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Registered qualificrttion

Rcgistere$’No. as a Certified Midwife. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

* Delete wldchever does not apply.

NOTICn-..This Certitlccdo mnst be delivered to the Registmr of Births rmd Deaths by the person attending to

give information concerning the Stillbirth.

It is NOTau authority for burial.

143
Reproduction of Death Registration Form

FORM B (Section 24)

DEATH REGISTRATION FORM

1. DEATH IN THE DISTRICT OF

2. PARISH 3. NO.

Do not write

in this margin

3

4. PLACE OF DEATH USUAL RESIDENCE OF DECEASED

.................................................................... 12.(a) Residence ..............................................

(b) Town or Viiage ......................................

.................................................................... (c) parish .......................................,,, ...........

PARTICULARS OF DECEASED i3. CAUSE OF DEATH

5. Date of Death ...........................................0. I (Immediate Cause)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (a) ....................................................................

6. Ftd I&me due to

...................................................

.................................................................... (b) ....................................................................

due to

7. Sex .............. 8. Condition ......................... (c) .......................................#...o...,,,..............0...

9. Age ....... years ....... months .................. days II (Contributory) ..............................................

10. Occupation or calling .................................. ......................................................................

..................................................................$. 14. Certified by .................................0............0..

11.Birthplace ,,.,.......$..,,,.................................. ................................................................0...,

Quakficufmn

INFORMANT

15. Names and Surname .................................... 17. (a) Residence .............................................

.................................................................... (b) Town or Village .....................................

16. Qualification ............................................... (c) Parish ....................................................

..................................................................................................................*................................0

Szgnature of Informant

REGISTRAR’S CERTIFICATE

18. (a) Signed in my presence by the said informant

(or)

(b) Entered by me from the particulars on a Certificate received from ..................................,.,.

...................................................................................................................................................

19. Witness ..............................................b.........

20. Date ............................................................

21. Signed ..........................................................

Registrar

144
Reproduction of Medical Certificate of the Cause of Death

REGISTRATION (BIRTHS AND DEATHS) LAW, CHAPTER 337

MEDICAL CERTIFICATE OF THE CAUSE OF DEATH

To be given by the Medlcd Attendant to the person whose duty it is to give it with information of the Death, to the Registrar of the District irr

which the Death took place and TO NO OTHER PERSON.

I HEREBY CERTIFY that I attended ............................................................................................................................whose age was stated to be

..........................,,..,,,..,.,,, ., that I last say h..,.. on the .............................. day of .............................................................. Id ......... . that ......... he Died*

,,,,.,,,,,, ,,,,0,.,,,... ,,,,,,.,,.,,,,,,.,,,,.,,. !!. on the .......................... day of .......................................................................................19.......... at..., ......................

,.......................................................................... arrd that to the best of my knowledge and belief the cause of h ......... death was as hereunder written.

CAUSE OF DEATH Approximate interd

between onset and death

*Should the Medical

Attendant not feel

justified in taking

upon himself the resp~nsibfky of certi-

$wrg the fact of

Death, he may here

insert the words “as

I am informed.”

I

Disease or condition directly

Years Months Days Hours

leading to deatht

Antecedent Causes (a) ..........d . . ... ..y.i.l.i..qi.rii.r:q:.:q... . ................ ................ ................ ...............

Morbid condition, if any, giving .

rise to the above cause stating the

{

(b) ..........di~..~..q.~~..~.~j:~~;;.;~j.... . ................ ................ ................ ...............

underlying condhion last

H (c) .................................................................. ................ ................ ................ ...............

Other sigri~lcant conditions conI

....................................................................... ................ ................ ................ ...............

tributing to the death, but not

....................................................................... ................ ................ ................ ...............

related to the disease or condkion

causing it.

t’This does not mean the mode of dying, e.g., heart fsilure, aathenia, etc. It

means the disease, injury or complication which caused death.

Witness my hand this .......................................................... day Of............................................................. 19----

tignature..o ...............................o............................................................ Registered Qualification .............................................................

Residence ..............................................................................................

N,B.-TH1S CERTIFICATE IS INTENDED SOLELY FOR THE USE OF THE REGISTRAR to whom it should be delivered by the person giving

information to him of the particulars required by law to be registered concerning the death. Penalty of Two Pounds for neglect of Informant to

deliver this certificate to the Registrar.

The Regktrar-Generd cautions all persons against accepting or usirrg this certifkate for any purpose whatever, except that of delivering it to the

Registrar.

FOR USE BY PUBLIC INSTITUTIONS

CONDITION

(Married-WidowBachelor-SpinsterInfant)

PARISH OF BIRTH RESIDENCE

OCCUPATION

(For married women or Widows–name

and occupation of husband)

For Legitimate children nsrne and

occupation of father.

For Illegitimate children name and

occupation of mother.

For Children under 1

year enter here:–

Age of mother at time

of Birth and livebirth order of deceased child

145
ChapterVI

Viii RegistrationSystems

in Five DevelopingCountries:

Honduras,Mexico,Philippines,

Thailand,and Jamaica

AComparativeStudy

BemldBe@alllin
CONTENTS

Introduction .............................................................................................................................................. 151

Core of the Problem .................................................................................................................................. 151

Basic Registration Function ...................................................................................................................... 152

Choice Between Central and Local Control ............................................................................................... 152

Registration Procedure .............................................................................................................................. 154

Medical Mmpower .................................................................................................................................... 155

Statistical O.ation ............................................................................................................................. 156

Users’ Requirements ................................................................................................................................. 157

Ttiting .................................................................................................................................................... 158

summary...................................................................................................................................................158

LIBT OF TABLES

VI-1. Charaftenstics of local officials responsible for registration: Honduras, Mexico, Philippines,

Thalmd. adJmtim .................................................................................................................. 153

VI-2. Birth and death registration procedures: Honduras, Merdco, PWlppines, Thailand, and Jamaica .... 155

VI-3. Comparison of registration systems: Honduras, Mexico, Philippines, Thailand, andJarnaica ......... 157

149
CHAPTER VI

VITAL ‘REGISTRATION SYSTEMS IN FIVE DEVELOPING

COUNTRIES: HONDURAS, MEXICO, PHILIPPINES,

THAILAND, AND JAMAICA

A COMPARATIVE STUDY

Bernard Benjamina

INTRODUCTION CORE OF THE PROBLEM

This report is based upon a review of the

findings prepared by members of World Health

Organization missionsb who visited Honduras,

Mexico, Philippines, Thailand, and Jamaica in

the early months of 1977 to observe the

operation of vital registration. In summarizing

these findings, a primary purpose is the identification of practical steps that might be taken,

given the necessary resources, to provide early

reduction of the deficiencies that were strikingly

apparent to the observers. In none of the

countries visited was vital registration even

nearly complete. In all the countries the calculation of vital rates could not be made with

accuracy; these rates could only be estimated

from national demographic surveys carried out

independently of the registration system.

aTemporary adviser, professor of actuarial science,

City of London University, London. (Chief Population

Statistickm, General Registrar Office of England and

Wales 1952-63.)

bThe missions were organized within the framework

of the vital and health statistics programs of the World

Health Organization, the National Center for Health

Statistics, and the U.S. Agency for International Development.

Apart from defects in the individual systEms,

which will be commented upon later in this

report, one serious obstacle to progress, which

may be alleviated but cannot be cured quickly,

exists; this is the fact that the countries are not

economically fully developed.

Registration systems are only successfully “

introduced at the stage of economic development when, simultaneously the demands of the

economy both for statistics and for the personal

protection of registration provide strong motivation and the capability of the economy is

adequate to provide educated manpower and

other resources to operate the system. It usually

happens that it is when the economy has

developed to a point at which it cannot function

properly without vital registration (if only to

link property or adjuncts to property, such as

insurance and people), that it finds it possible to

support such a system.

This means that even if greater resources are

provided than would, in the past, have been

available, a country that is not yet economically

developed is bound to face the problem of lack

of personal motivation on the part of individual

members of the population. This is not a

motivation to provide vital statistics-probably

151
only a fraction of the population is ever likely to

take a keen interest in birth and death r’ates-it is

a motivation to obtain documents for personal

identification. The best dt?signed statistical systems are likely to fail if this personal motivation

is lacking. Thailand provides an example of a

country that has a well-developed and organized

registration system but that still lacks this

motivation; birth coverage is only 85 pez’cent

complete, and death coverage, 70 percent,

Jamaica is the exception that proves the rule.

The upsurge in migration with its attendant

demand for regist.raticm documents has replaced

economic development as a motivating factor,

This does not mean that nothing can be

done to make progress in q developing country.

A determined government, which is itself

strongly motivated, need not wait for history. It

can. stimulate personal motivation in advance of

economic development, but it will not be easy.

Motivation needs to be made a persistent priority. Computers and systems analysts should,

meanwhile, be ready and waiting to be called

into service at the proper time. However, any

improvement in the use of derived information

(e.g., vital rates) as distinct from merely increased efficiency of their calculation, which is

the only gain from computers, may provide

some improvement in motivation as interest is

fed back from the users to the local officials and

in turn to the community. Such improvement

wiU, however, only be marjjmd.

BASIC REGKI’RA’I’ION tW?WTiON

In Honduras and Mexico, the act of regis~

tration is a purely local function because there is

no central body to exercise responsibility. In the

other three countries, the responsiblit y for

registration is v~sted in a central government

department: in the Philippine, it is the National

Census and Statistics Office (the Executive

Director is ex-officio Civil Registrar General)

emphasizing, somewhat prematurely, it might

appear, that the main government interest is in

derived information; in Thailand, it is the

Ministry of the Interior, emphasizing the pri~

mary identification role of registration (at the

sta~ of deriving

152

information, ‘control switches

to the Department of Public Health, but this is

beyond the normal awareness of the ordinary

village or municipal informant); in Jamaica, the

Ministry of Health and Environmental Control

has jurisdiction over the Registrar General (although his position is weakened by the fact that

he is stationed 22 kilometers (about 14 miles)

away from the Health Ministry and has no

contact with other central government departments).

CHOICE BETWEEN CENTRAL AND

LOCAL CONTROL

~~re is a dual need for firm central control

of awl registration. First, it is necessary to

ensure that the law is properly administered and

that the personal purposes of civil registration,

both on behalf of the individual citizen and on

behalf of the government, are fully achieved.

Second, if basic registration is ultimately to be

used for the production of vital statistics, central

control is necessary to ensure that the primary

record is uniform in content and format and of a

minimum quality to support usable national

statistics. The vesting of responsibility for primary registration in a central government department will normally be a prerequisite for the

provision and maintenance of standards by

leading to an organizational structure that facilitates the training of local registrars and the

supervision of their work. If these last conditions are not fulfilled, then central control loses

much of i~s advantage. T& is illustrated by the

situation in Jamaica where the Registrar General

has only two supervisors to cover 380 registrars,

and some local registrars have not been visited

for several years; moreover, many of the local

registrars are postmasters, and others are private

individuals who have set up offices in their own

homes so that the absence of inspection and

training is all the more serious. Central control

must have the resources to ensure proper

control.

The claim is sometimes made that local

control as opposed to central control brings the

adminktrator nearer to the people. This does

not appear to be an advantage. On the contrary,

the absence of central control appears to open
the way to laxity and divergence of practice, if

not actual failure. In Mexico and Honduras,

where there is no central control, the persons

appointed as registrars do not necessarily perform the duties themselves, and neither they nor

those who serve as their deputies have any

training in the purposes of civil registration; nor

do they have any incentives to make registration

coverage complete. (In Honduras, the Population and Migration Policy Board intends to

establish supervision of birth registration, but

this has not yet been arranged.) ,Central control

is expensive. It cannot be funded with money

provided by international bodies because this

would give the appearance of interference with

the local official civil administration; it, there-

‘fore, depends on the willingness of the government to provide the resources from the national

budget.

Characteristics of local officials who are

responsible for registration in the five countries

under consideration are presented in table VI-1.

It is clear that in all the countries visited the

officers appointed to carry out the duties of

primary registration are not selected because of

any special skill, are not provided with any

training (apart from the provision of a manual

and locally organized seminars in the Philippines

and the rare visits of an inspector in Jamaica),

and, except in Jamaica, are not paid in such a

way as to encourage a vigorous pursuit of

completeness of coverage. Only in two of the

countries (Philippines and Jamaica) are they

directly responsible to departments of the central government that have a particular interest in

completeness of coverage in the sense that these

departments themselves wish to obtain reliable

vital statistics. Pressure to produce complete

vital statistics does not (as stressed in the section

“Core of the Problem”) stimulate motivation in

the individual citizen, but it can do much to

stimulate motivation in officials if that pressure

is directly exercised by their employers. It may

be argued that this thesis is not supported by the

experience in Jamaica where the local registrars

are responsible to the central government departments that produce and use vital statistics.

For both countries, however, the reasons are

Table VI-I. Characteristics of local officials respansibla for registration: Honduras, Mexico, Philippines, Theiland, and Jamaica

Characteristic

official ,,,,,..., ......................

Suparvlslon ..............O....O.O..

hymnnt, ............................

Training .............................

Respon$lbllity ....................

Hmrdurca

Municipal: registrar

eppolnted by department politicel

gwernor (10 and

more municipalities to

each of 1S departments)

Rural eraas:

auxiliary mayor

appointad by mayor

of municipality

Nil

No specific sslery.

May exact additional

taxes by charging, for

axemple, for burial

permit

Nil

,

Does not do all the work,

but slgrrs certificates.

Responsible throunh departmental govarnor to

tha Minister of the

Interior and Justice

Mexico

Municipel: raglstrar

appointed by murdcipal

president (in Maxioo

CitY, by civil

justices}

Rural areas:

daputias appointed by

municipality

Nil

Sslaried

Nil

Has to meet, considerable

statistical damsnda

from cantral Govamment. Responsible to

civil justices

Philippines

Municipal: local firsence

officar or city haalth

officer

Rural areas:

n’sinicipaliw”

Nil

No specific calary

Manual is circulated.

Local seminars by

National Census and

Stctistic5 Office

Work done by designated

employees. Rewonsible

to National Census

and Statistics Office

Thailand

Municipal: appointed by

Minister of Interior

Rural: village

headman responsible

through commune

headman to district

officer

Nil

Spacific payment not

mentionad in report

Raspmrsible to

Ministry of tha

Interior

Municipal: appointad by

Ragistrcr-Genaral in

Ministry of Health

a~~twmantal

Rural: as almva

Negligible. Only 2

inspectors. Some local

offices not visitad

for years

Paid by fees from

cantral gwernment

Only training is by the

2 inspectors-covsrme

very incomplete

Actually does the Work,

is peid by results.

Responsible to

Ministry of Health

and Environmental

Control

153
simple—too high a staff turnover in the registration service of the Philippines, and in both that

country and Jamaica an inadequate exercise of

the kind of direction and supervision that is

essential for any feedback of motivation.

It is recommended, therefore, that local

registrars should be appointed, supervised, and

trained by officials of specific offices such as

that of the Registrar General situated withinc

the Ministry of Health or by an official of the

National Census and Population Statistics Office; that ‘they should be selected on the

basis of their pkior understanding of at least the

purposes and mechanisms of registration and an

elementary knowledge of the production and

uses of vital statistics; that they should be paid

specifically for their duties (and for their workload) and their careers should be structured so

as to encourage a spirit of vocation. (Further

reference is made, later, to training.)

This would undoubtedly increase the overall

cost of registration in comparison with present

levels of expenditure, but this increase would

not be great. It would, however, be cost effective. A part of this increase in cost would be

more apparent than real because expenses that

are currently covered by local budgets (probably

not always visible in accounts) would be transferred and made more explicit in the national

budget. In addition, complaints, such as the one

by the local registrars in the Philippines that

becau:e of dependence on local funds they are

understaffed, poorly equipped, and inaccessible’

to the population, would not be possible.

REGISTRATION PROCEDURE

In aIl the five countries, personal facts

pertaining to a vital event are given to the

registrar by a person who was present at the

place of occurrence of the event and who is

defined by law within a chain of responsibility

cThis means physical location in the office of the “

HealthMinistryand in close daily contact with senior

colleagues who need vital statistics. InJamaica, the Registrar-General’s Office is part of the Ministry of Health and

Environmental Control but is isolated in a separate office.

See “Basic Registration Function.”

extending from immediate and responsible relatives to attending health care personnel and

finally to some persons who “have knowledge”

of the event. (Curiously in the Philippines, for

births, the attending physician or the clinic

administrator takes priority over the parents.) It

is essential that there should be such a chain of

responsibility, but it is essential that it should be

reinforced by the imposition of a penalty on

failure to report. In all the five countries, the

penalties are either slight or only infrequently

imposed in practice. All the countries experience

a high incidence of late registration. Further

details are summarized in table VI-2.

It would appear that because there is a lack

of local funds registration is made more difficult

for the general public. Offices are frequently

situated far from the home of the informant and

are often understaffed and ill equipped; informants, therefore, are inconvenienced by

having, to wait in lines. Presumably because of

lack of staff and lack of career incentives, the

law relating to the time limit for registration and

to the withholding of a burial permit is not

firmly applied. As a result, registrations are

neglected or often delayed.

In addition to the improvements in conditions proposed under “Choice Between Central

and Local Control,” efforts should be made to

help informants carry out the process of registration. Steps should also be taken to make them

aware of the necessity for registering the events

(for example, there should be no exception to

the requirement that a death be registered

before a burial permit is issued). The requirement of witnesses, as in Mexico, seems to be an

unnecessary complication and possibly a deterrent. The presentation of birth certificates

should be made mandatory for as many important civil purposes as possible-education, employment, migration, and so forth. The public

must be made to realize that there are real

material advantages to registration. In counties

where public transportation systems are undeveloped, 10 kilometers (about 6 miles) is a long

way to go to a registration office, and, in

addition, waiting in line can be a major discouragement. The aim should be to reduce the

difficulties and to increase the advantages of

registration in whatever way possible.

154
-–-.., .–. –., ,–––..

Registration procedure

Who reglners?l

Birth .............................

Deeth .,,,.,,..,,.,,,.,,..,,,,,.,.

who the Is Preeent?z .,,,,,,,.

3upporting documents

required ..........................

Time limit for

r2g19tratlon:

Binh .,,,,,,,,,,,,,., .............

Death ,.,,,, !..!.,., ........0.,,,.

Doaummte given to

inf0m8nt,,.,,,,,.,,,.,,.,..,,,,,

Prlnelpel defecm

Gmsmal .,,,,.,..,,.,,,.,.,,,,.,,

Birth ..,.,..,..,,,.,,,,,.,.,,.,.,.

Teeth ...................... ......’

Table Vi-2. Birth andderrth rwistretion prmedures Honduran, h4exico. Philip

Honduras

parents

Nearest relative

2 wltnwses

Not specified

8 &VS

24 hours

Certificate of registration details

Registers are notpreprinted eo registrar has

to depend on mamory

for Iagel formula

Long delay

Onlv 13 percent of da.eths

registered are medically

certified

Certificetee not elweys

givenby hoepitelto

relatives

Burial permit can h obtained without proof

of registration

Early infant deaths not

registered as births

Mexico

Paremts

Nearest relative

2 witnesses

Certifiaete of Daeth

15 days (father)

40 &y’s (~other)

Not stated

Certificate of registration details

Not stated

Long delays (fines

lenient)

If body rranefe~rad for

burial in another area,

it can be registered

twice

Burial permit can be obteirred without regime.

tion in some circumstances

lgee .Im llRe@ation prncedure!~ for chehr of responsibtity in rS@StrltiOn Pr~eSS.

21n ●ddltlon to inforrerent and rWhtreI.

~gea ,IW ,*Cholce Between Locel and COntrSl COntfOl.”

MEDICAL MANPOWER

A major difficulty, especially in death registration, is the lack of medical attendance at the

vital event. In the Philippines, three-quarters of

all births take place outside a hospital and

one-seventh of all confinements take place at

home without any medical attendant; the corresponding proportions in Honduras and Mexico -.

are probably higher. Again in the Philippines,

one-third of deaths are not medically attended,

and the proportion is substantial- elsewhere

except possibly in Jamaica. In these circumstances, the production of statistics on cause of

Philippines

Birth attendant and perent!

Neare$t relative

No one

Prior notificetinn *

attendirrg physicien

30 days

48 hnure for repnrt to

led heelth offiie,

Wch orders registration

within 30 days

Certificate of regiatretion demils

Inadequate etetiOnery.3

Incomplete

Incomplete

Burial permit giwn orr

death notification and

thnugh reghtretion is

ordered to be dnne

wkhin 30 *ye, it is

nnt akys done.

Thailand

parent

Neereatrelative

Not stated

CMtificetaof Death

15 dcys

Not stated

C8rtificete of registration details

Not Stid

Incomplete

.lemeice

parent

Nearest ralative

No one

For birth, notifiition

sigmed by mother

For decth, certificate

of daath

42 deYs (midwife required

to notify within 48

hours)

5 days

Certificate only that event

hea teen registered. Not

generally acaapted as

evidence of birth

Time limits nnt vigornudy

applied. Same officee

remote

Delays

Delays

Burial permit given on

certifiite of rW”stration lwt 7 percent

underregistretion exieta

death, a major national health indicator, is

impossible. -

The prospect of an immediate expansion of

medical manpower is minimal. If it were practicable (there are not enough medical schools), it

would be expensive. However there is a clear

opportunity here for the extension of the

growing practice of employing partially trained

medical assistants to make a broad and possibly

symptomatic rather than a systemic categorization of cause of death. An experiment along

these lines is being made in Honduras where

“health guardians,” who are volunteers in rural

communities, are trained to deliver primary

155
health care and to refer patients whom they

themselves cannot treat to rural health centers.

It is not ,clear whether or not they actually

attribute a cause of death, but there seems to be

no reason why they should not do so. Presently

two major defects in the experiment are apparent: There are too few health guardians

(10,000 are needed, but there are only 300), and

the information they gather remains at the rural

health centers because no organization has yet

been set up to incorporate these data into the

national data collection system.

The institution of experiments of this kind is

‘ possibly an activity to which extranational funds

could be legitimately applied, for example, from

the United Nations Fund for Population Activities or from international foundations, without

political embarrassment. It would be one important and effective way in which counties could

be helped to overcome their lack of economic.

development stressed in the section “Core of the ~

Problem” in this chapter.

Any experiment of this kind should not be

re~arded as simply of interest to health statisticians, but should embrace the national registration service whose members should be led to

appreciate that the objective is to improve basic

registration coverage and completeness. If the

local registrars could be involved and, more

especially, feel involved, it would be a considerable boost to their morale. It should be a

registration and not just a statistics “thing.”

Indeed, some of any money provided should be

devoted to holding seminars for’ registrars to

discuss the experiment’s progress and ways of

improving registration.

STATISTICAL ORGANIZATION

This topic has been left until the last for a

very important reason. The health statistician is

mainly and legitimately interested in the production and utilization of reliable vital rates as

primary national health indicators, but he

should not make the mistake of thinking that

this is the primary objective of vital registration.

It is not. Vital statistics are a valuable result of

registration, but they are not the central objective. Complete and adequate registration as an

object in itself is, however, a precondition of the

construction of a reliable vital statistics system.

To improve vital statistics, the major effort must

be directed toward improving the registration

system.

As already indica~ed in “Choice Between

Central and Local Control” in this chapter,

there is some feedback of motivation to the

registration system. This does not come from

demanding that registrars should give more

detailed statistical returns more often. On its

own, such pressure is likely to be counterproductive. Motivation can only come from

statistics being used and being seen to be used in

some way that will benefit health services or

economic development generally. It is important, therefore, that any training programs instituted for registrars should include not so much

the methodology of vital statistics as a clear

demonstration of the use of vital rates in health

administration, population projection, ‘manpower planning, and for other economic purposes. In none of the five countries visited does

this happen at present. In all five countries, a

#eat quantity of paper moves from office to

office; there is even talk in the Philippines and

Thailand of the development of health management information systems,d but nowhere are

reliable estimates of vital rates being produced.

What is more important than talk of systems

analysis is the insistence upon a single clear line

of communication of primary data to a single

focus of vital statistics generation and that this

focus should be within the central government

department where those statistics will be most

used for administrative and, above all, for

policymaking purposes.

The five systems may now be compared as

shown in table VI-3.

Instances exist of two or more departments

of the central government collecting and proc-

‘Such systems only work if there is a real point of

entry of basic information (in this case, reliable registration) and a real point of extraction for management (on

a conversational basis). They imply the existence of

sophisticated forms. of management, which arc not

appropriate to developing countries where the systems

could remain elegant but unused.

166
Itcm

fAdium of tmn:fm of

prlmcry information .......

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procctsing ,,,,,,,,..,.,,,,.,,,,..

C4ntrd gowrnmwttdepwt.

mmt that processes.......

Othw dcpartmmts

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Avmgs timo lagfor

publication .,....................

Rdlabllltv ..........................

Tabk W-S. Corn

Hondumc

Smtisticcl summwy of

oech registmtion sent

In bundles wneklv

Dlrcct

Gerwal Steti$ticc ●nd

Census Offiw (part of

Mlnistw of Economy)

Ministry of Public Heelth,

Highw Economic

Planning CXwrcil

Scmarel Board of Statistics and Censuses

I veer

!40 wrificatl on: operates

IW rule.af.thumb for

filling omitsions

3wcd on rogistratlont in

period not wcnts

3wcd on phC* of OCCUrrenw not resldmce

ikon of registrationRVM

Msxko

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mrnthlv bomhe$fbv

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month )

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Dirwtor4tc Geneml

of Sxctiatic$

>imqtomtcGonwelaf

Stctistict(pm of

Deportmentof Pro-

~mming and Bu~t)

Xpwtmant of Hmlth 8nd

Welfare (C3imotomt~

General of fliottatistics),

N@tionalFowl#tion

Council,W“xiocnIntth

two of SW191S6@tv

hp6rtment of Hwlth

●nd Wdfwo

I Vmre

IOnwcrwfewrificmion at

IocclStett offiG9sOf

DirectQratcGcnwd of

Smtistict

keel on mgi$tmtionsin

Psriod not ewnft

le~d on plwe of 00cur.

mncc not residence

lFor ,ummUY ~Bure$ only. Detsiled ●nalyseshavenot beenpubli:hcddnce 1964.

msing primary data independently of each

other. This is obviously wasteful of statistical

manpower, which is in short supply. Apart from

this, the statistical systems seem to be reasonably efficient. It would probably lead to some

improvement in the quality of the data if the

department that is the main user (e.g., Ministry

of Health) were also the department that processes and publishes; there could then be more

effective feedback. Some drudgery could probably be removed by the more effective use of

computers, but experience suggests that this

could mean an increase in costs. Priority for any

extra money should, at this time, go to the

improvement of the quality of primary registration. More improvement in data processing is of

no avail to repair deficient primary data,

Fililippilw$

QIMIIicsfc copic$Wthlv

(in first 10 *S of

followi~ month)

W regiotrsloffii of

Netierul eontw and

Stmistlm Office

,

N@t@nRl Conws md

Stmtkt Office

0m6mmt of Hmlth

Mtiond Cen#ut and

Stati$tkl Offim

sW6rt

Swd or! mgktmtiom in

pwiod nor wcnts

Mwd on PICCOof ocour.

rencc cot r8si*nce

TMIwrd

S@tistk61 P9rt of qi$,

trq;ion form sent monthly

(W Sth *V of following

momfrl

Sumcrwiz4dat FvOVincid

Offii of M/rfittcy of tfm

Intqrimr+urwnwv not

prigind form to

Mini~W-originals tet

Mini$fw @fPubliri H@cl!h

Mitfiltw of PuMiG

H@fr

Minlatrvof tfw Irmrior

Minixtrv of PubIii No61th

3 v~a

some Iood CFmcke

BatedWI@W Of OCCUr.

rcncc nor refidcnce

Cop@ of rqistmtion

fom$

IWtrkt offiw6 of Rc@I.

trcr Gcncrcl (MinisW

of Halth snd f3wironnwntel Control)

Fcrtlv Mlnittry of Fincnw

(Chpufmcntof St4ti8tics) .

8nd Ministryof Halth

(RogiatrcrGwr@), but

dso other orgmizatiorrs

Mini$tryof H.elth, F6milv

PlwtninSBoard,N@tiorrcl

PlccrnirqASEnCV

Ministwof Finmtw,

Ministrvaf Nwlth and

l%wiramncntel Control

f Vw 1

Bccoc=oJmldrrg in district

Mtedonwentr

Carected for residence

USERS’ REQUIREMENTS

In terms of statistics, the main users are:

Economic phmncrs who require reliable and

up-to-date vital rates (including specific fertility rates) for the measurement of changes

in the population structure and especially

for population projections

Health service planners and administrators

who require indicators of the health state of

the population as a means of assessing the

effectiveness ~f delivery of health care imd

the future tasks of the health services.

The latter users especially need Whiit, bccausc of deficient registration, they cwmot now

157
have, that is, good cause-of-death statistics. The to encourage others, a meeting of local registrars

obstacles have already been discussed in this to discuss the law, the practice, and the dayreport. to-day problems that arise. In these meetings,

vital statisticians should be present to express

their needs, but their intervention should be

TRAINING minimal.

In most of the countries visited, there are

training courses for the users of vital statistics

(in Mexico, a plethora of courses); but there is

very little, if any, training available for primary

producers. For example, it is important. that

medical students should have some training in

vital statistics so that they will understand the

need to specify correctly the cause of death. If

the death is not registered properly or not at all,

there still will be no vital statistics.

In Scotland, prior to 1960, it had long been

the custom for the local registration junior staff

to take a written examination in registration

practice. The Registrar General for Scotland had

recognized this examination, and the local urban

authorities who actually appoint registrars (reimbursed by the central government) had taken

this into account in making promotions to the

office of registrar. In 1960, the registrars formed

themselves into a professional organization

called the “Institute of Population Registration”

with a training program, a technical journal, and

a system of examinations leading to qualification. The Institute has done a great deal to raise

the educational level of the registration service

and also has introduced its members to wider

horizons, for example, to a study of registration

problems in other countries and to a better

understanding of their role as population information officers (normally the registrars become

local census officers during a population census).

Without suggesting that this development is

necessarily appropriate to developing countries,

it is proposed that experiments should be made

to bring registrars closer together both within

countries and between countries. A beginning

might be made by (1) arranging a regional

meeting between senior registration officers of

those countries that have a vital registration law

and senior administrators of those who do not as

yet have a registration system to discuss the

problem of obtaining complete registration and

(2) arranging in one or two countries, primarily

SUMMARY

The vital registration systems in the five

countries have been shown to have many defects, many of them arising from the country’s

lack of economic development. These defects

are:

A lack of incentive to register on the part of

the public and a lack of encouragement

and/or compulsion to register on the part of

the government. Registration is incomplete,

late, and inaccurate.

Insufficient medical certification of death

mainly because of a lack of medical manpower. Cause-of-death statistics are, therefore, inadequate.

Lack of training, supervision, and encouragement of registrars. A subsidiary failure is the

lack of standard rules of practice, concepts,

definitions, and so forth.

Delays in aggregation of records and in

dissemination of statistics.

In some cases, a multiplicity of discrepant

publications.

It is suggested that stronger centralization of

the registration system with a single focus or

direction and assembly of information would

lead to improvement and would not necessarily

require extensive additional resources; that more

medical manpower is needed and that this might

be supplemented experimentally by medical

assistants not fully trained; that medical stu-

‘dents need more education in vital statistics,

their derivation and use; that, above all, attempts should be made to raise the esprit de

corps of the local registrars by providing an

adequate career structure, by improving communication between registrars, especially in the

158
discussion of working problems, and by making

them feel more involved in the worthwhile

process of measuring population change and

public health trends; that communication should

be extended to the internatiomd level; and

finally, that given an improved organization,

more effort is needed to increase the incentive

for ordinary members of the public to register

the vital events of which they are the responsible

informants.

In this report, emphasis has naturally been

placed upon the need for national governments

to make a greater effort to promote effective

vital registration systems, However, a number of

other subsidiary suggestions have been made

that might alleviate specific difficulties and

could be implemented extranationally if the

necessary external ji’nancial aid were forthcoming. These are recapitulated here:

Tlie conducting of regional workshops of

short duration in which senior officers in the

registration services of a number of countries

fairly close together could come together to

discuss the problems besetting vital registration and the possible ways of overcoming

these problems. The problems to be discussed would include the basic organization

for vital statistics preparation and publication. Outside experts from countries with

experience in overcoming problems in the

development of compIete registration coverage and reliable vital statistics would attend.

The preparation of teaching material that

could be used within an individual developing country to instruct operating staff

in the nationaI vital registration system. This

might take the form of a manual for

instructors of vital registration staff.

The supply of audiovisual aids so that

teaching material can be prepared.

The offer of a technical expert to examine

particular national situations especially those

where, because organization is complicated

and responsibility is divided, the available

primary vital registration information does

not find its way to effective analysis and

publication, Such an expert should not be a

statistician or a computer systems analyst

but, rather, a person with knowledge of all

stages in the organization of vitaI statistics,

from initial registration to final printing of

tabulations. Such experts would need vast

experience and great tact and humility but,

given these qualities, they could be extremely effective trouble shooters.

,

MM, GOVERNMENTPRINTING OFFICE: 1981 341-161/30 1-3 159
VITAL AND HEALTH STATISTICS Series

Series 1, Programs and Collection Procedures. –Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions and data collection methods used and include

definitions and other material necessary for understanding the data.

Series 2. Data Evaluation and Methods Research. –Studies of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, new analytical

techniques, objective evaluations of reliability of collected data, and contributions to statistical theory.

Series 3. Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health

statistics, carrying the analysis further than the expository types of reports in the other series.

Swim 4, Documents and Committee Reports. –Final reports of major committees concerned with vital and

health statistics and documents such as recommended model vital registration laws and revised birth

and death certificates,

Series 10. Data From the Health Interview Survey, –Statistics on illness, accidental injuries, disability, use of

hospital, medical, dental, and other services, and other health-related topics, all based on data collected

in a continuing national household interview survey.

Series 11. Data From the Health Examination Survey and the Health and Nutrition Examination Survey .–Data

from direct examination, testing, and measurement of national samples of the civilian noninstitutionalized population provide the basis for two types of reports: (1) estimates of the medically defined

prevalence of specific diseases in the United States and the distributions of the population with respect

to physical, physiological, and psychological characteristics and (2) analysis of relationships among the

various measurements without reference to an explicit finite universe of persons.

Series 12. Data From the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports from

these surveys will be in Series 13.

Series 13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilities

providing long-term care, ambulatory care, hospital care, and family planning services.

Series 14. Data on Health Resouzces: Manpower and Facilities. –Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health

occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthly

reports. Special analyses by cause of death, age, and other demographic variables; geographic and time

series analyses; and statistics on characteristics of deaths not available from the vital records based on

sample surveys of those records.

Series 21. Data on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, and divorce other

than as included in regular annual or monthly reports. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not

available from the vital records based on sample surveys of those records.

Series 22. Data From the National Mortality and Natality Surveys. –Discontinued effective 1975. Future reports

from theie sample surveys based on vital records will be included in Series 20 and 21, respectively.

Series 23. Data From the National Survey of Family Growth. –Statistics on fertility, family formation and dissolution, ,farnily planning, and related maternal and infant health topics derived from a biennial survey

of a nationwide probability sample of ever-mamied women 15-44 years of age.

For a list of titles of reports published in these series, write to: Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Md. 20782
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