Vital Statistics Commission of Jamaica - Planning Institute of Jamaica

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Audit of Vital Registration and Vital Statistics Systems: Jamaica statistics divisions from the various police stations. For the two departments we visited, PCbased applications are used for reporting basic statistics. Kingston Police Department is using the MS Access application for collection and reporting; Spanish Town Police Department is using MS Word, but plans to implement MS Access. While this information is not gathered for the express purpose of death registration or statistics, RGD has recognized the usefulness of this information as a check on their number of registrations. This information is sent to RGD only on an as-requested basis, usually by download to diskette. HUMAN RESOURCES MOH and Hospital Staff There is no system in place to measure individual or departmental performance with respect to the collection of birth, stillbirth, and death information and the completion of the appropriate forms. Staff, including senior management, of the hospitals we visited (Kingston Public Hospital, Spanish Town Hospital, and Victoria Jubilee Hospital) did not seem to have a strong understanding of the procedures involving the reporting of births, stillbirths, and deaths. In several instances, we were told that hospital procedures for filling out forms are often not followed. The National Director for Medical Records (NDMR) indicated to us that a procedures manual developed by MOH exists, but that she believes few people read it. The NDMR suggested that we may want to recommend an orientation for the medical staff concerning the written medical record policy. In addition, the NDMR believes that midwifes need to be better trained in the gathering and reporting of birth information. There is no formal training of medical record staff, only on-the-job training, and no established competency model for these staff. Management acknowledged that people were hired with skills deficiencies and then provided on-the-job training to meet minimal job requirements. We were also told that the technical college education for medical record technicians supposedly does not include prerequisite courses in chemistry and physiology but we did not validate that issue. RGD With regard to recruitment of staff, unit managers are responsible for reviewing job descriptions every year and, as necessary, modifying the job descriptions to accommodate needed changes in requirements. The RGD has an assessment center for evaluating employment candidates which utilizes a psychometric analysis tool and checks references. We reviewed standard interview questions, job descriptions, and an orientation checklist, and found them to be adequate. Quarterly and annual performance reviews are conducted of all employees and reviews are a performance metric of managers. We reviewed several of the performance reviews and found them to be thorough. When we reviewed the competency profile of RGD staff for 2005, we discovered a listing of job descriptions and summaries of the skills and experiences of the incumbents in the position, not a catalog of the competencies for success in a given position. Nevertheless, we found that data entry standards and procedures are rigorous and that the data entry staff are held to these standards. Those data entry staff with substandard ratings and high error rates 9
Audit of Vital Registration and Vital Statistics Systems: Jamaica are dismissed. Coders are trained appropriately in the ICD-10 methodology. We evaluated the competency of one of the coders by asking her to select a record and walk us through the coding of the cause of death. We believe the employee is well able to perform her duties. The Births, Deaths, and Marriages System (BDMS) resides on a Microsoft SQL 2000 database. The database administrator appeared diligent and skilled to perform duties entrusted to him. He showed us a sample of data from the underlying tables and he seemed to have a good handle on everything related to the data. The statistical training of the staff is not adequate. The RGD’s “vital statistics officers” are well-trained in cause-of-death coding, but have little or no training in statistics, demography, or demographic methods. In addition, the vital statistics department manager, tasked with overseeing the production of vital statistics reports, has no training in statistics or demography. Our finding is that RGD does not currently have the expertise to produce and analyze vital statistics. They do, however, have staff competent to produce a vital statistics data set, including data collection, data entry, cause-of-death coding, and database management. MOJ/Coroners The annual performance evaluation of coroner’s office personnel comes under the auspices of the human resources function of the MOJ. We did not review any of the evaluations or the system utilized. With regard to deaths, coroner’s office employees lacked clarity as to what information could or should be completed by the coroner’s office and what information by the RGD. In general, there appears to be a lack of clarity around roles and responsibilities of other organizations. The Minister of Justice indicated that a change to a Medical Examiner-type system in which physicians were appointed as coroners would function more effectively and efficiently. The MOJ is currently exploring the possibility of such a system. STATIN and PIOJ Both STATIN and PIOJ currently have several well trained demographers and statisticians on staff and have programming staff capable of manipulating any data provided by RGD. It is our assessment that either agency is capable of producing and analyzing vital statistics for Jamaica. MANAGEMENT AND ORGANIZATIONAL STRUCTURE AND LINKAGES HIS policy We find that there is no overarching health information systems policy at the highest levels with regard to vital registration or the production of vital statistics. There is confusion as to the responsibilities of each agency with respect to the production and publication of vital statistics. 10
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Vital Statistics Commission of Jamaica - Planning Institute of Jamaica

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