Vital Statistics Commission of Jamaica - Planning Institute of Jamaica

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Audit of Vital Registration and Vital Statistics Systems: Jamaica Exhibit A I.D. Finding 47. The definition of “fetal death” as provided by the MOH is not consistent with the hospital’s policies. Right now the MOH’s definition is 28 weeks but the new law, consistent with WHO and the hospitals, will make it 22 weeks. 48. Births, deaths, and fetal deaths in a hospital are not reconciled with admissions 49. Monthly hospital census summaries are a manual system and prone to errors. There is no verification process between the summaries and actual data (medical records) 50. No system in hospitals, manual or electronic, to track number of outstanding autopsy reports 51. While data quality research was being performed, we did not find any mechanisms in place to ensure the results were being used to improve data collection and reporting at the hospitals and the RGD 52. Form E, Coroner’s Certificate of Finding of Jury, is routed by the CC to the RGD but there is no tracking of delivery or reconciliation with RGD records 53. There is no universal, unique personal numbering system to facilitate linking of births and deaths 54. It is our understanding that the RGD intends to develop a birth and death linkage 55. The RHAs collect information from the hospitals and if information is missing the RHA is supposed to call the hospital to obtain the information 56. Spanish Town – 15% of registrations are delayed registrations 57. Transfer of mortality and morbidity information from hospitals to MOH is not automated (is paper-based) 58. RGD coders had been trained by PAHO in the ICD-10 methodology. 59. Little or no training in demography or demographic methods for RGD staff 60. RGD 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. 61. The RGD has an assessment center for evaluating employment candidates 62. The RGD utilizes a psychometric analysis tool and checks references of candidates 63. The statistical training of the RGD staff is not extensive 64. The RGD’s vital statistics department manager has no training in statistics or demography 65. RGD unit managers are responsible for reviewing job descriptions every year and as necessary, modifying the job descriptions to accommodate needed changes in requirements 66. We evaluated competency of one of the RGD coders by asking her to select a certificate and walk through a coding of that chart. We believe the employee is well able to perform her duties. 67. We reviewed the RGD’s standard interview questions, job descriptions, and an orientation checklist 68. PIOJ has trained demographers and statisticians on staff 69. PIOJ has programming staff capable of manipulating any data provided by RGD 43
Audit of Vital Registration and Vital Statistics Systems: Jamaica Exhibit A I.D. Finding 70. STATIN has trained demographers and statisticians on staff 71. STATIN has programming staff capable of manipulating any data provided by RGD 72. The NDMR suggests that we may want to recommend an orientation for the medical staff concerning the written medical record policy 73. Senior management of some hospitals did not seem to have a strong understanding of the processes around births, fetal deaths (stillbirths), and deaths 74. No formal training of hospital medical record staff, only OJT 75. No established competency model for hospital medical record, OJT’d staff. Mgt. acknowledged that people were hired with skills deficiencies and then provided OJT to meet minimal job requirement 76. The NDMR believes that midwifes need to be better trained in the gathering and reporting of birth information 77. CC employees lacked clarity as to what information could/should be completed by the CC and what information by the RGD. In general, there appears to be a lack of clarity around roles and responsibilities of other organizations 78. The annual performance evaluations of CC personnel come under the auspices of the human resources function of the MOJ. We did not review any of the evaluations or the system utilized. 79. When we reviewed the RGD’s competency profile 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 80. The MOJ suggested that if Medical Examiners (physicians) were appointed as Coroners, then cases could be processed faster because of the dual role 81. Staff at the CC stated that the RGD will require an individual to return to the CC to obtain missing information on Form D. However, 82. One manager in the RGD stated that such would be true because the RGD is not authorized to modify an official form (by entering missing information or correcting any obvious errors) 83. Another manager in the RGD stated that her staff would indeed enter missing information if provided by the CC via telephone or if it was obvious, such as a street address. Corrections would also be made by RGD staff under similar circumstances 84. No system in place to measure individual or departmental performance within hospitals with respect to collection of birth, fetal death, and death information 85. Hospital procedures for filling out forms are often not followed – told that no one reads the procedure manuals 86. The District Medical Officer is employed by the MOH. However, findings and reports are filed with the MOJ (Coroner) 87. No direct RHA link or collaboration with the RGD 88. According to the NDMR, the role of an accurate hospital medical record is not understood and appreciated by hospital management and staff outside of the medical records department 44
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Vital Statistics Commission of Jamaica - Planning Institute of Jamaica

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