Table 1 Key Strengths and Weaknesses of Mortality Reporting Systems in the Pacific Islands

Societal Issues

Social incentives for registration

Private land burials without official approval

Administrative Environment

Existing legal framework

Inadequate/inconsistent implementation of laws

Health systems involvement in Civil registration and vital statistics operations

Passive registration i.e. onus to report on citizen

Registration process for “off-island” deaths unclear

National statistics committees

Complex statistical reporting requirements

System Issues – Administration

Community nurses formally tasked to notify vital events

Improper emphasis on community nurses to report cause of death

Routine compilation of mortality data by different health departments

Need for better coordination to generate one reconciled mortality dataset from the health system

Private health intuitions rarely integrated adequately into reporting systems

No clear delineation of responsibility across institutions, leading to task duplication

Personnel lack authority to query/clarify data

System Issues – Technical

Standard international medical death certificate (except Nauru)

Lay reporting of cause for deaths outside facilities in some countries

Medical certificates of death not routinely tabulated in all countries

Trained ICD coders

High turnover of trained staff

Key personnel adequately skilled for data management at national level

Statistical analysis limited to ten leading causes of death

Insufficient data quality assessment and control

Initiatives to set data standards for health information

Dysfunctional/outdated software programs not amenable to modification or upgrade

System Issues – Ownership

Strong ownership of systems/interest at national levels that has contributed substantially to ongoing survival of the systems

Generally poor feedback to local level staff

Many systems are highly dependent on one or two key individuals with a strong interest in providing health data