An-Najah Staff

Executive Summary
Background: The Cause of Death Registry is a vital national statistics database of deaths and the underlying and contributing causes of death in Palestine. The database is located at the Palestinian Health Information Center at the Ministry of Health (MoH) and was legally established in 1994 by virtue of the Civil Registration Law of 1966. The National Health Information System Assessment and Strategy conducted by MoH in 2010-2012 made the following three recommendations: 1. Improve the national database on mortality that can be used for appropriate planning for improving population health; 2. Modify the current death notification form, and 3. Build the capacity of staff responsible for filling the death notification forms.
Aims and objectives: The overall aim of this focused assessment is to make suggestions for an improved Cause of Death Registry for Palestine. The specific objectives are to propose improvements to the registration process, mainly in hospitals, and in the registration instrument: the Death Notification Form.
Methods: The assessment follows the general methodology for formal assessments of surveillance systems and registries as described by WHO and the Centers for Disease Control and Prevention in the USA. It was carried out on 16-25 October 2012 in the West Bank and Gaza Strip in close collaboration with the MoH. In addition to collecting background information from stakeholders, the assessment team used qualitative methods of focus groups, in-depth interviews, workshops and meetings.
Results: Some of the main findings are as follows: There are no formal descriptions, quality documents or standard operating procedures for the Cause of Death Registry in Palestine. There are no guidelines to assist doctors in completing the form; there is minimal training of doctors and little supervision by senior doctors of junior doctors in hospitals. There are only limited data quality checks and a near total lack of quality assurance systems at every level of the Cause of Death Registry data flow. There is often time pressure to finalise the form, little understanding of what the cause of death diagnosis is used for and no feedback of the results to doctors or hospitals. The coding process is vulnerable considering that only two people code the forms using the International Classification of Diseases-10 diagnoses. Dissemination is limited to a few fixed tables in an annual report.
Recommendations: The focused assessment concludes 10 recommendations: 1. Develop guidelines on completion of the death notification form; 2. Develop a set of standard operating procedures to cover all aspects of the Cause of Death Registry; 3. Revision of the death notification form; 4. Establish a training program for hospital doctors; 5. Develop a quality assurance system for hospitals and for the district and national levels including the appointment of a doctor as the focal point for the Cause of Death Registry in each hospital; 6. Develop feedback reports from the Cause of Death Registry to each hospital; 7. Synchronise the flow of data on deaths and the causes of death to the Cause of Death Registry and the Population Registry in close collaboration between the MoH and Ministry of Interior; 8. Conduct an audit of the quality of diagnoses in the Cause of Death Registry; 9. Improve data output from the Cause of Death Registry; 10. Explore the feasibility of introducing a data dictionary and electronic coding aid systems like IRIS into the Cause of Death Registry.
Assessments of other parts of the Cause of Death Registry are further advised, especially in relation to deaths occurring in locations other than hospitals. Other attributes of the Cause of Death Registry, including data quality, should be assessed.