Civil Registration Vital Statistics Palestine Role of MOH

Civil Registration & Vital Statistics Palestine Role of MOH Dr. Jawad Bitar Epidemiologist Director of Palestinian Health Information Center (PHIC) National Focal Person for Health Information & Statistics Tunis, Tuesday, 27 March 2018

Palestine • Historical Palestine is about 27, 000 km 2 • Now Occupied Palestinian territories (Opt) about 22% (6020 km 2) from Palestine. • West Bank (included East Jerusalem) 5, 655 km 2 (11 Governorates) • Gaza Strip 365 km 2 (5 Governorates)

Palestine, 2017 • Population West Bank Gaza Strip 4, 952, 168 3, 008, 770 1, 943, 398 • Male / Female Ratio: 103. 3 : 100 • Population is young; 39. 0% < 15 year (WB 36. 7%, GS 42. 6%) • Population 65 years & above: 3. 1% (WB 3. 3%, GS 2. 4%) • Fertility Rate 4. 1 (4. 5 in GS & 3. 7 in WB) • 99. 9% of deliveries are in health institutions.

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Palestine Population by Age Group & Gender, 2017 80 + 75. . . 70. . . 65. . . 60. . . 55. . . Male 50. . . Female 45. . . 40. . . 35. . . 30. . . 25. . . 20. . . 15. . . 10. . . 5 -9 0 -4 400, 000 300, 000 200, 000 100, 000 200, 000 300, 000 400, 000

Distribution of Palestine Population by Locality, 2016 In Palestine 41. 9% are Refugees 66. 7% in Gaza Strip 26% in West Bank Camps 9. 5% GS 15. 9% WB 5. 4% Rural 16. 6% GS 2. 8% WB 25. 5% Urban 73. 9% GS 81. 3% WB 69. 1%

Life Expectancy, Palestine, 1990 - 2016 Life Expectancy among Palestinian males 72. 1 years Life Expectancy among Palestinian females 75. 2 years

CRVS in Palestinian MOH • The national health information system (HIS) including Vital Statistics (Births & Deaths) (as one of the HIS components) has been identified as one of the priority areas in the Palestinian national health since the end of 1994. • WHO was the technical supporter of HIS in Palestine.

Permanent National Committee for Updating and Development of Population Register in Palestine

Main Institutions Members of the National Population Register Committee 1. Ministry of Interior: As responsible for the storage, management, operation and maintenance of the population register. 2. Ministry of Health: As responsible for the vital events of births and deaths included the cause of death. 3. Court of Chief Justice: As responsible for the events of marriages and divorces. 4. PCBS: As user of data for statistical purposes and evaluation of data.

Rapid Assessment of National CRVS in Palestine Done on 3/ 12/ 2012

Result of Rapid Assessment of Civil Registration & Vital Statistics, West Bank, Palestine Percent 0 Score 89% 100% Legal framework Registration infrastructure 100% Organization and functioning 67% Completeness of registration 100% Data storage and transmission 100% ICD-compliant practices 100% Quality of cause-of-death data 100% ICD coding practices 0% Coder qualification and training 50% Data quality 75% Data access 83% Overall score 20 40 60 80 100 120

Result of Rapid Assessment of Civil Registration & Vital Statistics, Gaza Strip, Palestine Percent 0 Score 78% 83% Legal framework Registration infrastructure Organization and functioning 83% Completeness of registration 83% Data storage and transmission 100% ICD-compliant practices 33% Quality of cause-of-death data 33% ICD coding practices 0% Coder qualification and training 50% Data quality 75% Data access 71% Overall score 20 40 60 80 100 120

Rapid Assessment of Civil Registration & Vital Statistics

Comprehensive Assessment of CRVS in Palestine Done in Amman- Jordan, 26 - 29 April, 2015

The Main Recommendations of Comprehensive Assessment of CRVS in Palestine • To activate the direct electronic connection to update and develop the civil registry in order to consolidate all data, ensure availability and flow, including causes of death between the Ministries of Health and Interior. • To strengthen the partnership at the national level through the Permanent National Committee for Updating and Development of Population Register in Palestine. • To raise public awareness of the importance of recording the events of the population registry. • To build and strengthen the national capacities in the field of CRVS registration, statistics and reporting.

Role of Palestinian MOH (PHIC) in CRVS

Electronic Notification of Live Birth • All maternity and general hospitals in West Bank are electronically connected with Palestinian Health Information Center (PHIC) in MOH for easily, quick and correct notification of newly live births. • MOH looking to complete the cycle with electronic connection with MOI. • Now, MOH working to applied the electronic notification for deaths through electronic connection between PHIC & PHC District Directorate.

MOH & Vital Statistics Data & Indicators • Palestinian Health Information Center (PHIC) in MOH collecting, analyzing and disseminates annually Vital statistical data and indicators (birth and death) of Palestine through the Health Annual Report of Palestine. • PHIC in MOH providing EMRO/ WHO with complete Palestine mortality file including the cause of death according of ICD 10 and all the vital indicators required from WHO.

MOH Annual Publishing Vital Statistics • Number of reported births. Indicators • Number of reported deaths • Crude reported birth rate. • Crude reported mortality rate. • Reported Neonatal mortality rate. • Reported Infant mortality rate. • Reported Child (under five) mortality rate. • Maternal mortality rate. • Percentage of low birth weight. • Percentage of deliveries in health institutions. • Percentage of Reproductive age women deaths from the total deaths. • Top ten causes of death in Palestine with percentages.

MOH Annual Publishing Vital Statistics Reports 1. BIRTH: • Distribution of reported live births and stillbirths by sex & governorates. • Percentage of reported live births by place of delivery and governorates. • Percentage of reported live births weight by sex & governorates (low birth weight, normal & overweight). • Distribution of reported live births by month & governorate.

MOH Annual Publishing Vital Statistics Reports 2. Death (1): • Distribution of reported deaths among population by age groups & governorates. • Distribution of reported causes of death (ICD 10) among population by age groups & sex. • Distribution of reported infant deaths by sex & governorates. • Distribution of reported stillbirth cases by sex & governorates. • Distribution of reported cause of death (ICD 10) among infant by sex & region. • Distribution of reported under five years deaths by sex & governorates.

MOH Annual Publishing Vital Statistics Reports 2. Death (2): • Distribution of reported causes of deaths (ICD 10) among age group 0 - 4 years by sex. • Distribution of reported causes of death among age group 1 - 4 years by sex. • Distribution of number, percentage & incidence rates of reported cancer deaths by sex & governorates. • Distribution of reported cancer deaths by site, sex & region. • Distribution of reported causes of cardiovascular diseases death by sex & region.

MOH Annual Publishing Vital Statistics Reports 2. Death (3): • Distribution of reported diabetes mellitus deaths by age group, sex & region. • Distribution of reported maternal mortality by death time (during pregnancy, delivery & postpartum period) & governorates. • Distribution of maternal mortality by cause of death (ICD 10), age groups & region. • Distribution of reported reproductive age women deaths by cause of death (ICD 10) & age groups. • Distribution of reported reproductive age women deaths by age group & governorates.

Palestine Reported Crude Death Rate 1, 000 Pop. , 1996 - 2016 4 3. 6 3. 5 3. 35 3. 1 3 2. 8 3. 1 3 2. 7 2. 8 2. 6 2. 5 2. 9 2. 7 2. 6 2. 5 2. 4 2 1. 5 In Gaza Strip 2. 0 / 1, 000 of Population West Bank 2. 7 / 1, 000 of Population 1 0. 5 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009 2010 2011 2012 2013 2014 2015 2016

Palestine Reported Infant & Under 5 Mortality Rate 1, 000 Live Births, 1991 - 2015 40 38 36 35 32 32 30 29 29 29 24 25 29 28 27 25 26 27 25 25 25 26 25 23 23 22 20 20 22 24 23 23 21 25 24 24 21 21 17 16 14 15 16 15 13 19 14 16 16 14 15 14 13 13 12 13 10 11 11 Under 5 Infant 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 0 1991 5

Palestine Reported Maternal Mortality Rate, 2009 - 2016 40. 0 In Gaza Strip 15. 5 / 100, 000 Live birth West Bank 12. 4 / 100, 000 Live birth 38. 0 35. 0 32. 0 28. 0 30. 0 23. 7 25. 0 24. 1 24. 7 20. 0 15. 7 15. 0 13. 8 10. 0 5. 0 0. 0 2009 2010 2011 2012 2013 2014 2015 2016

Main Cause of Death Problems in Palestine • About 40% of death causes are attributable to undetermined or inadequately defined causes. • About 40% of death causes attributable to how did the death not the cause of death. • The majority of physicians are not aware about ICD 10.

Ongoing Projects for Updating & Development of CRVS in Palestine • Enhance cooperation and coordination between all partners of CRVS to control and record all birth and death events and Cause of death. • Training the physicians and medical graduate students to fill correctly the death notification form and correctly to define the cause of death. • Completion of electronic connection between PHIC and PHC directorate and hospitals for notification of death cases and cause of death. • Completion of work on the project of electronic connection between MOH and MOI, that the reporting of the of births & deaths to be electronically from MOH to MOI, not by the citizen. • Continued cooperation between MOH and MOI to monitoring the of completeness reported births and deaths. • Using the census data for 2017, for monitoring of the completeness of reporting births and deaths.

Thank you Email: drjawadbitar@gmail. com