USERS’ REQUIREMENTS In terms of statistics, the main users are:

Economic phmncrs who require reliable and up-to-date vital rates (including specific fer-tility rates) for the measurement of changes in the population structure and especially for population projections

Health service planners and administrators who require indicators of the health state of the population as a means of assessing the effectiveness ~f delivery of health care imd the future tasks of the health services.

The latter users especially need Whiit, bc-causc of deficient registration, they cwmot now

have, that is, good cause-of-death statistics. The to encourage others, a meeting of local registrars obstacles have already been discussed in this to discuss the law, the practice, and the

day-report. to-day problems that arise. In these meetings,

vital statisticians should be present to express their needs, but their intervention should be

TRAINING minimal.

In most of the countries visited, there are training courses for the users of vital statistics (in Mexico, a plethora of courses); but there is very little, if any, training available for primary producers. For example, it is important. that medical students should have some training in vital statistics so that they will understand the need to specify correctly the cause of death. If the death is not registered properly or not at all, there still will be no vital statistics.

In Scotland, prior to 1960, it had long been the custom for the local registration junior staff to take a written examination in registration practice. The Registrar General for Scotland had recognized this examination, and the local urban authorities who actually appoint registrars (reim-bursed by the central government) had taken this into account in making promotions to the office of registrar. In 1960, the registrars formed themselves into a professional organization called the “Institute of Population Registration”

with a training program, a technical journal, and a system of examinations leading to qualifica-tion. The Institute has done a great deal to raise the educational level of the registration service and also has introduced its members to wider horizons, for example, to a study of registration problems in other countries and to a better understanding of their role as population infor-mation officers (normally the registrars become local census officers during a population census).

Without suggesting that this development is necessarily appropriate to developing countries, it is proposed that experiments should be made to bring registrars closer together both within countries and between countries. A beginning might be made by (1) arranging a regional meeting between senior registration officers of those countries that have a vital registration law and senior administrators of those who do not as yet have a registration system to discuss the problem of obtaining complete registration and (2) arranging in one or two countries, primarily

SUMMARY

The vital registration systems in the five countries have been shown to have many de-fects, many of them arising from the country’s lack of economic development. These defects are:

A lack of incentive to register on the part of the public and a lack of encouragement and/or compulsion to register on the part of the government. Registration is incomplete, late, and inaccurate.

Insufficient medical certification of death mainly because of a lack of medical man-power. Cause-of-death statistics are, there-fore, inadequate.

Lack of training, supervision, and encourage-ment of registrars. A subsidiary failure is the lack of standard rules of practice, concepts, definitions, and so forth.

Delays in aggregation of records and in dissemination of statistics.

In some cases, a multiplicity of discrepant publications.

It is suggested that stronger centralization of the registration system with a single focus or direction and assembly of information would lead to improvement and would not necessarily require extensive additional resources; that more medical manpower is needed and that this might be supplemented experimentally by medical assistants not fully trained; that medical

stu-‘dents need more education in vital statistics, their derivation and use; that, above all, at-tempts should be made to raise the esprit de corps of the local registrars by providing an adequate career structure, by improving com-munication between registrars, especially in the

discussion of working problems, and by making them feel more involved in the worthwhile process of measuring population change and public health trends; that communication should be extended to the internatiomd level; and finally, that given an improved organization, more effort is needed to increase the incentive for ordinary members of the public to register the vital events of which they are the responsible informants.

In this report, emphasis has naturally been placed upon the need for national governments to make a greater effort to promote effective vital registration systems, However, a number of other subsidiary suggestions have been made that might alleviate specific difficulties and could be implemented extranationally if the necessary external ji’nancial aid were forth-coming. These are recapitulated here:

Tlie conducting of regional workshops of short duration in which senior officers in the registration services of a number of countries fairly close together could come together to discuss the problems besetting vital registra-tion and the possible ways of overcoming these problems. The problems to be dis-cussed would include the basic organization for vital statistics preparation and

publica-tion. Outside experts from countries with experience in overcoming problems in the development of compIete registration cover-age and reliable vital statistics would attend.

The preparation of teaching material that could be used within an individual de-veloping country to instruct operating staff inthe nationaI vital registration system. This might take the form of a manual for instructors of vital registration staff.

The supply of audiovisual aids so that teaching material can be prepared.

The offer of a technical expert to examine particular national situations especially those where, because organization is complicated and responsibility is divided, the available primary vital registration information does not find its way to effective analysis and publication, Such an expert should not be a statistician or a computer systems analyst but, rather, a person with knowledge of all stages in the organization of vitaI statistics, from initial registration to final printing of tabulations. Such experts would need vast experience and great tact and humility but, given these qualities, they could be ex-tremely effective trouble shooters.

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VITAL AND HEALTH STATISTICS Series

Series 1, Programs and Collection Procedures. –Reports which describe the general programs of the National Center for Health Statistics and its offices and divisions and data collection methods used and include definitions and other material necessary for understanding the data.

Series 2. Data Evaluation and Methods Research. –Studies of new statistical methodology including experi-mental tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, objective evaluations of reliability of collected data, and contributions to statistical theory.

Series 3. Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health statistics, carrying the analysis further than the expository types of reports in the other series.

Swim 4, Documents and Committee Reports. –Final reports of major committees concerned with vital and health statistics and documents such as recommended model vital registration laws and revised birth and death certificates,

Series 10. Data From the Health Interview Survey, –Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other health-related topics, all based on data collected in a continuing national household interview survey.

Series 11. Data From the Health Examination Survey and the Health and Nutrition Examination Survey .–Data from direct examination, testing, and measurement of national samples of the civilian noninstitu-tionalized population provide the basis for two types of reports: (1) estimates of the medically defined prevalence of specific diseases in the United States and the distributions of the population with respect to physical, physiological, and psychological characteristics and (2) analysis of relationships among the various measurements without reference to an explicit finite universe of persons.

Series 12. Data From the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports from these surveys will be in Series 13.

Series 13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilities providing long-term care, ambulatory care, hospital care, and family planning services.

Series 14. Data on Health Resouzces: Manpower and Facilities. –Statistics on the numbers, geographic distri-bution, and characteristics of health resources including physicians, dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthly reports. Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses; and statistics on characteristics of deaths not available from the vital records based on sample surveys of those records.

Series 21. Data on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, and divorce other than as included in regular annual or monthly reports. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not available from the vital records based on sample surveys of those records.

Series 22. Data From the National Mortality and Natality Surveys. –Discontinued effective 1975. Future reports from theie sample surveys based on vital records will be included in Series 20 and 21, respectively.

Series 23. Data From the National Survey of Family Growth. –Statistics on fertility, family formation and dis-solution, ,farnily planning, and related maternal and infant health topics derived from a biennial survey of a nationwide probability sample of ever-mamied women 15-44 years of age.

For a list of titles of reports published in these series, write to: Scientific and Technical Information Branch National Center for Health Statistics Public Health Service

Hyattsville, Md. 20782

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NCHS

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES P“bl,c Haalth Swvrce

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