Table 1.

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

Category	Strengths	Weaknesses
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	Initiatives to set data standards for health information	Dysfunctional/outdated software programs not amenable to modification or upgrade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

Source data: [16].