Establishing mortality surveillance in Papua New Guinea

Historically in Papua New Guinea (PNG), the two major health systems for capturing deaths and causes of death (DHIS, a software platform specific to PNG for reporting health facility discharge data and NHIS, a paper-based system for reporting aggregate data from rural areas) have not provided complete or timely information.

Using paper systems for mortality data is cumbersome, often requiring separate data entry at more than one administration level. Furthermore, data entry is time-intensive, which means that when data becomes available, it may already be outdated information that is no longer useful for government policymaking.

To improve completeness and timeliness, eNHIS was introduced in 2014. eNHIS is an electronic version of NHIS that incorporates all aggregate data. It has been piloted in five of PNG’s 22 provinces with an expected rollout to the entire country by the end of 2019.

eNHIS enables notification of health facility births and deaths to the National Department of Health, and provides morbidity-coded details of deaths and discharges.

Focus is now on developing CRVS reporting systems that will be integrated into the national e-NHIS rollout, including integrating data collected from SmartVA interviews. The use of these verbal autopsy (VA) interviews to improve cause of death data from rural areas is important for improving the country’s vital statistics.

In a first for PNG, the Data for Health team are trialling the use of mobile phone technology for death notifications in selected local level government areas (LLGs) in Alotau District, Milne Bay Province; this strategy, when assessed, will potentially be rolled out in districts in West New Britain and Western Highlands. A digital notification system should facilitate prompt follow-up of community deaths by a SmartVA interview, and ultimately registration of death.

This use of digital technology aligns with the PNG Government’s commitment to an Integrated Government IT System (IGIS) which is being built to support the whole of government IT system in PNG. IGIS is based on cloud computing and is currently connected to 47 government entities, with further work planned this year.

In the eNHIS system, tablets are used at the health facility to input patients’ admission, discharge, consultation, vaccinations, birth, death and other health information.

An independent review of eNHIS found:

  • the eNHIS reports in nearly real-time (eliminating the need for monthly, paper-based reports)
  • electronic transfer of data previously on the paper NHIS system is feasible at both facility and provincial levels
  • the piloted provinces had begun taking action on the basis of new information, which if continued, could create ‘profound change’ in the use of data with the potential to substantially improve system performance
  • the system is financially and technically sustainable.

However, the current version of eNHIS relies on nurses and health staff to assign a cause of death, using successive drop down menus – this will be improved with the incorporation of medical certification of cause of death and verbal autopsy into eNHIS. The system will also incorporate electronic birth and death notification forms and the verbal autopsy form, which are currently being trialled in Alotau District.