Kamal Ghorui
NEW DELHI: Even as Delhi reports relatively strong medical certification of deaths, the national picture remains stark — only 22% of registered deaths in India were medically certified in 2023, exposing a serious gap in how the country tracks disease trends and plans health policy.The concern was flagged at a two-day National Symposium on Strengthening Mortality Information Systems held in the capital, which concluded on February 11. Experts warned that despite years of reform efforts, large sections of India’s death data remain incomplete.Latest Civil Registration data reveal sharp disparities across States and Union Territories. Delhi recorded 66% of registered deaths as medically certified, placing it among the better-performing regions. Goa (100%), Lakshadweep (99.2%) and Puducherry (91.4%) have near-universal certification, while Chandigarh (76.4%) and Andaman & Nicobar Islands (67.2%) also report high coverage. In contrast, several large states lag significantly — Maharashtra (42.4%), Tamil Nadu (39.1%), Telangana (38.4%), Karnataka (26.7%), Odisha (23.4%) and Gujarat (23.3%) — pulling the national average down to 22%.Dr Harshal Ramesh Salve of AIIMS told TOI that barely 1 in 5 deaths nationally undergo proper medical certification of cause. A substantial proportion of deaths — particularly in rural areas — occur outside health facilities, where formal certification is often absent.Inaugurating the symposium, Dr V K Paul, Member, NITI Aayog, stressed that robust and interoperable mortality systems are essential for evidence-based governance. He said health planning must be driven by reliable, real-time data and underscored the need for coordinated action across sectors to ensure that every death is counted and its cause scientifically determined.Experts said counting every death and accurately recording its cause is critical for estimating disease burden, identifying risk factors and designing prevention strategies. Without reliable cause-of-death data, health planning risks relying on projections rather than evidence. Stronger data sharing between ORGI, the health ministry and academic institutions, they added, would help generate science-driven, decentralised policies and improve India’s self-reliance in disease estimation.Over the past decade, AIIMS and the Office of the Registrar General of India strengthened surveillance through verbal autopsy and digital systems. More than 10 lakh cases were reviewed, and over 4 lakh deaths were assigned a probable cause, with about 1,000 trained doctors engaged across 27 institutes. However, much of this supports sample-based surveillance rather than universal coverage. With nearly 1 crore deaths reported annually, comprehensive certification remains a work in progress.Verbal autopsy is used mainly when a person dies outside a hospital. It involves interviewing family members about symptoms and circumstances before death, after which trained doctors assign the most likely cause using standard medical classification systems. While it improves national estimates, experts say expanding routine medical certification of deaths in hospitals and communities remains essential.The symposium concluded with the launch of a National Consortium for Strengthening Mortality Data Systems to improve data quality, expand certification and accelerate digital integration nationwide.Public health experts said that while Delhi’s 66% certification rate reflects progress, the national gap underscores the urgency of ensuring that every death — and its cause — is systematically recorded.
