As 40% of India's deaths occur at home, there's no mechanism to track morbidity: Report

By Rajiv Shah
A research paper on India’s “readiness” to track down how well it is doing to meet international health and nutrition targets has said that the country’s ability to collect data on both morbidity and death is extremely poor, with “no published report giving cause-specific death rates in India.”
Pointing out that since 40% of deaths in India “occur at home”, the paper, authored by two researchers, Purushottam M. Kulkarni and Nandita Saikia, insists on the use of “appropriate low-cost technology driven methodology” for assigning causes of death “through verbal autopsy method” through smartphone applications.
Pointing out that the published reports on death “do not provide detailed information on the number of persons exposed and events by age, sex and causes of death”, the paper regrets, as a result, “it is not possible for researchers to calculate the United Nations’ Sustainable Development Goals (SDG) set for different countries “related to cause-specific deaths.”
“Besides”, says the paper, “The age groups for which distributions are published are broad, and for a large proportion of deaths, the cause of death is not known.” Further, it underlines, “there is hardly any available data on mortality attributable to pollution and poor sanitation and hygiene.”
The result of the failure to avail necessary data, suggests the report, has been disastrous. India was able to achieve the UN’s previous Millennium Development Goals (MGDs) in “halting and reversing the HIV epidemic”, but “the country failed in the MDGs related to child and maternal health.”
Thus, though India is close to attaining the goal set for the under-five mortality rate, it missed the targets for infant mortality (39 per 1000 births in 2014 vs. targeted 27 for 2015) and maternal mortality (167 for 2011-13 vs. target of 109 in 2015), says the researchers.
The researchers add, India is also reported as moderately off-track for the reversal of the incidence of malaria and other major diseases.
One of the researchers, Kulkarni has been a consultant to the United Nations Population Fund (UNFPA), while the other one, Saikia, is Assistant Professor of Population Studies at the Centre for Study of Regional Development, Jawaharlal Nehru University.
Published by the Observer Research Foundation, a Reliance Industries Ltd (RIL) thinktank, the paper says, “There has been improved death registration coverage in some countries which had poor coverage in the past. For example, death registration in South Africa increased from 50 percent in 1990 to 90 percent in 2014 and in Turkey, from 50 percent in 2007 to 85 percent in 2013.” G

It wonders, “How many decades will India take to achieve complete civil registration and be part of modern world?”
Coming down heavily on the Civil Registration System (CRS), the paper says, “11 states/UTs (all southern states, Haryana, Mizoram, Nagaland and Punjab) of India have 100-percent coverage; another 11 states/UTs have 80-99-percent coverage; 10 states/UTs have 50 to 80-percent coverage; the other four states (Arunachal Pradesh, Bihar, Assam and Uttar Pradesh) have below-50-percent coverage of death registration.”
Giving instances of poor data collection by different official sources, the paper says, the National Family Health Survey’s (NFHS’) data on neon-natal mortality rate as well as maternal mortality rate has a “large” relative sampling error, adding, same is the case with the Sample Registration System (SRS).
In fact, there has been no “regular data” mortality rate attributed to “cardiovascular disease, cancer, diabetes or chronic respiratory disease”, the paper says, adding, as for the Suicide Mortality Rate (SMR)there is “no published report”.
Similarly, there is no data on “mortality rate attributed to household and ambient air pollution”, or “mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene”, or “mortality rate attributed to unintentional poisoning”.
As for tuberculosis incidence per 1,000 population, NFHS’ coverage is confined to “lay reporting”, and for malaria incidence per 1,000 population, its “seasonal variations” are not regularly captured. On hepatitis B incidence per 100,000 population, the paper adds, there is “no data on population based information”.