A working paper for the Center for Global Development, co-authored by former Chief Economic Adviser Arvind Subramanian, concludes that excess deaths during the pandemic period could be as high as 49 lakh in India as against the 4.14 lakh reported in government data. The Hindu has come out with estimates of excess deaths based on Civil Registration System (CRS) data for many States which showed that the death toll was several times higher than the official death toll due to COVID-19. Such discrepancies have been reported from other countries including the U.S. and Europe though they may not have been of such magnitude.
Capturing excess mortality
‘Excess deaths’ are defined as the difference between the observed number of deaths in specific time periods and the expected number of deaths in the same time periods. At the time of a pandemic, when the normal system is disrupted, it is not likely that every person who dies could have been tested for COVID-19 or the death could have been mistakenly assigned to some other cause.
Soumya Swaminathan, Chief Scientist at the World Health Organization, has tweeted in this connection: “For every country, it’s important to capture excess mortality – only way to prepare the health system for future shocks & to prevent further deaths. It’s also why we need to invest in strong civil registration and vital statistics, so policies can be adjusted based on real data”.
Section 19 of the Registration of Births and Deaths Act, 1969, stipulates that the State governments have to “publish for the information of the public a statistical report on the registered births and deaths during the year at such intervals and such form as may be prescribed”. The Act also stipulates that the deaths be registered at the place of occurrence.
In India, the annual report for 2019 that is based on the data provided by the Chief Registrars has been released though the States themselves have not published the data. According to the Rules, these were to be submitted by the Chief Registrars to the State governments by July 31, 2020 and published within five months thereafter. Considering that technology enables the States to release data on the number of deaths registered on a monthly, weekly or daily basis, it is shameful that in some States researchers had to use the Right to Information law to obtain data on the number of deaths registered. What stands in the way of our ability to record deaths and bring out reports that are of critical importance today?
Complicating factors
Let us look at the organisational structure of the administrative machinery that is responsible for this task. While the Registrar General, India, is the head of the national organisation tasked with the registration of births and deaths, the actual work is carried out by the State and Union Territory (UT) administrations. The heads of the State organisations are called Chief Registrars. These officers come from the Health Department in 21 States/UTs and the Department of Planning, Economics and Statistics in 13 States/UTs. In two States/ UTs, they are from the Panchayat/Local Administration Departments. We also have Secretaries to the State government functioning as Chief Registrars in a few States. The multiplicity of agencies responsible for the registration of births and deaths is replicated at the district and lower levels with municipalities and panchayats playing a major role in registration. This impedes effective oversight. Also, the traditional bureaucratic practice is to function within departmental silos.
Another complicating factor is that civil registration involves good coordination between different actors. The responsibility to report births and deaths to the Registrar rests with the hospital where the event occurred or with the head of the household if it occurred at home. The Registrar then provides them with a legal document (the birth or death certificate) that is the evidence for registration. The Registrar could be a full-time government employee, or a medical officer in a hospital or a health centre, or the secretary of a local panchayat or municipality as appointed by the State government. In case of deaths occurring in public places, other agencies like the police or the local government would need to be involved. The State governments have not given adequate attention to the CRS. This has resulted in an inadequate budget for carrying out its regular activities including processing of the data.
Editorial | Counting the dead: On measuring excess deaths
The data needed to establish ‘excess deaths’ originates from the processes described briefly above. The information on deaths registered are compiled at regular intervals by the Chief Registrar. Dissemination of this data is neglected to such an extent that the Health Departments, including the States where they are in charge of the system, are generally not aware of this data.
All the agencies involved in the processes of civil registration will need to coordinate their activities seamlessly to ensure that the civil registration work is carried out efficiently. Committees established at the State, district and local government levels to ensure coordination meet rarely and the challenges of coordination continue to be a major issue in most parts of the country.
Strengthening the system
The first step that needs to be taken to address this is to accord high priority to strengthening civil registration and generation of vital statistics. The top level of the leadership at the Central and State governments must announce a time-bound commitment to achieve 100% registration of deaths in the country.
While eleven States register more than 90% of deaths, they do not include several of the larger States including Madhya Pradesh, Telangana, Uttar Pradesh and Bihar. Uttar Pradesh registered 63% of the deaths and Bihar registered only 51.6%, according to the 2019 report of the Registrar General, India.
Also read | Given robust system of reporting, missing out on COVID-19 deaths unlikely: Govt
Vital Statistics Reports that the government is required to publish are expected to meet a standard that is set by the UN Statistics Division, which seeks to ensure that all national reports are produced in a way that they can be internationally comparable. Apart from the problem that our reports are overdue, they do not contain all the tables that are prescribed even under our own Rules. Data include deaths that took place in previous years but are registered in the years that the report is published. This distorts the accuracy of the report. Some reports do not cover some major areas in the country. For instance, the Kerala report does not include data for Kochi Corporation.
We need data that fully meets quality standards. This is what the pandemic has called on us to do. We need to use this as an opportunity to mend matters in this critical area of public concern and swiftly assign resources and give high priority to make the changes that are badly overdue in all States and UTs.
Gopalan Balagopal is a former civil servant and continues to work on Civil Registration and Vital Statistics Systems, primarily in Africa. K. Narayanan Unni is a statistician and former Deputy Registrar General (CRS)
