Cause of death reporting systems in India: A performance analysis

Background. Reliable statistics on the causes of death in the population ar e essential for setting priorities in the health sector. Most cause of deat h reporting systems: in developed countries rely on medical certification o f the cause of death according to the International Classification of Death (ICD-10), and have achieved near-total coverage, Developing countries such as India, where adequate medical facilities are not available, depend on l ay reporting of the cause of death in rural areas, using a sample registrat ion system. The use of the cause of death statistics in India is questioned in view of the poor coverage, and poor compliance with guidelines for caus e of death reporting, coding and classification. Methods A brief description of the reporting system in India is followed by the characteristics of a usable cause of death reporting system. We identi fied 9 criteria based on a review of the literature and our own assessment of the problem; The performance of the cause of death reporting system for rural and urban areas of India was examined against each of the 9 criteria. We offer a subjective rating on a three-category rating scale consisting o f (i) satisfactory, (ii) tolerable, and (iii) poor. Results. The major factors affecting the use of the cause of death statisti cs in India are: (i) poor coverage; (ii) high incidence of unclassifiable d eaths; (iii) long delay and irregular publication of statistics; and (iv) l ack of systematic screening. Conclusions. We recommend the following steps to improve the usability of c ause of death statistics in India. Introducing periodical reviews jointly b y the Departments of Health and Municipal Administration to identify non-re porting municipalities, sample units, and further identification of non-rep orting health care institutions sustained over a period of, say, five years will raise coverage substantially. The other measures include: (i) trainin g programmes to build up cause of death report writing skills among physici ans; (ii) compilation and publication of cause of death statistics at the s tate level; (iii) sponsored research on the cause of death reporting struct ure and its implications for policymaking; and (iv) computerization of fili ng, tabulation and flow of cause of death statistics at the municipality an d the state levels. To reduce the unusually high level of unclassifiable de aths, the Registration of Births and Deaths Act should be amended to ensure that hospitals and health care institutions maintain medical records, For accurate cause of death data from rural areas, we recommend that the perfor mance of the sample registration survey-cause of death (SRS-COD) component, be evaluated according to the above criteria.