Issue of inaccurate Death reporting in India

Synopsis: Official death reporting in India is not realistic. Government and experts need to rely on these numbers only for every purpose. If realistic estimates of COVID-19 deaths by city, rural settings, districts, and States are known, India can plan a more targeted response towards the pandemic.

Background

• Registration of Deaths in India is fragmented and inaccurate. For instance, even before the Pandemic, India registered only 85% deaths and only one-fourth of the registered deaths were medically certified for the causes of death.
• Apart from this, there is a wide variation among States and within rural and urban areas. For instance, the lack of access to COVID-19 testing services and treatment facilities in rural areas makes an accounting of Deaths more challenging.
• In the absence of robust data on the realistic number of deaths and the causes of death, India should make efforts to calculate the estimated deaths in India.
• In the short term, the death estimates could be very useful to plan for the next wave of the pandemic and in the long run, it will help to strengthen the Indian health care system

The issue of inaccurate Death reporting

• Public health experts estimated that COVID-19 deaths in India could be in the range of 3 to 14 times the officially reported number of deaths. Whereas, the Union and State governments have continuously denied the estimates.
• However, reconciliation of COVID-19 deaths in Bihar and Maharashtra reveals the state of under- reporting of Deaths in India.
• After reviews and audits, these States show a nearly 75% increase in COVID-19 deaths over the officially reported deaths for the specified periods.
• In some districts, there has been a two to three times increase in the number of reported deaths after revision.
• Apart from this, underreporting of deaths in rural India is also high owing to fewer rural health facilities providing COVID-19 care.

What needs to be done?

In the absence of realistic data on the number of deaths related to Covid-19, India needs to rely on estimates. India can refine estimates by following the four approaches

1. First, every State should conduct death audits to classify all the deaths that occurred during the pandemic. The focus should be on health facilities, the public, and private sector, as well as deaths in homes.
2. Second, Excess deaths during the Pandemic period need to be analyzed more systematically.
3. Third, need to conduct death surveys followed by verbal autopsies in rural areas to collect additional data. Death registers at the village level, Panchayats, the sample registration system team, booth-level officers can be mobilised to collect additional information on reported deaths. This can help the government in getting more realistic death estimates in the next few months. The Jharkhand government completed one such survey, focused exclusively on rural areas, which found 43% excess deaths than the comparable period before the pandemic.
4. Fourth, need to initiate the decadal Census in India. Inter-censal growth will provide an important insight into excess mortality. The U.S. and China have conducted their census in 2020 during the pandemic.

Developing realistic COVID-19 death estimates could be more helpful in policy formulation, planning, resource allocation, and health system strengthening. Therefore, the governments at all levels (Union, States, and districts) should work to come up with the estimated number of COVID-19 deaths.

Source: The Hindu