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News: Recently, the World Health Organisation (WHO) has attempted to measure the cost of the Covid-19 pandemic across the world. This has been done through the estimation of excess deaths.
What is the excess death measure?
Registered deaths during the pandemic are compared to an average of registered deaths before the pandemic (baseline estimates) to produce estimates of excess deaths.
India’s institutional arrangement for birth and death registration that have been used for estimating excess death
The Civil Registration System (CRS) is the repository of all registered births and deaths in the country at the national, state, and district levels.
The provisions of the Registration of Births and Deaths Act of 1969 require every death to be registered within 21 days of the event.
Another source of data used to estimate excess deaths in the household survey, such as the CVoter tracker survey.
What were the issues in the estimation of excess death in India?
(A) Infrastructural issues
Unlike developed countries, the developing countries including India lack adequate birth and death registration infrastructure. This led to the generation of unreliable data which lead to imprecise and speculative estimation of excess deaths.
Even before the pandemic, India did not have an infrastructure for collecting real-time robust death data.
(B) CRS: The careful research of the death data from CRS has repeatedly revealed serious shortcomings, as given below:
The baseline estimates of death from the CRS are not a reliable source of death. There has been underreporting of the number of dead in the pre-pandemic period (example for 2019). For instance, the overall death registration in the CRS was 92% of the overall deaths estimated by the Sample Registration System (SRS).
Furthermore, when data is disaggregated on other parameters like gender, age, etc. the report becomes more unreliable.
The CRS death data for the pre-pandemic period were used as the baseline without adjusting for age, gender, and location. This would lead to exaggerated numbers of excess deaths.
In fact, the registration level in the CRS has not been uniform over the earlier years. It ranged from 75% in 2015 to 85% in 2018.
(B) Issues in Household Survey
The primary purpose of the survey is to track perceptions of governance, media, and other social indicators, not to collect death data from households. The CVoter tracker survey covers only 0.14 million adults. And the self-reported data on death numbers gathered from telephonic surveys has no on-field verification.
A reliable source of death data in India is the Sample Registration System (SRS). Unfortunately, the SRS survey was not carried out during the pandemic.
In addition, media coverage and overall fear and interest levels during waves of the pandemic led to varying responses from people. The lack of accurate data on deaths has led to intense speculation and politicization.
The Way Forward
The Sample Registration System (SRS) should be conducted soon. No matter how sophisticated the statistical methodology, there is no substitute for high quality data.
The pandemic has provided a window of opportunity to invest heavily in building a robust and reliable infrastructure that collects timely data on vital statistics, such as births, deaths and migrations.
This project should be given national importance and an urgent priority as such an infrastructure would become the cornerstone of public health in India. The central and state governments must cooperate.
Source: The post is based on an article “Don’t play politics with Covid death numbers, let’s learn from them” published in the Indian Express on 14th May 2022.