An update
on Civil Registration System,
Sample Registration System &
Annual Health Survey
BHASKAR MISHRA
DEPUTY REGISTRAR GENERAL
Office of the Registrar General, India
25th September 2012
OUTLINE
• Civil Registration System- Current Status, Challenges and initiatives
• Key Results from Sample Registration System
• Highlights from the baseline survey of Annual Health Survey
Civil Registration System- Why?
• A complete & up to date CRS can provide reliable statistics on fertility & mortality along with their co-variates at all level of aggregations, almost on a real time basis, which is not possible from any sample survey.
• CRS as the key for evidence based planning has no parallels and levels of registration reflects the quality of governance.
Civil Registration System (CRS)- Key Features
• Registration of Births and Deaths falls under the Concurrent list of the Constitution.
• Registration of Births, Deaths and Still births in India mandatory with the enactment of Registration of Births and Death Act (RBD Act), 1969.
• Registrar General, India unifies and coordinates the activities of the States
• States are responsible for implementation of RBD Act.
• National Population Policy mandates cent percent registration.
• LOR(Birth) – India: 59.5% to 76.4 % ( + 16 %)
• LOR( Death)– India 52.1% to 66.4% ( + 14%)
• 12 States/UTs have achieved 100% registration of
births.
• 5 States/UTs have achieved 100% registration of
deaths
• Performance of Uttar Pradesh & Bihar remains the
main concern.
Registration Scenario in India during last 6 years
56.8 56.2 58.0
59.5 57.7
60.4
62.5
69.0
74.5 76.4
50.0 48.7
52.2 52.1 53.5
55.2 55.0
63.2
69.3
66.4
45.0
50.0
55.0
60.0
65.0
70.0
75.0
80.0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Level o
f R
egis
trati
on
(in
%)
Year
Level of Registration of Births and Deaths, India, 1999-2008
LOR (Births) LOR (Deaths)
Still every 4th birth & every 3rd death goes un-registered
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Births 65.0 70.3 73.1 81.5 72.8 77.6 78.3 84.3 86.3 89.2
Deaths 55.5 60.2 61.9 69.6 67.4 69.8 69.0 72.7 73.7 73.2
65.0
70.3
73.1
81.5
72.8
77.6 78.3
84.3 86.3
89.2
55.5
60.2 61.9
69.6 67.4
69.8 69.0
72.7 73.7 73.2
50.0
60.0
70.0
80.0
90.0L
ev
el
of
Re
gis
tra
tio
n (
in %
)
Year
Performance of Level of Registration , India, 1999-2008, excl. UP & Bihar
Births Deaths
UP & Bihar suppresses the National LOR for Births and Deaths by 13 & 9 % points respectively.
Challenges
+ Awareness among the public about the need of birth &
death certificates - a cause of concern.
+ States/UTs are functioning at different level of efficiency.
+ Besides registration, problems also lies in timely
reporting (Registration takes place but it’s not reported).
+ Netting of infant deaths and misclassification of maternal
deaths remains a concern in better performing States like
Kerala and Tamil Nadu.
+ Delay of about 2-3 years in preparing the State level
Statistical Reports mars the utility of data.
Recent Initiatives to re-vitalise the system
+ Ministry of Health has made registration as one of the focus areas under NRHM. + Delivery of services are being linked with registration. + Provisions of the Act are being simplified for better implementation. + Supreme Court’s directive for revamping the system. + Updating of National Population Register linked with CRS at the sub-district level. + ORGI to collaborate with various partners to provide requisite boost.
Introduced in early 1970s to provide cause-specific
mortality profile.
Restricted to urban areas, that too few selected hospitals
At various stages of implementation across different
States.
Coding is as per ICD-10.
Covers about 19% of the total registered deaths only
Garbage codes(R00-R99) are to the tune of 15%
Medical Certification of Causes of Death (MCCD)
ORGI has expanded the scope under MCCD to all Institutions including individual practitioners and the coverage , extended to rural areas as well.
Sample Registration System – An Overview Introduced as an interim system in 1969-70 due to deficient CRS
Key features
o Fixed panel survey and a dual record system
o Reliable and continuous estimates
o State level estimates separately for rural/urban on
• All indicators of fertility and mortality including birth rate, death rate, IMR, Maternal Mortality Ratio, TFR, etc
• Under 5 mortality rate also generated from 2008 annually
• Panel revised once in 10 years based on Census frame
Current Panel of SRS (2004)
o Covers 4433 rural and 3164 urban areas (1.3 million households and 7 million population)
o Sample size determination based on IMR
o Permissible level of RSE: 10% (bigger states)
• Of the 8 MDGs, IMR, U5MR and MMR are generated by SRS.
Goal No.
Goals Indicators Targets by 2015
4
Reduce infant mortality
Infant Mortality Rate (IMR)
28
Reduce child mortality
Under 5 Mortality Rate (U5MR)
42
5 Improve maternal health Maternal Mortality Ratio (MMR) 109
MILLENNIUM DEVELOPMENT GOALS(MDG)
• IMR measures number of infant ( < 1 year) deaths per
1000 live births.
• Every 6th death in India pertains to an infant
• IMR in India has registered a 3 points decline to 47 in
2010 from 50 in 2009.
• Still, 1 in every 21 infants - National level, 1 in every 20
infants - rural area, and 1 in every 33 infants - urban area
die within one year of birth (against 1 in 37 under MDG)
IMR ESTIMATES 2010
80
74
68
58
47
86
80
74
64
51 50 48 44
40
31
20
30
40
50
60
70
80
90
1990 1995 2000 2005 2010
Total Rural Urban
Since 1990, IMR at the National level has declined by 33 points (1.65 points annually) against 35 points( 1.75 points annually) in Rural Areas and 19 points( 0.95 points annually) in Urban Areas.
80 74
68
58
47
78 73
67
56
46
81 76
69
61
49
-
10
20
30
40
50
60
70
80
90
1990 1995 2000 2005 2010
Total Male Female
Female infants continue to experience a higher mortality than male infants
IMR ESTIMATES BY RESIDENCE & SEX 1990-2010
53
48 44
37 33
57
52 49
41
36
31 29 27
23
19
10
20
30
40
50
60
70
1990 1995 2000 2005 2010
Total Rural Urban
NNMR for the Country declined by 20 points (rural NNMR
by 21 points vis-à-vis urban NNMR 12 points) in the last 20
years at an annual average decline of about 1 point.
Rural-Urban Gap in NNMR is narrowing.
NEO-NATAL MORTALITY BY RESIDENCE 1990-2010
80
74
68
58
47
53
48 44
37 33
27 26 23 22
14
-
10
20
30
40
50
60
70
80
90
1990 1995 2000 2005 2010
IMR NNMR PNNMR
• Share of NNMR in the overall IMR is increasing over the
years (54% in early 70s to 67% now)
• Interventions are required to effectively curb NNMR
IMR Vs. NNMR Vs. PNNMR 1990-2010
• U5MR denotes number of children (0-4 years) who died
before reaching their fifth birthday per 1000 live births
• U5MR for the country has declined by 5 points over 2009
(59 in 2010 against 64 in 2009)
• A uniform decline of about 5 points is seen in male and
female U5MRs.
U5MR ESTIMATES 2010: HIGHLIGHTS
U5MR for the country declined by
59 points (rural IMR by 62 points
vis-à-vis urban IMR 33 points) in
the last 20 years at an annual
average decline of about 3 points
118
98
85
77
59
128
111
98
85
66 71
67
55 49
38
20
40
60
80
100
120
140
1990 1995 2000 2005 2010
Total Rural Urban
11
8
98
85
77
59
11
0
96
84
72
55
12
6
11
0
95
82
64
-
20
40
60
80
100
120
140
1990 1995 2000 2005 2010
Total Male
Male-female mortality
differential has narrowed down
over the years, yet the gap
remains significant
“ Child deaths are falling, but not quickly enough to reach the MDG target”
U5MR BY RESIDENCE & SEX: 1990-2010
• MMRatio measures number of women aged 15-49 years dying due to maternal causes per 1,00,000 live births.
• Decline in MMR estimates in 2007-09 over 2004-06: – For India: 212 from 254 (a fall of about 17%)
– In Empowered Action Group (EAG) states & Assam: 308 from 375 (18%)
– Among Southern States: 127 from 149 (15%)
– In Other States: 149 from 174 (14%)
• States realizing MDG target of 109 have gone up to 3 with Tamil Nadu & Maharashtra (new entrants) joining Kerala. Andhra Pradesh, West Bengal, Gujarat and Haryana are in closer proximity to achieving the MDG target.
MMR ESTIMATES 2007-09 : HIGHLIGHTS
Maternal Mortality Ratio (MMR); India, EAG & Assam, Southern States and Other States, 2004-06 and 2007-09
India & Major States MMR
2004-06
MMR
2007-09
INDIA TOTAL 254 212
Assam 480 390
Bihar/Jharkhand 312 261
Madhya Pradesh/Chhattisgarh 335 269
Orissa 303 258
Rajasthan 388 318
Uttar Pradesh/Uttarakhand 440 359
EAG AND ASSAM SUBTOTAL 375 308
Andhra Pradesh 154 134
Karnataka 213 178
Kerala 95 81
Tamil Nadu 111 97
SOUTH SUBTOTAL 149 127
Gujarat 160 148
Haryana 186 153
Maharashtra 130 104
Punjab 192 172
West Bengal 141 145
Other 206 160
OTHER SUBTOTAL 174 149
TREND IN MMRatio- India
(2004-06)
2009
2007-09 SRS
212
56 000
(2007-09)
Region MMR
Life time risk
% share of female Popln.
% to total maternal
deaths
EAG states 308
1.1% 48.0 61.6
Southern states
127
0.3% 21.0 11.4
Other states
149
0.4% 31.0 27.0
India 212
0.6% 100 100
LEVELS OF MMRATIO BY REGIONS, 2007-09
100
150
200
250
300
350
400
450
500
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
MM
RA
TIO
Years
Maternal Mortality Ratio (MMR) in India - SRS: Trends based on Log-Linear model (1997-2015)
• TFR for the country has come down to 2.5 from 2.6 in 2009.
• Bihar has reported the highest TFR (3.7) while replacement level TFR, viz 2.1, has been attained by Tamil Nadu(1.7), Kerala(1.8), Andhra Pradesh (1.8), Himachal Pradesh (1.8), Punjab (1.8), West Bengal (1.8) , Delhi (1.9), Maharashtra (1.9), Jammu & Kashmir(2.0) & Karnataka (2.0).
• At present, a rural woman (having a TFR of 2.8) at the National level would have about one child more than an urban woman (having a TFR of 1.9), on average
Total Fertility Rate (TFR) estimates 2010: Highlights
• TFR for the country declined by 1.3 points (down by more than a child), rural TFR also by 1.3 points and urban TFR by 0.9 point over last 20 years
• Another 10-12 years to achieve the replacement level of 2.1 at the current fertility rates
3.8 3.5
3.2
2.9
2.5
4.1
3.9
3.5
3.2
2.8 2.8
2.6
2.3
2.1
1.9
1.5
2.0
2.5
3.0
3.5
4.0
4.5
1990 1995 2000 2005 2010Total Rural Urban
Total Fertility Rate (TFR) BY RESIDENCE, 1990-2010
ANNUAL HEALTH SURVEY- A NEW INITIATIVE
“ To yield a comprehensive, representative and reliable dataset on core vital indicators including composite ones like IMR, MMR and TFR along with their co-variates (process and outcome indicators) at the district level and map changes therein on an annual basis”
OBJECTIVE OF AHS
Coverage : Annual Health Survey
Odisha
Chhattisgarh
JharkhandMadhya P radesh
Bihar
AssamRajasthan
Uttar Pradesh
Uttarakhand
o AHS States constitute: • 48 percent of country’s Population • 59 percent of Births • 70 percent of Infant Deaths • 75 percent of Under 5 Deaths • 62 percent of Maternal Deaths
o Enable direct monitoring of UN Millennium Development Goals on Child Mortality and Maternal Health at the district(s) level.
o Help in identifying high focus districts meriting
special attention in view of stark inter-district variations in these States.
WHY AHS ?
• Panel Survey on the pattern of SRS
• Coverage- All the 284 districts of 8 EAG States and Assam.
• Sample Size- IMR as the decisive indicator with 10%RSE.
• Sample Units- 20,694 statistically selected sample unit
(Census Enumeration Blocks in urban areas and Villages or a
part thereof in rural areas)
• Sample Population- About 20.1 million
• Sample Households - 4.1 million households.
• Sample Units per district- 73.
• Sample Population per district - About 71 thousand.
• Sample households per district - About 14.5 thousand.
The Largest Sample Survey in the World
KEY FEATURES
• In all, 161 indicators are available from AHS baseline: Fertility- 13 Sex Ratio- 3 Marriage- 5 Mortality- 7 Mother & Child Care- 63
Ante Natal Care: 11 Delivery Care: 8 Post Natal Care: 5 Janani Suraksha Yojana (JSY): 3 Immunization: 8 Vitamin A & Iron Supplements: 2 Birth Weight: 2 Childhood Disease: 6 Birth Registration: 2 Breastfeeding & Supplementation: 12 Awareness in Mothers: 4
Abortion- 6 Family Planning Practices- 15 Disability- 1 Morbidity- 19 Personal Habits:adults-4 Housing & HH Characteristics- 13 Others- 12
INDICATORS UNDER AHS
State Total no. of
districts State Value
Districts with minimum IMR
Districts with maximum IMR
Range
UTTARAKHAND 13 43 Rudraprayag (19) Haridwar (72) 53
RAJASTHAN 32 60 Kota (36) Jalor (79) 43
UTTAR PRADESH 70 71 Kanpur Nagar (36) Shrawasti (103) 67
BIHAR 37 55 Patna (39) Madhepura (71) 32
ASSAM 23 60 Dhemaji (44) Kokrajhar (76) 32
JHARKHAND 18 41 Purbi Singhbum (26) Godda (64) 38
ODHISSA 30 62 Baleshwar (49) Balangir (100) 51
CHHATTISGARH 16 53 Durg (43) Raigarh (65) 22
MADHYA PRADESH 45 67 Indore (40) Panna (93) 53
IMR across 284 districts ranges between 19 (Rudraprayag; Uttarakhand) & 103 (Shrawasti, UP) – a variability of 5 times!
6 districts viz. Purbi Singhbhum & Dhanbad (Jharkhand); Chamoli, Rudraprayag, Pithoragarh & Almora (Uttarakhand) have already achieved MDG-4 National target of 28 by 2015
INFANT MORTALITY RATE
Oriss a
Chhattisgarh
Jharkhand
M adhya P radesh
Bihar
AssamRajasthan
Uttar P radesh
Uttarakhand
Infant M ortality Rate
Top 100 D istricts in AHS States
NNMR across 284 districts ranges between 11 (Rudraprayag; Uttarakhand) & 75 (Balangir, Orissa) – a variability of 7 times!
Out of every 10 infant deaths, 6-7 pertains to neonates
NNMR in rural areas of districts is significantly higher than that in urban areas
State Total no. of
districts State Value
Districts with minimum NNMR
Districts with maximum NNMR
Range
UTTARAKHAND 13 30 Rudraprayag (11) Haridwar (50) 39
RAJASTHAN 32 40 Kota (25) Jalor (58) 33
UTTAR PRADESH 70 50 Kanpur Nagar (24) Shrawasti (73) 49
BIHAR 37 35 Patna (22) Madhepura (49) 27
ASSAM 23 39 Dhemaji (27) Dhubri (50) 23
JHARKHAND 18 26 Purbi Singhbum (17) Lohardaga (41) 24
ODISHA 30 40 Anugul (31) Balangir (75) 44
CHHATTISGARH 16 35 Durg (29) Raigarh (45) 16
MADHYA PRADESH 45 44 Indore (25) Panna (66) 41
NEO NATAL MORTALITY RATE
State Total no. of
districts State Value
Districts with minimum U5MR
Districts with maximum U5MR
Range
UTTARAKHAND 13 53 Pithoragarh (24) Haridwar (94) 70
RAJASTHAN 32 79 Kota (45) Jalor (99)
Banswara (99) 54
UTTAR PRADESH 70 94 Kanpur Nagar (52) Shrawasti (142) 90
BIHAR 37 77 Patna (53) Sitamarhi (106) 53
ASSAM 23 78 Dhemaji (52) Kokrajhar (103) 51
JHARKHAND 18 59 Purbi Singhbum (36) Godda (93) 57
ORISSA 30 82 Balasore (58)
Jharsuguda (58) Kandhamal (145) 87
CHHATTISGARH 16 70 Durg (52) Surguja (103) 51
MADHYA PRADESH 45 89 Indore (51) Panna (140) 89
U5MR ranges between 24 (Pithoragarh, Uttarakhand) & 145 (Kandhamal, Orissa) - a variability of 7 times!
7 districts viz. Pithoragarh, Almora, Rudraprayag, Chamoli, Nainital & Bagheswar (Uttarakhand) and Purbhi Singhbum (Jharkhand) have already achieved MDG National level target of 42
U5MR MORTALITY RATE
MMR ranges between 183 (Kumaon HQ, Uttarakhand) & 451(Faizabad Mandal, UP)
MMR for Uttarakhand along with its two divisions is lower than the
National Average (212)
State Total no. of
Admin. Division State Value
Admin. Division with minimum MMR
Admin. Division with maximum MMR
Range
UTTARAKHAND 2 188 Kumaon HQ (183) Garhwal HQ (190) 7
RAJASTHAN 7 331 Bharatpur (292) Udaipur (364) 72
UTTAR PRADESH 18 345 Jhansi Mandal (241) Faizabad Mandal (451) 210
BIHAR 9 305 Patna (258) Purnia (377) 119
ASSAM 4 381 Hills & Barak Valley
(342) Upper Assam (430) 88
JHARKHAND 5 278 Uttari Chota Nagpur
(208) Santal Paragana (325) 117
ODISHA 3 277 Northern (253) Southern (311) 58
CHHATTISGARH 4 275 Raipur (243) Bastar (312) 69
MADHYA PRADESH 10 310 Gwalior (262) Shahdol (435) 173
MATERNAL MORTALITY RATIO
Oriss a
Chhattisgarh
Jharkhand
M adhya Pradesh
Bihar
Assam
Rajasthan
Uttar P radesh
Uttarakhand
M aterna l M ortali ty Ra tio
Top 2 5 Ad m in istrative D ivisions in
A H S S tates
M M R
Top 25
Ad m in is tra tive D iv is ions
Total Fertility Rate (TFR)
State State value Minimum Maximum Range
Assam 2.6 Kamrup (2) Hailakandi (4.2) 2.2
Bihar 3.7 Patna (2.8) Sheohar (4.7) 1.9
Jharkhand 3.1 Purbi Singhbhum (2.4) Lohardagga (4) 1.6
Madhya Pradesh 3.1 Indore (2.2) Shivpuri (4.5) 2.3
Chhattisgarh 2.9 Koriya (2.4) Kawardha (3.7) 1.3
Odisha 2.3 Jharsuguda (2) Boudh (3.7) 1.7
Rajasthan 3.2 Kota (2.6) Barmer (4.7) 2.1
Uttar Pradesh 3.6 Kanpur Nagar (2.3) Shrawasti (5.9) 3.6
Uttarakhand 2.3 Pithoragarh (1.7) Haridwar (3.1) 1.4
Across 284 districts in 9 AHS States, it ranges from 1.7 in Pitthoragarh (Uttarakhand) to 5.9 in Shrawasti (UP)- a variability of more than 4 children.
20 districts have already achieved the replacement level of 2.1. • 164 districts have recorded TFR of 3.1 and above, the National
level TFR of 2001 (SRS).
Total Fertility Rate (TFR)
Top 100 districts in order of IMR constitute about 50 percent of total Infant Deaths across 9 States
Top 25 Administrative Divisions (comprising 104 districts) in order of MMR constitute 41 percent of the total Maternal Deaths
Top 100 districts in order of U5MR account for 63 percent of total child deaths.
57 districts are in common – Hot Spots
Replacement level of TFR 2.1 has been achieved in only 20 out of 284 AHS districts.
A Component of Clinical-Anthropometric & Bio-chemical (CAB) Test on a sub-sample basis is scheduled to be introduced in October.
KEY FINDINGS
No survey can be an effective and sustainable substitute for Civil Registration System
Thank You
Registrar General and Census Commissioner, India,
2 A Mansingh Road, New Delhi 110011, India
Phone: +91-11-24105383
Fax: +91-11-23383145
E mail: [email protected] Website: http://www.censusindia.gov.in