Health services are mainly concerned with the well being of general masses. The availability of the Statistics related to health schemes is essential for planning & monitoring the impact of various services designed for improvement in the health status. Considering this need the responsibility of collection, compilation of Civil Registration data was entrusted to a separate Bureau of vital statistics in year 1955. After the integration of preventive & curative health services, the responsibility to handle hospital statistics was entrusted to the bureau in the year 1970.
Consequently the Bureau of vital statistics was upgraded & recognized as State Bureau of Health Intelligence & vital Statistics (SBHI & VS) from the year 1976.
Thus the main functions of SBHI & VS are collection, compilation & publication of comprehensive vital statistics for the entire state & maintaining liaison with the central Bureau of Health Intelligence, Director General of Health Services, Registrar General Cum Census Commissioner of India & State Directorates.
About the Bureau
The main activities carried out by the Bureau are
- Development of a sound Civil Registration System (C.R.S.)
- Monitoring of Medical Certification of Causes of Death Scheme.(M.C.C.D.)
- Implementation of survey of Causes of Death (Rural) Scheme. (S.C.D.)
- To handle establishment of statistical cadre in the Health Department.
Introduction & History
The history of Civil Registration System in Maharashtra State can be observed by 3 time span viz.
- The System prior to 1/4/1969.
- The System during the period 1/4/1969 to 6/2/1976.
- The System from 7/2/1976 & onwards.
The registration & its monitoring were in the hands of the Revenue & police department, while collection, compilation & preparation of the reports on Vital Statistics, were assigned to the Directorate of Health Services, being a most immediate user of Vital Statistics data. Further the health personnel were very actively helping & also supervising registration activity.
II. The System during 1/4/1969 to 6/2/1976
With the formation of Zilla Parishad & in accordance with the provisions of section 45 of the Bombay Village Panchayat Act1958, the registration work was transferred to the Village Panchayat (VP) in the rural area of the entire State with effect from 1/4/1969. There is no change in urban area. Activity of registration is being carried out by Corporation & Municipal Councils, as previously.
III. The System from 7/2/1976 onwards
Realizing the growing importance of birth & death registration for the planning of socio–economic development, provisions for statutory registration was made in the entire country including Maharashtra under the Central registration of Birth & Death Act 1969, which was made applicable with effect from Apr. 1970 in Maharashtra. The State Rules i.e. The Maharashtra State registration of birth & death Rules 1976 were formed & notified in the Gazette dated 7/2/1978.
As per the guidelines from Govt. Of India, revised rules of Registration of Birth & Death were formed in the year 2000, known as Maharashtra state registration of Birth & death Rules 2000. These rules are enforcing from 1/4/2000.
Registration in Urban area
Registration of birth & death was statutory compulsory in all municipal & Corporation areas under the various Acts previously. After the formation of Registration of Birth & Death act 1969, the registration is made compulsory according to the Act 1969 & rules of 1976.
Medical Certification of Causes of Death
Introduction & History
Medical Certification of cause of Death is an important tool of obtaining authentic & scientific information regarding causes of mortality. The Scheme is formulated by Office of the Registrar General, India is a big step towards the establishment of a system in the country for obtaining data on causes of death. The Scheme had undergone phase – wise implementation in the State, starting from medical college hospitals. In second phase, District hospitals, specialized hospitals were covered. The office of the Registrar General had given necessary administrative guidelines regarding coverage of MCCD Scheme in both urban & rural area. Attempts are being made to cover all private & govt. hospitals since 1998.
M.C.C.D. scheme was introduced for the first time in Maharashtra State in Pune in 1951. Late on it was extended to the cities, nagpur (1957), Mumbai (1962) & Solapur (1969). the remaining urban areas of the state were covered in 1970 & onwards with the encouragement of the Director General Of Health Services, G.O.I. & with the co–operation of the director Of Municipal administration. a directive was issued to all the Municipalities towards the end of 1969 to bring into effect MCCD, in their respective areas, for certifying the cause of death under the Maharashtra Municipality Act 1965.
Survey of Causes of Death Scheme (Rural)
Introduction & History
Mortality influences the rate of growth of the population & provides a dimension of demographic perspective, which is vital for socio–economic planning. The pattern of deaths by causes, age & sex reflect the health status of the community & in turn provides a rational basis for health planning. It is not feasible to build up statistics of mortality by causes based on “Medical Certification of Causes of Death (MCCD)” due to paucity of medical institutions, & physicians in rural area. Still the percentage of non–institutional & unattended death is at higher side in the State as well as in the Country. This most important statistical gap has been bridged, to some extent by the scheme “Survey Of Causes Of Death”.
- The Office Of the Registrar General, India initiated in the 1960s a Scheme called as “Model Registration System” (MRS). With a view that, there should be some centers, which are to be model in Registration of vital events. The scheme was introduced according to recommendations made in the ‘Conference on improvement of Vital Statistics’ held in 1961.
- The Registrar General, India had launched the scheme in some States on pilot basis in 1965. Further the scheme has expanded in 10 states Andhra, Bihar, Asam, Gujrat, keral, Orisa, Punjab, Rajasthan, Tamilnadu, West Bengal, The states Maharashtra, Hariyana, Jammu & Kashmir, Karnataka, M.P., U.P. are covered under the scheme in 1967.
- The scheme was renamed in 1982 as “Survey of Causes of Death Scheme (Rural)”.
- The implementation of the scheme has stopped by Registrar General, India in 1997 at central level & merged in the S.R.S. Scheme.
- The progress & data received under the scheme was satisfactory in the Maharashtra State., & there was no any financial burden, in view of this, State has decided to continue the Scheme in Maharashtra.
- The Scheme was implemented in 600 H.Q. villages of P.H.C. in the State previously.
- The enforcement of the SCD scheme has been included in the Project Implementation Plan of Maharashtra Health System Development Project in 2003–04 & received the financial support.
- The implementation of the Scheme has been shifted from P.H.C.H.Q. village to village level, without changing the nos. of villages.
- The lists of classification of the diseases have been modified base on ICD–10. Now the frame of 109 diseases through 19 major groups have been made available to the M.O. P.H.C. to select the cause of death, based on “Lay diagnosis reporting”.
Objectives of Health Intelligence & Vital Statistics
Civil Registration System
- To register all events of births & deaths on de–facto basis.
- To publish important fertility & mortality data based on registered events.
- To issue certificates as a proof of birth & death events, to the people.
- To provide scientific & authentic information on causes of death related to ages & sex.
- To study the trends & changes in mortality pattern over the years.
- The important objective of the Scheme is to build–up the statistics on Most probable Cause of Death according to age & sex in selected villages by adopting “Lay diagnosis reporting method (Post Death Verbal Autopsy Technique)” through post death enquiry based on signs, symptoms, conditions, duration & anatomical site of the disease as reported by family members of the deceased.
- To collect the data on fertility along with the mortality information & examine the status of fertility.
- To produce district wise fertility & mortality rates based on information collected under the Scheme.
- Evaluation of Civil Registration System.
|Sr||Circle||Registered Births: Year 2001|
|Sr||Circle||Registered Deaths: Year 2001|
|Sr||Circle||Registered Infant Deaths: Year 2001|
Performance of Health Intelligence & Vital Statistics
|Sr||District||Registered Live Births: Year 2001|
|Statement showing Birth Registration during January to June 07|
|Birth Registration (SRS 19)|
|Sr||District||Registered Deaths: Year 2001|
|Statement showing death Registration during January to June 07|
|Death Registration (SRS 6.7)|
|Sr||District||Registered Infant Deaths: Year 2001|
Civil Registration System
In Maharashtra state the Civil Registration System has been in operation as per the legal provision of Birth and Death registration Act 1969 and as per the revised rules framed by the Government of Maharashtra in the year 2000. The registration is done by DE–FACTO method, i.e. the events – births and deaths are registered where they are occurred.
The Civil Registration System is operational in five stages as follows
- Registration of vital events
- Preservation of records
- Feedback, inspection and supervision
For registration of vital events, following Officers are declared as a Registrar of birth & death at various levels.
|Designation of Officer||Designation specified under the act||Jurisdiction|
|The Director of Health Services, Maharashtra State||Chief Registrar of Birth & Death||Maharashtra State|
|The Deputy Director of Health Services (SBHI&VS), Maharashtra State||Deputy Chief Registrar of Birth and Death||Maharashtra State|
|The District Health Officer of all Zilla Parishad in Maharashtra State||District Registrar of Birth and Death||Concern Revenue district|
|The Dy. Chief Executive officer (Panchayat) of all Zilla Parishad in Maharashtra State||Additional District Registrar of Birth and Death||Concern Revenue district|
|The Block Development Officer of all Blocks in Maharashtra State||Additional District Registrar of Birth and Death||Concern Revenue Block|
|The executive Health Officer/Health Officer/Chief Officer of all urban areas in Maharashtra State||Registrar of Birth and Death||Concerned Municipal Corporation/Council|
|The Cantonment Executive Officer of all cantonment Boards in Maharashtra State||Registrar of Birth and Death||Concern area of cantonment board|
|The Gram Sevak or if there is no Gram Sevak, Assistant Gram Sevak of all Gram Panchayats in Maharashtra State||Registrar of Birth and Death||oncern area of Village/Gram panchayat|
|The Administrator of the specified area in Maharashtra state||Registrar of Birth and Death||Concern specified area|
Flow of Rural Area & Urban Area Reporting System
On every 10th, monthly reports are received at state office of Deputy Chief Registrar of Birth and Death at Pune. From rural area 43,722 villages and from urban area 257 urban units are reporting every month to this office. Approximately 2,38,000 registered events of birth/death/stillbirths are reported to this office every month. The entire data is coded and computerized. Since Sept. 2004, decentralization of data is proposed at district level from rural area to begin with.
Feed back, inspection and supervision
In rural area, the Additional District Registrar for the block i.e. BDO and the Extension Officer (Panchayat) takes the review of village registrars for reporting as well as recording of events. In the same way the District Registrar i.e. District Health Officer (DHO), takes the review of the registration activities. At district, in Zilla Parishad, a Statistical Officer and a Statistical Investigator are specifically looking after reporting, monitoring analysis and feedback activities.
At the state level Bureau, the review of all districts is taken by analyzing the registered events. The activities are monitored and feedback is given to take corrective steps in the field. Regular inspection is also carried from state level/district level/block level officers in the field. Reporting
In rural area, the registrars submit the registered events of birth, death and stillbirth to additional district registrar at respective block level. At block level the village registers are maintained and updated every month, after the collection of reports from village registrars. The reports are compiled in a simple abstract. The copy of abstract is also given to district registrar i.e. District Health Officer, for monitoring and feedback at district level. The registrars of urban area send the monthly reports directly to Deputy Chief Registrar of birth and death – Pune, and a copy of abstract is submitted to District Registrar of respective district for monitoring and feedback at district level. Deputy Chief Registrar of Birth and Death – Pune, at the state level, complies & analyses the reports and district wise monthly and annual reports are submitted to Chief Registrar of Birth and Death, Maharashtra State and Registrar General, India, New Delhi.
Strategy: Medical Certification of Causes of Death
- In the case of deaths occurred in the institutions, Head of the institution is responsible for submission of form no.4 to the Local Registrar.
- In the case of domiciliary death attended by any physician prior to death is responsible to submit form no.4A to the local registrar.
- It is the duty of the registrar to provide forms No.4 & 4A to the Institutions & Physicians in his jurisdiction.
- It is the duty of Registrar, to ask about form No.4 & 4A according to occurrence of death, while entering the death event.
- Civil Surgeon of District Hospital & District Health Officer Z.P. is responsible for review of quantity, quality & training of M.C.C.D. at district level.
- Deputy Director is responsible for compilation, coding & analysis of data received through MCCD according to ICD–10.
- The Paramedical staff (ANM & MPW) working in the selected villages is the important & root level worker called as “Field Agent”. The field agents are expected to keep House hold register, visit the community twice in a month & collect the data on fertility & mortality. In respect of mortality, they should contact the family members, collect the information on sign & symptoms, disease, duration of the diseased, by applying their experience in providing health services. The data collected under the scheme is according to De jury method.
- Field agents are expected to submit the collected information in the prescribed format to the M.O. PHC at the end of the month.
- Field recorder at PHC level is expected to supervise the villages selected under the scheme. He should consolidate the information received by the field agent every month. He should prepare the monthly report & submit to the Dist. level.
- Six monthly survey are to be conducted to detect the omissions if any, by field recorder.
- M.O.PHC is expected to verify all cause of death forms (C form). Based on sign & symptoms given by the field agent. He should write the probable cause of death, with the help of Classification of diseases made available to them. In case of Institutional deaths & the deaths in which any other Private Practitioners identify cause of death, MO should write the same cause of death.
- M.O. is also responsible for the development of technique of field agent in respect of Post death verbal autopsy.
- District Health Officer/Additional District Health Officer (A.D.H.O) are expected to monitor, supervise, evaluate, & verification of the scheme, time to time with the help of statistical wing at district level.
- Deputy Director (State Bureau Of Health intelligence & vital Statistics) is the whole in charge of the scheme at State level. He is expected to review the scheme, take corrective actions in respect of progress Further he should generate the information on mortality statistics related to Causes, age, & sex. of the scheme. Similarly District & Circle wise fertility & mortality rates in the form of State Annual Report.
Civil Registration System (CRS)
A) Registration of Births and Deaths of Rural and urban areas of the state.
- The Registration of Births and Deaths activity is carried out with the help of 256 Urban and 43722 Rural Centers. 100% work is expected from these centers (not only registration of Births and Deaths but submission of specific statutory obligated reports also). The efforts are being made to collect reports from all villages for 100% registration in time by contacting the Chief Executive Officer and concerning Block Development Officer in rural area. Multipurpose Health Worker, Auxiliary Nurse Midwife, Anganwadi Workers and Dais are also making attempts successfully in registration of Births and Deaths. The periodical review is taken to know the impact of their assistance in this respect in relation to the qualitative improvement in registration work.
- An effort had been made by this Bureau to decentralize the computerization of compilation of data at block level, regarding events registered in the jurisdiction of respective block in rural area.
- Meetings at various levels are conducted in rural as well as urban areas to improve the civil registration system.
There are two types of meetings:
- Routine meetings
- Meetings of committees formed according to Government Resolution.
Routine meetings: Annual Meeting of Chief Registrars at National level, Half Yearly Meeting of District Registrars at State level, Half Yearly Meetings of Statistical Officers of district at State level, Monthly Meetings of Medical Officers and Supervisors of Primary Health Centres at District level. Fortnightly Meetings of Village registrars at Block level.
Meetings of committees formed according to Government Resolution: Half–yearly meeting of Interdepartmental Co–ordination committee at State level, Quarterly meeting of committee at District, Block and village level to improve Birth and death registration and vital statistics, Quarterly meeting of committee at Corporation level to improve Civil Registration System.
- Training: Training of newly recruited Statistical Investigators and officers, training of various software’s to health personnel, training of CRS to registration functionaries (as and when grants are available)
- IEC Activity
To improve coverage and quality of MCCD following activities are carried out.
- Publication of data
1. Meetings: Half Yearly Civil Surgeons at State level, Monthly of Superintendents of Rural and Cottage Hospitals at District level, Meetings of Private Practitioners and Medical Officers in corporation ares are taken as and when required by the corporation.
2. Training: Continuous training of Civil Surgeons, Superintendents, Medical officers at Health and Family welfare Training Centres for ICD–10 and MCCD.
3. Publication of data: Annual Publication is done on the basis of data received through MCCD.
C) Survey of Cause of Death (Rural)
- Half yearly Survey: the half yearly surveys are conducted in the villages selected under the scheme for detection of omissions of Births & Deaths event. The survey is expected to conduct by field recorder of respective PHCs.
- To improve the quantitative and qualitative aspect of information collected under Survey of Cause of Death Scheme (Rural), as well as to receive the reports of this scheme in time, the scheme is monitored under Health Management Information System (HMIS). The system is monitored through the following indicators.
Ind.70(i): Birth Reporting.
Ind.70(ii): Death Reporting.
Ind.70(iii): Infant death Reporting.
Ind 70(iv): Cause of Deaths verified by MOPHC.
- Half yearly meeting of Statistical Officer/Statistical Inventigator (SO/SI) to review the performance, instructions, & to prepare plan of action, strategy at state level.
- Monthly meeting of MOPHC & field agents/recorder at district level.
- This is the continues activity. Training is being given to the SI/SO regarding the scheme, as & when required according to availability of grants.
- Training of field agent, field recorder & Mo is being carried out at district level by SO, Medical Officer District Training Team (MODTT), & ADHO.
The annual data compiled, analyzed & statistical inferences are published through annual report. The bureau is publishing the data through annual report from the year 2001 onwards.
D) Assistance in the work of Epidemiology
To accelerate the surveillance of epidemic disease and study related to epidemiology, the specific individual instructions to the Civil Surgeon and District Health Officers were given. Every month, collection, compilation of the information regarding causes of mortality was started since 1975–1976. The feedback is given to district health personnel, in alarming situation.
E) Health Management Information System (HMIS)
With the intention to keep the vigilance on progress of different health programmes, the Government has introduced the Health Management Information System. Health Management Information System involves information like comparative performance Status, Inter District ranking of performance and status of achievement of various indicators at State level etc.
How the programme is implemented.
Civil Registration System
This is implemented in Rural and Urban area. In case of rural area Gramsewak submits Birth and Death reports of the revenue villages under his jurisdiction to Block Development Officer (BDO). BDO submits consolidated reports to Deputy Chief Registrar, for Births and Deaths Pune In case of Urban area Exe. Health Officer/Health Officer/Chief Officer submits reports of Births and Deaths to Deputy Chief Registrar, Births and Deaths Pune. After receiving reports these are scrutinized, and computerized. At the end of the year Annual Vital Statistics Report is prepared and submitted to Higher Authorities.
Now this process is decentralized at district level. All the rural births and deaths reports will be computerized, in the office of the District Health Officer, of respective Zilla Parishad. The floppy or Compact Disc of the consolidated report will be sent to Dy. Chief Registrar, Births and Deaths Maharashtra State Pune.
Medical Certification of Cause of Death
Hospital incharge in urban area submits these certificates to Deputy Chief Registrar Pune. Recently from 1998 this scheme is extended in Rural Hospitals. After receiving the certificates causes of death are coded as per International Classification of Diseases revision 10 (ICD – X). After coding the information is compiled & analyzed. The report is submitted to Central Bureau of Health Intelligence, New Delhi. From this scheme we can observe medically certified causes of deaths by age sex in urban area.
Monthly Report of Communicable Diseases
The monthly report of 26 communicable diseases is collected from all district level officers – District Health Officers, Civil Surgeons Health officers of Corporations and identified Medical Colleges. After consolidations the report is sent to Director General Health Services Mumbai and Secretary Public Health Department, Mumbai, every month through Health Management Information System. Also this report is sent to Director, Central Bureau of Health Intelligence, New Delhi.
Information on identified 194 diseases
The report of 194 diseases is collected quarterly from all District officers i.e. District Health Officers, Civil Surgeons and identified Medical College Hospitals. After consolidation annual report is sent to Director, Central Bureau of Health Intelligence, New Delhi and Director General Health Services Mumbai. The morbidity pattern of the disease, prevalence in the state is known from this report.
Survey of Causes of Death (Rural)
- The scheme is implemented in 600 villages, which are randomly selected among the 33 districts.
- The scheme covers 12.5 lakhs (rural) population.
- The health worker uses verbal autopsy technique instrument to collect the signs and symptoms of diseased, at the time of death.
- Medical Officer of Primary Health Center writes the cause of death according to signs and symptoms collected by health worker by referring the list of causes based on ICD – X.
- From this scheme, the mortality pattern existing in the rural community is known. The various mortality indicators are calculated from the available data and information.
Services to Common People
Village Level Service
Every birth or death event occurred in rural area is registered at Grampanchayat. Gramsevak or Village Development Officer does this registration. The procedure for registration is quoted in Maharashtra Births and Deaths Registration Rules 2000.
- Rural Hospitals, Sub–District Hospitals, Other Hospitals, District Hospitals, Super Specialty Hospitals.
- At all these hospitals Birth Reports, Death Reports, Still Birth Reports, Medical Certificates of causes of death are filled and are sent to respective Registrars, Births and Deaths. This submission of reports is as per procedure in Maharashtra Births and Deaths Registration Rules 2000. After receiving the reports Registrar registers the events.
- Services centers available in each district.
- Service centers for registration of birth and death are nothing but Registrars office.
Service centers for registration of birth and death are nothing but Registrars office. In each district service centers are as follows:
Rural Area: Grampanchayat of every revenue village.
Urban Area: Municipal Corporation/Municipal Council/Cantonment Board/Ammunition Factory Hospital.
Role of NGOs
NGOs can help for improving the registration of birth and death in community. Awareness of registration is necessary especially in rural area. NGOs can arrange lectures, demonstrations on this topic in rural area.
Health Education Messages
Important Health Education Messages
- Ensure registration of every birth and death event.
- Birth certificate ensures a hurdle–free future for your child.
- Register the event of birth alongwith the name of child.
- Obtain the birth certificate with name of child.
Registration of Birth and Death is multidepartmental activity. In this activity Rural Development Department, Urban Development and Public Health Department are involved. Co–ordination of these three departments is necessary for effective registration.
Expected Community Participation
The registration of birth/death event is obligatory as per Registration of Births and deaths Act, 1969. Every parent is supposed to register the event of birth of their child, similarly every death event is supposed to be registered by the relative of deceased. After registration it is useful to take the certificate of birth or death for various purposes.
Birth Certificate is useful for
- Evidence of birthplace and date.
- For obtaining passport/visa, driving license etc.
- For admission in school.
- Establishing the heritage.
- Evidence of place and date of death.
- For obtaining family pension and insurance claim.
Birth, Death and Infant Death Efficiency
|Year||Estimated Population||SRS Birth Rate||Estimated Birth||Registered Birth||Efficiency %||SRS Death Rate|
Vital Statistics as per (SRS)
- Improvement in CBR from 26.2 in the year 1991 to 19.1 in 2004.
- Improvement in CDR from 8.2 in the year 1991 to 6.2 in 2004.
- Improvement in IMR from 60 in the year 1991 to 36 in 2004.
- CBR is less by 2.0 for urban area than rural.
- CDR is less by 1.4 for urban area than rural.
- There is vast difference in rural & urban areas for IMR. IMR for rural area is 42 & for urban area is 27.
Total Fertility Rate
As per SRS data, TFR of state is showing slow decline over a period of 10 years. It was 3 during 1991 & reduced to 2.5 in the year 2000.