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.
Registration Scenario in India during last 6 years
• 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.
80.0
Level of Registration of Births and Deaths, India, 1999-2008
LOR (Births)
Level of Registration (in %)
75.0
LOR (Deaths)
74.5
69.0
70.0
76.4
69.3
66.4
65.0
60.0
62.5
56.8
56.2
55.0
50.0
50.0
58.0
59.5
52.2
52.1
2001
2002
63.2
60.4
57.7
53.5
55.2
55.0
2004
2005
48.7
45.0
1999
2000
2003
Year
2006
2007
2008
Still every 4th birth & every 3rd death goes un-registered
90.0
Performance of Level of Registration , India, 1999-2008, excl. UP &
Bihar
86.3
Births
Deaths
89.2
84.3
81.5
Level of Registration (in %)
80.0
77.6
73.1
70.3
72.7
72.8
69.8
69.6
70.0
78.3
67.4
73.7
73.2
2007
86.3
73.7
2008
89.2
73.2
69.0
65.0
60.2
61.9
60.0
55.5
50.0
Births
Deaths
1999
65.0
55.5
2000
70.3
60.2
2001
73.1
61.9
2002
81.5
69.6
2003
72.8
67.4
Year
2004
77.6
69.8
2005
78.3
69.0
2006
84.3
72.7
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.
Medical Certification of Causes of Death (MCCD)
 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%
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)
MILLENNIUM DEVELOPMENT GOALS(MDG)
• Of the 8 MDGs, IMR, U5MR and MMR are generated by SRS.
Goal
No.
Indicators
Targets
by 2015
Reduce infant mortality
Infant Mortality Rate (IMR)
28
Reduce child mortality
Under 5 Mortality Rate (U5MR)
42
Improve maternal health
Maternal Mortality Ratio (MMR)
109
Goals
4
5
IMR ESTIMATES 2010
• 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 BY RESIDENCE & SEX 1990-2010
90
80
90
86
80
70
80
74
80
50
48
40
74 73 76
70
74
68
61
47 46 49
40
30
40
31
30
58 56
50
51
47
44
68 67 69
60
64
58
60
50
80 78 81
20
10
20
1990
1995
2000
Total
Rural
2005
2010
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.
1990
1995
2000
Total
Male
2005
2010
Female
Female infants continue to
experience a higher
mortality than male infants
NEO-NATAL MORTALITY BY RESIDENCE 1990-2010
70
60
50
57
52
49
53
41
48
40
36
44
31
29
37
27
30
23
33
19
20
10
1990
1995
2000
Total
Rural
2005
2010
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.
IMR Vs. NNMR Vs. PNNMR 1990-2010
90
80
80
74
68
70
58
60
53
48
50
47
44
40
37
33
27
30
26
23
22
20
14
10
1990
1995
2000
IMR
NNMR
2005
2010
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
U5MR ESTIMATES 2010: HIGHLIGHTS
• 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.
98
98
80
100
85
80
59
55
64
100
77
72
82
118
95
120
111
85
84
120
110
140
128
98
96
140
118
110
126
U5MR BY RESIDENCE & SEX: 1990-2010
85
71
67
77
66
60
55
60
49
59
38
40
40
20
-
20
1990
1995
2000
2005
Total
Rural
Urban
2010
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
1990
1995
2000
Total
2005
2010
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”
MMR ESTIMATES 2007-09 : HIGHLIGHTS
• 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.
Maternal Mortality Ratio (MMR); India, EAG & Assam, Southern
States and Other States, 2004-06 and 2007-09
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
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
174
149
India & Major States
Kerala
OTHER SUBTOTAL
TREND IN MMRatio- India
2007-09 SRS
212
(2004-06)
56 000
(2007-09)
2009
LEVELS OF MMRATIO BY REGIONS, 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
Maternal Mortality Ratio (MMR) in India - SRS: Trends based on
Log-Linear model (1997-2015)
500
450
400
300
250
200
150
Years
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
100
1997
MMRATIO
350
Total Fertility Rate (TFR) estimates 2010: Highlights
• 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) BY RESIDENCE, 1990-2010
4.5
4.1
4.0
3.9
3.8
3.5
3.5
3.5
3.2
3.2
3.0
2.9
2.8
2.8
2.6
2.5
2.3
2.5
2.1
1.9
2.0
1.5
1990
1995
Total
2000
Rural
2005
2010
Urban
• 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
ANNUAL HEALTH SURVEY- A
NEW INITIATIVE
OBJECTIVE OF AHS
“
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”
Coverage : Annual Health Survey
Uttara kha nd
R aja stha n
Uttar Prade sh
A ss am
B iha r
M a dhy a P ra des h
Jha rk han d
C hha tti sga rh
Od is ha
WHY AHS ?
o
o
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
Enable direct monitoring of UN Millennium
Development Goals on Child Mortality and Maternal
Health at the district(s) level.
Help in identifying high focus districts meriting
special attention in view of stark inter-district
variations in these States.
KEY FEATURES
• 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
INDICATORS UNDER AHS
• 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
Post Natal Care: 5
Immunization: 8
Birth Weight: 2
Birth Registration: 2
Awareness in Mothers: 4
 Delivery Care: 8
 Janani Suraksha Yojana (JSY): 3
 Vitamin A & Iron Supplements: 2
 Childhood Disease: 6
 Breastfeeding & Supplementation: 12




Abortion- 6
 Family Planning Practices- 15
Disability- 1
 Morbidity- 19
Personal Habits:adults-4  Housing & HH Characteristics- 13
Others- 12
INFANT MORTALITY RATE
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
State


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
In fa nt M o rta lity R a te
To p 1 00 D is tric ts in A H S S ta te s
U tt a ra k h a n d
U tt a r P r ad e s h
Ra ja s th a n
Bih a r
Jh a r kh a n d
M ad h y a P ra d e s h
O riss a
Ch h a tt is g ar h
As s a m
NEO NATAL MORTALITY RATE
Total no. of
districts
State Value
Districts with
minimum NNMR
Districts with
maximum NNMR
Range
UTTARAKHAND
13
30
Rudraprayag (11)
Haridwar (50)
39
RAJASTHAN
UTTAR PRADESH
BIHAR
ASSAM
32
70
37
23
40
50
35
39
Kota (25)
Kanpur Nagar (24)
Patna (22)
Dhemaji (27)
Jalor (58)
Shrawasti (73)
Madhepura (49)
Dhubri (50)
33
49
27
23
JHARKHAND
18
26
Purbi Singhbum (17)
Lohardaga (41)
24
ODISHA
CHHATTISGARH
MADHYA PRADESH
30
16
45
40
35
44
Anugul (31)
Durg (29)
Indore (25)
Balangir (75)
Raigarh (45)
Panna (66)
44
16
41
State

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
U5MR MORTALITY RATE
State
Total no. of
State Value
districts
Districts with
minimum U5MR
Districts with
maximum U5MR
Haridwar (94)
Jalor (99)
Banswara (99)
Shrawasti (142)
Sitamarhi (106)
Kokrajhar (103)
Godda (93)
70
Kandhamal (145)
87
Surguja (103)
Panna (140)
51
89
UTTARAKHAND
13
53
Pithoragarh (24)
RAJASTHAN
32
79
Kota (45)
UTTAR PRADESH
BIHAR
ASSAM
JHARKHAND
70
37
23
18
94
77
78
59
ORISSA
30
82
CHHATTISGARH
MADHYA PRADESH
16
45
70
89
Kanpur Nagar (52)
Patna (53)
Dhemaji (52)
Purbi Singhbum (36)
Balasore (58)
Jharsuguda (58)
Durg (52)
Indore (51)
Range
54
90
53
51
57

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
MATERNAL MORTALITY RATIO
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
CHHATTISGARH
3
4
277
275
Northern (253)
Raipur (243)
Southern (311)
Bastar (312)
58
69
MADHYA PRADESH
10
310
Gwalior (262)
Shahdol (435)
173
State

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)
M a te rn a l M o rta li ty R a tio
T o p 2 5 A d m in is tra ti v e D iv is i o n s in
A H S S ta te s
U tt a ra k h a n d
As s a m
Ra ja s th a n
U tt a r P r ad e s h Bih a r
Jh a r kh a n d
M ad h y a P ra d e s h
O ris s a
Ch h a tt is g ar h
Ad m in is tr a tiv e D iv is io n s
MMR
Top 25
Total Fertility Rate (TFR)
State
State value
Assam
Bihar
Jharkhand
Madhya Pradesh
Chhattisgarh
Odisha
Rajasthan
Uttar Pradesh
Uttarakhand
2.6
3.7
3.1
3.1
2.9
2.3
3.2
3.6
2.3
Total Fertility Rate (TFR)
Minimum
Kamrup (2)
Patna (2.8)
Purbi Singhbhum (2.4)
Indore (2.2)
Koriya (2.4)
Jharsuguda (2)
Kota (2.6)
Kanpur Nagar (2.3)
Pithoragarh (1.7)
Maximum
Hailakandi (4.2)
Sheohar (4.7)
Lohardagga (4)
Shivpuri (4.5)
Kawardha (3.7)
Boudh (3.7)
Barmer (4.7)
Shrawasti (5.9)
Haridwar (3.1)
Range
2.2
1.9
1.6
2.3
1.3
1.7
2.1
3.6
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).
KEY FINDINGS

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.
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