Recording the causes of mortality and using that data to drive public health interventions like drug and vaccine procurement, running screening and awareness campaigns, and providing secondary and tertiary care under health insurance schemes can help public health achieve better outcomes.
Epidemiological findings from morbidities and mortalities play an important role in health policy. Information of total deaths or “all-cause mortality” are helpful in getting a broad understanding of the overall disease pattern and health of the population, as well as strengths of health systems.
Disease incidence data is currently only available from public health facilities, and that too is not compiled well by cause and never made public. There is almost no data from the private sector on hospital days, inpatient days, drug and vaccine consumption, as per different procedures. Outpatient data from the private sector is a far cry when government hospital data is not properly available.
Causes of Morbidity and mortality
Several states have started insurance-based healthcare delivery schemes to plug the shortage of doctors and facilities in rural areas. Such schemes have data captured for all the empanelled hospitals under the scheme, including from empanelled private hospitals, which, if analysed periodically, can help understand the causes of morbidity and mortality.
In addition, it is necessary to integrate all the databases currently available with health departments across the country. Each scheme has its own database. New scheme has new database. Hence, the data does not link to each other, there is no standard taxonomy or coding of the various fields or variables, and there is no data triangulation.
As a result, different databases have different variables, which are not standardised. Substantial funds are spent on capturing data under each scheme, which leads to duplication, and no effort is made to build a common, publicly-accessible database.
Employment State Insurance Scheme (ESIS), Rashtriya Swasthya Bima Yojna (RSBY), Central Government Health Scheme (CGHS), Railways, central PSUs, LIC of India, government insurance companies … all have a large number of beneficiaries and data which is never made public, or used, for public policy-making.
The most important change can be aligning funds with trends and mortality and morbidity outcomes. We can have village- and block-level profiles of morbidity and mortality by cause of death, which can form the basis for budget allocations. It is time we moved away from state plans to village plans, and also target delivery and outcomes using village/block as a unit.
It is very important to guide people towards a healthy lifestyle to contain the spread of non-communicable, chronic and lifestyle diseases due to the increase in lifespan. In addition, there is increased lifespan of women, both in rural and urban areas of the country, and this will require public health interventions for better access to quality healthcare.
Recording all-cause mortality and using that data to drive public health interventions like drug and vaccine procurement, running screening and awareness campaigns, and providing secondary and tertiary care under health insurance schemes can help public health departments across the country to use evidence for priority setting. Time is ripe to roll out reforms that are long overdue and very much required for improving the health of the nation.