What Happened
- Data reveals that only 22% of deaths nationwide have a medically certified cause of death (MCCD), despite the scheme being in operation for decades.
- Delhi leads among states and union territories with a 66% MCCD coverage rate.
- The vast majority of states, particularly in eastern, central, and northeastern India, have MCCD rates far below the national average.
- The low coverage undermines India's ability to accurately track disease patterns, allocate health resources, and formulate evidence-based public health policy.
Static Topic Bridges
Medical Certification of Cause of Death (MCCD) Scheme
The MCCD scheme, implemented under the Registration of Births and Deaths (RBD) Act, 1969, requires attending physicians to certify the cause of death for all institutional deaths using a standardised form (Form 4/4A) based on the WHO International Classification of Diseases (ICD). The scheme is administered by the Office of the Registrar General of India (RGI) and provides critical data for understanding mortality patterns and disease burden.
- MCCD coverage nationally has remained around 22-22.5%, with minimal improvement over the past decade (only 2.5 percentage point increase)
- The scheme only covers institutional deaths (deaths occurring in hospitals and medical facilities)
- 60-70% of deaths in India occur outside medical institutions (at home), and these are excluded from MCCD
- Form 4 requires physicians to record the sequence of causes leading to death, following WHO guidelines
- The Registration of Births and Deaths (Amendment) Act, 2023, strengthened digital registration and data linkage provisions
Connection to this news: The 22% national MCCD rate means India effectively has no reliable cause-of-death data for nearly four out of five deaths, severely constraining epidemiological surveillance and evidence-based health planning.
Civil Registration System (CRS) in India
India's Civil Registration System, established under the RBD Act 1969, is responsible for the compulsory registration of all births and deaths across the country. While overall death registration completeness has improved significantly (reaching 76.6% by 2015, up from about 55% a decade earlier), the gap between death registration and medical certification of cause remains enormous.
- Death registration completeness improved by approximately 40% between 2005 and 2015
- Eastern, central, and northeastern regions have completeness rates below the national average
- The RBD Amendment Act 2023 enables digital registration through a national portal and Aadhaar-linked birth/death certificates
- A 2026 study identified a cluster of 23 states with the lowest average MCCD rate of 18%, attributed to only 0.14 doctors per 1,000 population
- High-performing clusters achieved 60-63% MCCD rates, supported by 0.27-0.33 doctors per 1,000 and over 80% hospital reporting
Connection to this news: The data gap between Delhi (66%) and the national average (22%) mirrors the broader urban-rural and inter-state health infrastructure divide, where doctor density and hospital reporting capacity directly determine MCCD coverage.
Verbal Autopsy and Alternative Mortality Surveillance
Given India's low MCCD coverage, the country relies on alternative systems to estimate cause-specific mortality. The Sample Registration System (SRS) uses verbal autopsy -- structured interviews with family members of the deceased to determine probable cause of death -- to generate nationally representative mortality estimates. The Million Death Study, based on SRS verbal autopsy data, has been the primary source for cause-of-death statistics in India.
- The SRS covers approximately 8 million population across 8,850 sampling units
- Verbal autopsy assigns cause of death through trained interviewers and physician review, but has lower accuracy than medical certification
- The Million Death Study (conducted by the Registrar General of India and Centre for Global Health Research, Toronto) analysed over 1 million deaths
- India's National Family Health Survey (NFHS) also provides mortality-related data but not cause-specific
- WHO recommends all countries achieve 80% MCCD coverage for reliable health planning
Connection to this news: India's reliance on verbal autopsy as a substitute for proper medical certification demonstrates the consequences of the MCCD gap: policy decisions about disease control, resource allocation, and pandemic preparedness are based on estimated rather than directly measured cause-of-death data.
Key Facts & Data
- National MCCD coverage: 22% (only 2.5% improvement over the past decade)
- Delhi MCCD coverage: 66% (highest in India)
- 60-70% of deaths in India occur outside medical institutions
- Death registration completeness: 76.6% nationally (as of 2015)
- 23 states have MCCD rates as low as 18%, with only 0.14 doctors per 1,000 population
- WHO recommends 80% MCCD coverage for reliable health planning
- RBD Amendment Act 2023 strengthens digital registration and data linkage
- High-performing clusters achieve 60-63% MCCD rates with 80%+ hospital reporting