Beyond Counting Deaths: Why India must Strengthen Civil Registration and Vital Statistics Systems for Equitable Health Governance.

Accurate death registration is one of the most fundamental components of an effective public health system. Mortality data provide critical insights into disease patterns, demographic transitions, healthcare needs, and social inequalities. In India, the civil registration and vital statistics (CRVS) system and the sample registration system (SRS) collectively serve as the primary sources of mortality information. However, despite decades of efforts to improve registration completeness, substantial disparities continue to exist across states and union territories. Analysis of National Family Health Survey-5 (NFHS-5) data demonstrates marked variations in death registration coverage, ranging from universal registration in some regions to less than 40% in others. An unexpected finding is the higher death registration rate in rural areas compared with urban areas at the national level. These disparities reflect deeper differences in governance, administrative efficiency, digital infrastructure, public awareness, accessibility, and socio-cultural practices. Incomplete death registration weakens mortality surveillance, hampers health planning, limits evidence-based policymaking, and obscures the true burden of disease. This viewpoint argues that strengthening death registration should be viewed not merely as an administrative responsibility but as a public health, governance, and social justice priority. A six-pillar framework involving legal reforms, institutional strengthening, digital transformation, community engagement, service integration, and data-driven monitoring is proposed to achieve universal and equitable death registration across India.