Comment
Public health priorities for India
Indian states are in different phases of epidemiological
transition, resulting in large variations in disease burden
across the states.1 However, the public health priorities
across the country remain similar. Addressing the
availability of relevant and robust data for meaningful
planning of programmes and policies is a gap that needs
urgent consideration to improve population health and
the continuum of care.2
People in India are living longer than ever before,
but what they die of is still an extrapolation based on
verbal autopsies in a sample of deaths and is not based
on medically certified cause of death.3,4 Only 21% of
all registered deaths in India had a medically certified
cause of death available in 2019.4 This inadequacy
in the availability of medical certification of cause of
death has fundamental implications for the country’s
health system and policy efforts to improve health of
the population that lives in India. Addressing this gap in
data is among the most urgent public health priority for
the country.
India generates a substantial amount of data on
various aspects of health under the many national and
state health programmes. However, these data remain
fragmented, inadequate, non-standardised, and tedious
to collate and interpret. Improving the data quality
and integration of data is another major priority. In
recent years, substantial effort has gone into the use
of technology to improve data availability, but data
quality is yet to receive similar attention.2 Much of the
data in the health management information system
(HMIS) is generated on maternal and child health, and
yet neonatal mortality—a key indicator—is still not
readily available.5 Immediate attention is also needed
within the HMIS to track and improve data on health
services for conditions beyond maternal and child
health for India to address the increasing burden of
non-communicable conditions and injuries, which can
also facilitate priority-setting for public health resource
allocation to improve population health.
The factors that influence health outcomes extend well
beyond the authority remits of the health ministry. The
continuing burden of malnutrition in India highlights
the need for coordinated and intersectoral action
between the relevant ministries to address this complex
and persistent health challenge.6 Another example is
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the neglect of injuries, despite their substantial burden. For more on the burden of
injuries in India see
Injuries are reported as accident (unintentional injuries) https://vizhub.healthdata.org/
and crime (intentional injuries) on the basis of data from gbd-compare/india
police records by the National Crime Records Bureau,
under the Ministry of Home Affairs, which are fraught
with under-reporting and inadequate reporting of risk
factors and do not provide individual-level data that are
needed for strategising injury prevention to save lives
and to prevent disability.7 Therefore, an urgent public
health need is to co-create key priorities between the
key sectors and ministries for successful intersectoral
initiatives by sharing the accountability for the right to
health across the government as a whole, to achieve the
2030 Sustainable Development Goals.8
To track COVID-19 infections and vaccination, India
responded by linking the COVID-19-related health
services for individuals with a unique identification
number, thereby documenting that it is possible
to link records at such a large scale. The Ayushman
Bharat Digital Mission which aims to integrate health
infrastructure for the country, has developed a system
to generate a unique health identification number for
each person across the variety of health-care providers;
however, the use of this number is currently optional.9
As a priority, the availability of the unique health
identification number should be made mandatory
to ensure that each individual is unique in the health
system, and has health records available seamlessly over
the life course for continuity of care.2
The critical gaps in data availability and quality cannot
be ignored for India to effectively address and measure
progress towards improving population health, which
would require an integrated government response and
multi-sectoral action. How the second most populous
country addresses these public health priorities will have
implications for the global health agenda.
I declare no competing interests.
Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open
Access article under the CC BY-NC-ND 4.0 license.
Rakhi Dandona
rakhi.dandona@phfi.org
Public Health Foundation of India, Gurugram 122002, India; Institute for Health
Metrics and Evaluation, University of Washington, Seattle, WA, USA
1 India State-Level Disease Burden Initiative Collaborators. Nations within a
nation: variations in epidemiological transition across the states of India,
1990–2016 in the Global Burden of Disease Study. Lancet 2017;
390: 2437–60.
 Comment
2 Niti Aayog, Government of India. Health system for a new India: building
blocks. 2019. https://www.niti.gov.in/sites/default/files/2019-11/
NitiAayogBook_compressed_1.pdf (accessed Jan 5, 2021).
3 Office of the Registrar General of India, Government of India. Sample
Registration System. 2020. https://censusindia.gov.in/Vital_Statistics/SRS/
Sample_Registration_System.aspx (accessed Dec 1, 2021).
4 Office of the Registrar General of India, Government of India. Report on
medical certification of cause of death 2019. New Delhi: Government of
India, 2021.
5 Ministry of Health and Family Welfare, Government of India. HMIS:
Standard reports. 2021. https://hmis.nhp.gov.in/#!/standardReports
(accessed Dec 1, 2021).
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6 Swaminathan S, Hemalatha R, Pandey A, et al. The burden of child and
maternal malnutrition and trends in its indicators in the states of India:
the Global Burden of Disease Study 1990–2017. Lancet Child Adolesc Health
2019; 3: 855–70.
7 Dandona R, Bertozzi-Villa A, Kumar GA, Dandona L. Lessons from a decade
of suicide surveillance in India: who, why and how? Int J Epidemiol 2017;
46: 983–93.
8 WHO. Advancing the right to health: the vital role of law. Geneva: World
Health Organisation, 2017.
9 National Health Authority, Ministry of Health and Family Welfare,
Government of India. 2021. Ayushman Bharat Digital Mission.
https://abdm.gov.in/home/digital_systems (accessed Dec 2, 2021).