NEW DELHI: While medical certification of deaths reported in Delhi is relatively strong, the situation across the country remains grim – only 22% of deaths registered in India were medically certified in 2023, exposing serious gaps in the country’s ability to track disease trends and plan health policies.The concerns were raised at a two-day national workshop on strengthening mortality information systems held in the capital on February 11. Experts warn that despite years of reform efforts, much of India’s death data remains incomplete.The latest civil registration data shows huge disparities between states and territories. 66% of the registered deaths recorded in Delhi were medically certified, putting it among the better performing regions. Goa (100%), Lakshadweep (99.2%) and Puducherry (91.4%) have near-universal certification, while Chandigarh (76.4%) and Andaman and Nicobar Islands (67.2%) also have high coverage. In contrast, several large states are significantly behind – Maharashtra (42.4%), Tamil Nadu (39.1%), Telangana (38.4%), Karnataka (26.7%), Odisha (23.4%) and Gujarat (23.3%) – pushing the national average down to 22%.Dr Harshal Ramesh Salve of AIIMS told TOI that only one in five deaths across the country received proper medical certificate of death. A large proportion of deaths – especially in rural areas – occur outside health facilities, which often lack formal accreditation.Dr VK Paul, Member, NITI Aayog, inaugurating the workshop emphasized that a robust and interoperable mortality system is crucial for evidence-based governance. Health planning must be driven by reliable, real-time data, he said, stressing the need for coordinated action across sectors to ensure every death is counted and its cause is scientifically determined.Experts say counting every death and accurately recording its cause is critical to estimating disease burden, identifying risk factors and designing prevention strategies. Without reliable cause-of-death data, health programs risk relying on predictions rather than evidence. Greater data sharing between ORGI, health ministry and academic institutions will help in developing science-driven decentralized policies and increase India’s self-reliance in disease estimation, they added.Over the past decade, AIIMS and the Office of the Registrar General of India have stepped up surveillance through verbal autopsies and digital systems. More than 1 million cases have been reviewed and more than 400,000 deaths have had a possible cause identified, involving approximately 1,000 trained physicians at 27 institutions. However, most of these support sample-based monitoring rather than universal coverage. The number of deaths reported annually is close to 10 million, and comprehensive certification is still ongoing.A verbal autopsy is mainly used when a person dies outside a hospital. It involves interviewing family members about symptoms and circumstances leading up to the death, and then trained doctors assigning the most likely cause using a standard medical classification system. Experts say that while this improves national estimates, expanding routine medical certification of deaths in hospitals and communities remains vital.The workshop concluded with the formation of the National Alliance for Strengthening Mortality Data Systems to improve data quality, expand certification, and accelerate digital integration nationwide.Public health experts say that while Delhi’s 66% certification rate reflects progress, the national disparity highlights the urgency of ensuring the system records every death and its cause.