Excess deaths in India till May 2021 as per HMIS

If our eminent intellectuals and politicians have taught us anything, it is that one can have opinions on anything.

Introduction

This article is a continuation of the previous article on excess deaths in UP. In this article, I shall be looking at the excess deaths across the country as per National Health Mission's NHM's data. I have taken data from an article on IndiaSpend though my conclusions may be different. Kudos to the journalists who took this data out and more power to them.     

As a caveat, I would be using rounded numbers for ease. 

What is NHM?

As per the HMIS website: National Health Mission (NHM) is a flagship programme of the Government of India to address the health needs of under-served rural areas and health concerns of the urban poor population.

Now coming to HMIS: Health Management Information System (HMIS) is a Government to Government (G2G) web-based Monitoring Information System that has been put in place by Ministry of Health & Family Welfare (MoHFW), Government of India to monitor the National Health Mission and other Health programmes and provide key inputs for policy formulation and appropriate programme interventions.... HMIS was launched in October 2008. Currently, around 2 lakh health facilities (across all States/UTs) are uploading facility wise service delivery data on monthly basis, training data on quarterly basis and infrastructure related data on annual basis on HMIS web portal.

Monthly deaths as per HMIS

The Article on IndiaSpend is based monthly deaths data on HMIS. The article provides a graph on the monthly deaths for 2018, 2019, 2020 and for 5 months upto May 2021. I have pasted the pic of the graph below and one graph on the monthly average deaths and the total deaths in 2018, 2019, 2020 and 2021 (up to May). 

 


    

 



Analysis

HMIS reported around 24 lac deaths in 2018 and 26 lac deaths in 2019. This is equal to 34.6% of deaths registered for both these years. So, this comes to a monthly average 2 lac deaths in 2018, 2.2 lac deaths in 2019 and 2020 and 2.95 lac in 2021 (till May). Simply put, this is enough to show that COVID-19 in 2020 was not as devastating as the second wave and the hidden COVID-19 deaths in India in 2020 was not that huge. The total deaths in 2020 may have been 3 lacs in 2020 instead of the reported 1.5 lacs. But not more than that. 

However, 2021 shows a different story especially April 2021 and May 2021 as one can see the spike in the above graphs. The excess deaths (assuming registration levels in 2019 and 2021 are the same) per month in 2021 is 75k.

Total Excess Deaths 

In 2019, HMIS reported 34.6% of the total deaths registered and the total deaths registered is almost 92% of the total estimated deaths. Assuming the same trend for the excess deaths of 75k excess deaths per month mentioned above, we would reach a figure of 11.8 lac excess deaths for India from January 2021 to May 2021. The total COVID-19 deaths reported for this period is almost 2 lacs (after considering the backlog additions in Maharashtra, Bihar and Uttarakhand). So, the undercounting factor in 2021 is almost 6x from January 2021 onwards.

Assuming, that total COVID deaths in 2020 is 3 lacs (2x of reported figures since there is no data for substantial undercounting), the total COVID-19 deaths till May 2021 could be somewhere in the range of 14.8 lac deaths. This is 4x the reported figure.  

Sensitivity  

The above estimate can be on the higher side considering:
  1. The death registrations in India have been going up constantly for the past 10 years (refer graph below). The deaths registered (as % of total deaths) was around 67% in 2010 which has gone up to 92% in 2019. This shot up from 85% in 2018 and 92% in 2019. 
  2. While India may not have witnessed 100% registrations in 2021, it is reasonable to assume that it could have gone up to 95%.







    


                                                              
In a scenario where the registrations levels went upto 95% in 2021, the total excess deaths for would fall from 14.8 lacs to 13.4 lacs.     

Comparing with IHME data and other countries

I have seen experts comparing the excess deaths in India to the global reported figures. We should be consistent in such an approach and compare the global excess deaths to excess deaths in India.  As per IHME data, the global deaths is around 4 mn and the excess deaths globally as per them is around 8.4 mn. The undercounting factor is 2.1x at a global level. Hence, when we compare the excess deaths in India with the 8.4 mn global deaths and not the 4 mn number.  

On the one hand, we have developed countries like US, Germany, UK etc. the excess deaths are 1.4-1.6x reported COVID deaths. On the other hand, IHME expects countries like India, Indonesia etc. to have excess deaths at 3x of reported figures. At the other extreme, IHME expects Russia to have excess deaths at 5.4x and Egypt at 13x of reported figures.

Also, a recent study in Canada suggests that the actual COVID deaths in Canada could be 2x reported figures. 

It is absolutely necessary for the State governments in India to be transparent as possible and the media and we as citizens have all the right in the world to question them as much as possible. However, it is understandable that a country like India can have excess deaths of 4x the reported figures considering the speed at which the second wave spread and when even highly developed countries like Canada is at 2x. 

Sources: 

https://hmis.nhp.gov.in/#!/aboutus

https://www.indiaspend.com/covid-19/deaths-unknown-causes-national-health-mission-portal-covid-toll-760219

https://www.covid19india.org/

https://covid19.healthdata.org/global?view=cumulative-deaths&tab=trend

https://www.cbc.ca/news/health/canada-covid-19-excess-deaths-1.6084595

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