Article

Mapping Healthcare Data Sources in India Journal of Health Management

24(1) 146­–159, 2022
© 2022 Indian Institute of
Health Management Research
https://doi.org/10.1177/09720634221077322
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DOI: 10.1177/09720634221077322
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Amit Mishra1, Tushar Mokashi2, Arun Nair2 and Maulik Chokshi2

Abstract
Healthcare data sources collect and report various kinds of health data related to routine service delivery, patient-based
care, resources related to infrastructure, human resources and finance. Typically, in developing countries, multiple sources
are used for the provision of healthcare data, and these include national health surveys, census and civil registration systems,
and routine reporting systems. In addition, rapid infusion of information technology has increased adoption of management
information systems in public health programs. During the last decade, India has witnessed a sharp rise in the number of
healthcare data sources as identified in this review. These sources have increased data availability in multiple data deficient
areas. However, the careful appraisal indicates data gaps in numerous important areas. These sources also suffer from inherent
quality, coverage and standardisation issues. To overcome these challenges, remedial measures include the development of
a national healthcare data plan, a survey calendar, designation of a nodal survey agency, adoption of indicator dictionary,
adequate capacity building, and increased coordination among stakeholders.

Keywords
Healthcare data sources, routine reporting systems, management information systems, national health surveys, health data

Introduction meet the growing demand of health information from multiple

stakeholders such as healthcare workers, programme managers,
Good health information is critical for managing the population’s policymakers and researchers (Walsham, 2020). This ever-
health and preparing a health system response to address expanding demand–supply gap has its roots in the evolutionary
emerging disease challenges (Carla & Boerma, 2005). The need nature of health service delivery, coupled with rapid infusion of
for reliable health information is especially critical in the case of information technology (IT) in healthcare (Bloom et al., 2017;
healthcare emergencies where a rapid response from the health Kimaro et al., 2008). Countries have long relied on population-
system can save thousands of lives and prevent further spread of based health surveys to meet healthcare data needs. However,
a disease (World Health Organization [WHO], 2017). First- the quest to adopt IT in national health systems led to the
hand information about health service utilisation and disease implementation of multiple digital solutions such as mobile-
events in a population is recorded at healthcare facilities, which based reporting systems and patient tracking systems
after processing and aggregation through the health information (WHO, 2020).
system (HIS) becomes a useful source for health services India has also seen growth in the number of healthcare data
planning, disease surveillance and care quality measurement sources in the recent past, primarily due to the launch of new
(Boerma, 2013). However, management of health of the surveys by the Government of India (GoI) to bridge data gaps in
population requires data beyond what is recorded at healthcare areas such as mental health and nutrition, and also by the
facilities. It includes information about population demography, adoption of management information systems (MIS) for
socio-economic status, access and utilisation of healthcare improved management of public health functions such as drugs
services, the status of disease prevalence and causes of death in supply and logistics management. These sources have enabled
the community (Gable, 1990). Data on these parameters is
provisioned through various sources such as population-based
health surveys, census and HIS. 1 Ministry of Public Health, Qatar
Globally, countries have made concentrated efforts to ensure 2 ACCESS Health International, New Delhi, India
the supply of reliable statistics for planning and managing Corresponding author:
health services (WHO, 2013). However, many developing Amit Mishra, B-80, Z-33, Street-940, Doha, Qatar.
countries with low investment in healthcare have struggled to E-mail: [email protected]
Mishra et al. 147

the availability and accessibility of information in newer areas. Survey – NFHS), HIS, programme management systems
However, these have also led to the multiplicity and duplication (training MIS) and studies and publications of the Ministry of
of data, making it difficult for programme managers to identify Health and Family Welfare (MoHFW). The review also focused
the most suitable data source for making management decisions. on documenting the type of information available in each of
Healthcare data sources also suffer from inherent challenges of these data sources and the associated issues and challenges.
inconsistency in data collection, lack of standardisation, poor Keeping these objectives in mind, a comprehensive review
quality and incomplete coverage (Mishra et al., 2012). of the various publications of national health programmes,
Careful review of healthcare data sources is necessary and websites of MoHFW, National Health System Resource
the first step in this regard is the identification and listing of Centre (NHSRC) and other partner agencies was conducted.
major healthcare sources in India. With this intention, a In addition, reports of Common Review Mission of National
narrative review has been conducted of the major national Health Mission (NHM) were also examined to identify health
healthcare data sources between June–August 2021. This data sources listed under national and state programmes.
article lists available national healthcare data sources and Internet search was conducted to identify Indian equivalent
indicates major challenges associated with these. This review surveys of those recommended by WHO and UNICEF. The
does not include state-level healthcare data sources. exercise yielded a list of 69 healthcare data sources in India
(Table 1). To understand the type of data available and to
document issues and challenges, a thorough review of each
data source was conducted, including detailed review of the
Objectives and Methodology
latest survey reports in case of a survey and review of the
This review was conducted to document all current national website, user manual, and reporting formats in case of a HIS.
healthcare data sources in India, including indirect sources Quick telephonic interviews were conducted with key
(census), national health surveys (National Family Health programme officers to bridge any knowledge gaps.

Table 1. List of Healthcare Data Sources in India.

S. Latest Round/
No. System Objective Organisation Report/Status References
A. Indirect sources of health data
1. Census Provides population statistics, Office of Regis- 2011 https://censusindia.gov.in/2011-
demographics, social and eco- trar General of prov-results/prov_results_paper1_
nomic characteristics, housing and India (ORGI) india.html
household details.
2. Civil Registra- Registration of births, deaths, and ORGI 2019 https://censusindia.gov.in/2011-
tion System still births and publication of an- Common/Annual_Report.html
(CRVS) nual statistics.
3. Sample Regis- Panel household survey to pro- ORGI 2021 https://censusindia.gov.in/vital_sta-
tration System vide reliable estimates of births tistics/SRS_Bulletins/Bulletins.html
(SRS) and death in the country.
4. Medical Cer- Provides cause-specific mortal- ORGI 2019 https://censusindia.gov.in/2011-
tification of ity statistics from all states in Documents/mccd_Report1/
Cause of Death country. MCCD_Report-2018.pdf
(MCCD)
B. Population-based health surveys (PHS)
5. National Family Large-scale, multi-round national International 2019–2021 http://rchiips.org/nfhs/
Health Survey survey conducted in a representa- Institute for
(NFHS) tive sample of households. Population Sci-
ences (IIPS)
6. District Level Household survey conducted IIPS 2014 http://rchiips.org/
Health Survey at the district level to provide
(DLHS) district MCH estimates.
7. Annual Health Panel household survey designed ORGI 2013 https://censusindia.gov.in/2011-
Survey (AHS) to collect district-level details Common/AHSurvey.html
annually.
(Table 1 continued)
148 Journal of Health Management 24(1)

(Table 1 continued)

S. Latest Round/
No. System Objective Organisation Report/Status References
8. Rapid Survey Focuses on the wellbeing of UNICEF, 2013–2014 https://wcd.nic.in/sites/default/files/
on Children children below 6 years and their MoWCD RSOC%20National%20Report%20
(RSOC) mothers covering aspects of 2013-14%20Final.pdf
child development, maternal care,
school/college attendance among
persons aged 5–24 years.
9. Integrated Child Evaluates the impact of Mission MoHFW 2015 https://cddep.org/wp-content/
Health and Im- Indradhanush in improving full uploads/2021/04/INCHIS-1_2_Re-
munisation Sur- immunisation coverage among port_ITSU-1.pdf
vey (INCHIS) children.
10. Coverage Evalu- District-level survey in 190 dis- MoHFW, UNICEF, 2018 https://nhm.gov.in/New_Up-
ation Survey tricts to assess the impact of the WHO dates_2018/NHM_Components/
(CovES) 2018 Intensified Mission Indradhanush Immunization/Guildelines_for_im-
strategy. munization/IMI_CES_Survey_Re-
port.pdf
11. Coverage Evalu- Provides information on coverage UNICEF 2009 http://ghdx.healthdata.org/record/
ation Survey of routine immunisation along india-coverage-evaluation-sur-
(CES) 2009 with maternal care services and vey-2009-2010
child feeding practices.
12. Multiple Indica- Provides information on vital UNICEF 2000 https://catalog.ihsn.org/index.php/
tor Cluster health, nutrition, education and catalog/835
Survey (MICS) water and sanitation among chil-
dren and women.
13. Comprehensive Presents data on nutritional sta- UNICEF, MoHFW 2018 https://nhm.gov.in/index1.php?lang=
National Nutri- tus of pre-schoolers (0–4 years), 1&level=2&sublinkid=1332&lid=713
tion Survey school-age children (5–9 years)
(CNNS) and adolescents (10–19 years).
14. National Mental Representative study to assess National Institute 2015–2016 http://indianmhs.nimhans.ac.in/
Health Survey the mental health situation. of Mental Health index.php
(NMHS) and Neurosci-
ences
15. National Sample Provides estimates for morbidity, MoSPI 2017–2018 http://www.mospi.gov.in/unit-level-
Survey (NSS) reasons for hospitalisation, ex- data-report-nss-75th-round-july-
75th Round penditure on care and developing 2017-june-2018-schedule-250so-
elderly profile. cial-consumption-health
16. Global Adult Enhances country capacity to IIPS, Tata Institute 2016–2017 https://tiss.edu/view/6/mumbai-
Tobacco Survey design, implement and evaluate of Social Sciences campus/school-of-health-
(GATS) national tobacco action plan. systems-studies/global-adult-
tobacco-survey-2-india-2016-17/
outcomespublications-3/
17. Global Youth Provides data on prevalence of IIPS 2019 https://www.iipsindia.ac.in/content/
Tobacco Survey cigarette and other tobacco use global-youth-tobacco-survey-gyts-4
(GYTS) as well as information on deter-
minants of tobacco use.
18. Global School School-based cross-sectional sur- MoHFW, WHO, 2009 http://journal.waocp.org/
Personnel Sur- vey among grades associated with CDC Atlanta article_26186_c447bc389d-
vey (GSPS) students aged 13–15 years to 28970d0c490218a43cd1b7.pdf
know prevalence of tobacco use
and level of awareness regarding
harmful effects of tobacco.
(Table 1 continued)
Mishra et al. 149

(Table 1 continued)

S. Latest Round/
No. System Objective Organisation Report/Status References
19. Global Health Tracks tobacco use among Respective pro- 2005 https://www.indianjcancer.com/
Professions third-year dental, medical, nursing fessional councils article.asp?issn=0019-509X;year=2
Students Survey and pharmacy students across 010;volume=47;issue=5;spage=30;e
(GHPS) countries. page=34;aulast=Sinha
20. Longitudinal Large-scale, nationally representa- IIPS, Harvard 2020 https://www.researchgate.
Aging Study in tive, longitudinal survey on aging, School of Public net/profile/Jinkook_Lee2/
India (LASI) health, and retirement. Health publication/254416481_Lon-
gitudinal_Aging_Study_in_In-
dia_Vision_Design_Implementa-
tion_and_Some_Early_Results/
links/0f3175346155a1b9c9000000.
pdf
21. WHO STEPS Conducted twice for chronic ICMR, WHO 2007 https://www.who.int/ncds/surveil-
survey disease risk factor surveillance in lance/steps/india/en/
2004 in four centres and in 2007
in seven states.
22. National Nutri- NNMB conducted three surveys ICMR 1997 https://www.inteqsolutions.com/
tion Monitoring to collect and generate good- ninindia.org/nnmb/Home.html
Bureau quality data on diet and nutri-
(NNMB) tional status of the communities
in the urban, rural and tribal areas.
C. Studies and publications
23. National Health NHP provides information for ef- Central Bureau 2020 https://www.cbhidghs.nic.in/index1.
Profile (NHP) fective planning, decision-making, of Health Intel- php?lang=1&level=1&sublinkid=75
monitoring and evaluation of vari- ligence (CBHI) &lid=1135
ous health programmes & health
sector development activities.
24. Rural Health RHS provides details about avail- MoHFW 2019–2020 https://main.mohfw.gov.in/sites/
Statistics (RHS) ability of human resources and default/files/Final%20RHS%202018-
health facilities in rural areas. 19_0.pdf
25. National Health Describes health expenditures National Health 2016–2017 http://nhsrcindia.org/category-de-
Accounts and the flow of funds in both Systems Resource tail/national-health-accounts/ODU=
(NHA) public and private sector in the Centre
country for a given time period.
26. Study on Provides information on health IIPS, WHO 2007 www.who.int/healthinfo/systems/
global AGE- and well-being of adult popula- surveydata/index.php/catalog/65/
ing and adult tions as part of a global survey in download/2011
health(SAGE) India, China, Ghana, Mexico, Rus-
sian Federation and South Africa.
27. Million Death Premature mortality study con- Centre for Global 2014 http://www.cghr.org/projects/
Study (MDS) ducted using verbal autopsy to Health Research, million-death-study-project/
determine disease patterns. ORGI
28. Accidental Provides data on accidental National Crime 2020 https://ncrb.gov.in/en/accidental-
Deaths & deaths and suicides. Records Bureau deaths-suicides-india-adsi
Suicides in India
(ADSI)
D. Healthcare registries and databases
29. National Listing and allocation of unique MoHFW Ongoing http://nin.nhp.gov.in/
Identification identification to public health
Number to facilities.
Health Facilities
(NIN Portal)
(Table 1 continued)
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(Table 1 continued)

S. Latest Round/
No. System Objective Organisation Report/Status References
30. Registry of Listing and allocation of unique Insurance Regula- Ongoing https://rohini.iib.gov.in/
Hospital in identification to private hospitals tory and Devel-
Network of empanelled for insurance reim- opment Authority
Insurance bursement with IRDA.
(ROHINI)
31. National Health Repository of health facilities and CBHI Ongoing https://bhuvan-nhrr.nrsc.gov.in/nhrr/
Resource providers in the country.
Repository
(NHRR)
32. Clinical Online registration system of MoHFW Ongoing http://www.clinicalestablishments.
Establishment health facilities as per CERR Act, gov.in/cms/national_register_of_
Registration & 2010. clinical_establishments.aspx
Regulation Sys-
tem (CERRS)
33. National Organ Registry of organ donors Directorate Ongoing http://notto.nic.in
& Tissue Trans- General of Health
plant Organisa- Services (DGHS)
tion (NOTTO)
34. National Injury Registry of trauma—accident, DGHS Ongoing http://www.nisc.gov.in/mapDGHS.
Surveillance burn injuries aspx
Trauma Registry
& Capacity
Building Centre
(NISTR)
35. National Can- Registration of cancer patients ICMR Ongoing https://www.ncdirindia.org/cancers-
cer Registry to build database of cancer cases amiksha/
Programme and effectively estimate preva-
lence and incidence of cancer.
36. Indian Medical Registry of MBBS graduates National Medical Ongoing https://www.nmc.org.in/informa-
Registry (IMR) maintained by National Medical Commission tion-desk/indian-medical-register
Commission.
37. National Portal Registry of Ayurveda, Unani & Central Council Ongoing https://www.ccimindia.org/index.
of Ayurveda, Siddha Doctors maintained by of Indian Medi- php
Siddha & Unani Central Council of Indian Medi- cine
Practitioners cine.
(NPASUP)
38. Nurses Reg- Registry of nurses managed by Indian Nursing Ongoing https://nrts.indiannursingcouncil.
istration & Indian Nursing Council. Council gov.in/login.nic
Tracking System
(NRTS)
39. Central Regis- Registry of homeopathy doctors Central Council Ongoing https://cchindia.com/home
ter of Home- managed by Central Council of of Homeopathy  
opathy (CRH) Homeopathy.
40. Health Facility Comprehensive repository of National Health Under devel- https://facility.ndhm.gov.in/
Registry (HFR) health facilities across different Authority (NHA) opment
systems of medicine.
41. Healthcare Comprehensive repository of all NHA Under devel- https://hpr.ndhm.gov.in/en
Professionals healthcare professionals involved opment
Registry (HPR) in delivery of healthcare services
across modern and traditional
systems of medicine.
(Table 1 continued)
Mishra et al. 151

(Table 1 continued)

S. Latest Round/
No. System Objective Organisation Report/Status References
42. Health ID Patient registry which would help NHA Under devel- https://healthid.ndhm.gov.in/
in unique identification of patient opment
and bundling of their health
records.
E. Routine reporting system (RRSs)
43. Health Manage- Routine reporting of service MoHFW Ongoing https://hmis.nhp.gov.in/
ment Informa- delivery data under NHM.
tion System
(HMIS)
44. Reproductive Tracks eligible couple, mother MoHFW Ongoing https://rch.nhm.gov.in/
and Child Portal and children to ensure necessary
(RCH Portal) service delivery.
45. Integrated Reporting of CDs for surveillance National Center Ongoing https://idsp.nhp.gov.in/idsp/
Disease Surveil- and outbreak reporting. for Disease
lance Project Control
(IDSP)
46. Nikshay—TB TB case tracking and reporting MoHFW Ongoing https://nikshay.in/
Management system.
Information
System
47. National Anti- Reporting of Malaria cases and National Vector Ongoing https://idsp.nhp.gov.in/malaria/
Malaria Manage- action taken from facilities. Borne Disease
ment Informa- Control Program
tion System
(NAMMIS)
48. Strategic Infor- Integrated web-based reporting, NACO Ongoing https://sims.naco.gov.in/simshome/
mation Manage- data management and decision
ment System support system with monthly
(SIMS) reporting for AIDS control.
49. AYUSH Hospi- System for appointment schedul- Central Council Ongoing https://ehr.ayush.gov.in/
tal Management ing and reporting outpatient- for Research in ayush/#&panel1-1
Information related information from the Siddha, Ministry
System (A- AYUSH facilities. of AYUSH
HMIS)
50. Rapid Report- Reports monthly and annual per- MoWCD Ongoing https://icds-wcd.nic.in/
ing System on formance data from Anganwadi
ICDS Scheme centres.
F. Programme Management Information Systems (PMIS)
51. Nursing Scheme Monitors the effective imple- MoHFW Ongoing http://nadrsgis1.nic.in/scheme/
Monitoring Sys- mentation of the schemes and
tem (NSMS) expedites the processes.
52. Pharmacovigi- Monitors adverse drug reactions Central Drugs Ongoing http://www.ipc.gov.in/
lance Pro- in the population. Standard Control
gramme (PvPI) Organisation
53. National AMR collects data from the All India Institute Ongoing https://www.haisindia.com/
Programme on selected hospitals about anti- of Medical Sci-
Containment microbial resistance. ences
of Anti-Micro-
bial Resistance
(AMR)

(Table 1 continued)
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(Table 1 continued)

S. Latest Round/
No. System Objective Organisation Report/Status References
54. eRakt Kosh Centralised blood bank manage- MoHFW Ongoing https://www.eraktkosh.in/
ment system for reporting of
blood stock from all public and
private licensed blood banks.
55. Mera Aspataal Patient feedback system on MoHFW Ongoing https://meraaspataal.nhp.gov.in/
(Patient Feed- quality of services rendered by a
back System) healthcare facility.
56. National Online portal for documenting NHSRC Ongoing www.nhinp.org
Healthcare innovations taken up by states,
Innovations NGOs and other private sector
Portal (NHInP) organisations.
57. Clinical Trials Launched in 2007 CTRI is an on- National Institute Ongoing www.ctri.nic.in
Registry of India line system for registration of all of Medical Sta-
(CTRI) clinical studies being conducted. tistics
58. eHospital Hospital management system Respective state Ongoing https://ehospital.gov.in/ehospitalsso/
implemented 423 hospitals in 25 health depart-
states to facilitate documentation ments and NIC
of patient care activities.
59. Drug Inven- Management and reporting of Centre for Ongoing https://www.cdac.in/index.
tory System drug stock supplies in the state. Development of aspx?id=hi_dms_noida_130318_au-
(eAushadhi) Advanced shadhi
Computing
60. Online registra- Appointment scheduling system National Ongoing https://ors.gov.in/index.html
tion System to book appointments in 405 hos- Informatics
(ORS) pitals across states. Centre
61. Electronic Vac- Strengthens the vaccine supply MoHFW, UNDP, Ongoing https://www.nhp.gov.in/electronic-
cine Intelligence chain by digitising information GAVI vaccine-intelligence-network(evin)_
Network on vaccine stocks and storage pg
(eVIN) temperatures.
62. Intensified Mis- Manages the campaign and data MoHFW Ongoing https://imi3.nhp.gov.in/
sion Indradha- reporting and analysis.
nush 3.0
63. Ayushman Reporting of activities, infrastruc- MoHFW Ongoing https://ab-hwc.nhp.gov.in/home/
Bharat—Health ture and supplies from HWCs. aboutus
& Wellness
Centre MIS
64. Ayushman State-wise system for docu- NHA Ongoing https://tms.pmjay.gov.in/
Bharat—Trans- mentation of patient healthcare
action Manage- claims by hospitals and tracking
ment System reimbursement.
65. National System for registration of health DGHS Ongoing https://npcbvi.gov.in/
Programme facilities and patients for receiving
on Control incentives for eye surgeries.
of Blindness
(NPCB)
66. Training Man- Web-based application to docu- MoHFW Ongoing http://tmis-mohfw.gov.in/
agement Infor- ment training status of health ser-
mation System vice providers.
(TMIS)

(Table 1 continued)
Mishra et al. 153

(Table 1 continued)

S. Latest Round/
No. System Objective Organisation Report/Status References
67. Central Records services given to central MoHFW Ongoing http://www.cghs.nic.in/
Government government employees and
Health Scheme pensioners enrolled under the
(CGHS) scheme.
68. Maternal Death Line listing of maternal death to MoHFW Ongoing https://www.nhm.gov.in/images/pdf/
Surveillance & ascertain possible causes of death. programmes/maternal-health/guide-
Response Soft- lines/Guideline_for_MDSR.pdf
ware (MDSR)
69. Pradhan Mantri Tracking and monitoring of high- MoHFW Ongoing https://pmsma.nhp.gov.in/
Surakshit Ma- risk pregnancies; registration of
tritva Abhiyan volunteer doctors to provide
(PMSMA) services from public facilities.

Current Healthcare Data Sources recording of details of individuals and health facilities.
In addition to uniquely identifying providers, patients
India currently has multiple healthcare data sources, and these and health facilities, these generate excellent statistics
range from HIS used for routine reporting of data from health for the computation of multiple indicators such as
facilities to periodic publication of population-based national doctor–patient ratio. MoHFW has initiated various
health surveys. Digital solutions, used as programme programmes to build registries for patients (e.g., health
management tools, also produce a large amount of data ID under National Digital Health Mission – NDHM),
necessary for management of programmes. In addition, state health facilities (e.g., National Identification Number)
governments have also implemented large-scale HIS to manage and providers (e.g., Indian Medical Registry for
the public health system and ensure supply of health statistics. doctors). In addition, there are specific purpose
Based on the data collection process and purpose of the registries developed to address important issues, such
system, these sources can be classified into six categories. as the National Organ & Tissue Transplant
Organisation (NOTTO) registry, which is used for the
1. Indirect sources of health data such as census, birth and
registration of organ donors in India.
death registration and cause of death reporting: Their
6. Programme management information systems (PMIS)
primary purpose is to supply population statistics,
used by various national health programmes (e.g.,
which facilitates computation of population-based
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana-
health indicators such as infant mortality rate.
AB-PMJAY), schemes (e.g., Central Government
2. Population-based health surveys originally started to
Health Scheme) and specific activities (e.g., Patient
build healthcare and demographic database in the
Feedback Collection). These systems have grown
country: These periodic surveys such as NFHS provide
more relevant recently due to their association with
data on a range of demographic and socio-economic
the newly launched priority public sector programmes.
indicators and health status of the population.
3. Studies and publications by MoHFW including Rural This list of healthcare data sources in India may become
Health Statistics, and National Health Accounts redundant over time, as new systems and surveys are being
(NHA), which provide data on health infrastructure introduced at regular intervals. The next section discusses
and health expenditure, respectively. the availability and coverage of information in each of
4. HIS designed for reporting of services delivery these sources.
information from health facilities on a fixed frequency:
They are known as routine reporting systems (RRSs)
and are the primary data sources to assess the Availability and Coverage of Information
functioning of public health systems in India and
provide disaggregated sub-district data on the status of Indirect Healthcare Data Sources
health service delivery, outpatient and inpatient care,
emergency services, disease incidences and deaths. The Census of India provides statistics on the population’s
5. Healthcare registries and databases: These are demographic, social and economic characteristics, and
contemporary electronic registers used for longitudinal housing and household characteristics every 10 years since
154 Journal of Health Management 24(1)

1881. The data is available up to village level. Analysed Scheme (ICDS) related infrastructure and extent of utilisation
reports from census data are also published routinely of its services in all states (MoWCD, 2014).
(Chandramouli & General, 2011). Civil Registration System MoHFW launched Mission Indradhanush (MI) in 2014 in
(CRS) annually publishes birth, death and still-birth data in select districts to improve the full immunisation coverage up
India (Kumar et al., 2019). Medical Certification of Cause of to 90% by reaching out to partially immunised and
Death (MCCD) notifies causes of death from selected unimmunised children and pregnant women. Based on the
hospitals in urban areas on ICD-10 codes (Patel et al., 2011). initial success, the mission was further extended thrice as
Sample Registration System (SRS) is a panel household Intensified Mission Indradhanush (IMI) between 2017 and
survey meant to provide reliable estimates of births and death 2021 (Gurnani et al., 2018). To assess the impact of these
across states in the country. It also provides estimates of missions, two consecutive surveys were conducted. Integrated
infant and child mortality and fertility at different levels Child Health and Immunisation Survey in 164 districts in
according to the size of the state (Mahapatra, 2010). 2015 and Coverage Evaluation Survey (CovES) in 2018 in
191 districts (Summan et al., 2021). These surveys were
conducted to assess the immunisation coverage and measure
Population-Based Health Surveys (PHS) quality of immunisation services. A previous round of CovES
in 2009 by UNICEF provided information on routine
India has rich experience of implementing reproductive health immunisation coverage and information about maternal care
(RH) and maternal and child health (MCH) surveys since services and child feeding practices (UNICEF, 2009). Only
1992 when the first round of NFHS was conducted (Kanitkar, one round of Multiple Indicator Cluster Survey was conducted
1999). Till date, five rounds of NFHS have been conducted in 2000 with the help of UNICEF. The survey provided
with the latest being NFHS-5, undertaken in 2019–2021. information on vital health, nutrition, education and water
NFHS provides data on RH, MCH, infant, child and maternal and sanitation among children and women.
mortality, malnutrition among children, the prevalence of The first Comprehensive National Nutrition Survey (CNNS)
certain diseases such as anaemia, tuberculosis (TB), asthma, among children and adolescents (0–19 years) across India was
diabetes, heart disease, cancer, HIV infection, the prevalence conducted in 2018. The CNNS provides national and state
of non-communicable disease (NCD) risk factors such as estimates for feeding practices, anthropometric measurements,
tobacco and alcohol consumption, blood pressure and blood micronutrient deficiencies and NCD risk factor prevalence
glucose levels in adults, and social issues such as women among school-age children and adolescents. The survey,
empowerment and domestic violence. First three rounds of however, did not cover the adult population (UNICEF, 2019).
NFHS reports had information up to state-level only. However, Similarly, the first ever round of National Mental Health Survey
rounds four and five went one step further to provide (NMHS) was conducted in 2015 in a nationally representative
disaggregated data up to district-level, making it one of the population in 12 states of India among adults. The survey
most robust healthcare data sources in the country. provides data on the prevalence of mental morbidities including
Prior to NFHS-4, District Level Household Survey mental and behavioural problems due to psychoactive substance
(DLHS) provided district-level estimates for all states on RH use, schizophrenia and other psychotic disorders, mood
and MCH and had four rounds conducted between 1998 and disorders, neurotic- and stress-related disorders, stigma around
2014 (International Institute of Population Science [IIPS], mental health and the barriers to mental health care delivery.
2013). However, it was later discontinued in favour of NFHS The survey also reviewed mental health infrastructure using
to provide district-level information at shorter intervals of secondary data sources (Murthy, 2017).
three years (Kaul, 2019). Similarly, the Annual Health Survey The National Sample Survey Office (NSSO) under the
(AHS) was a special purpose survey conducted consecutively Ministry of Statistics and Programme Implementation (MoSPI)
for three rounds in the same households between 2010 and conducts large-scale survey of diverse socio-economic subjects
2013 to provide information on RH and MCH indicators, in India. Till date, 76 rounds of National Sample Survey (NSS)
death rates, infant, child and maternal mortality rates, have been conducted in India and, of these, five rounds were
childhood morbidity and disability. The AHS was conducted full-fledged health surveys conducted in 1973–1974 (28th
in only 284 districts of nine states with weak MCH indicators round), 1995–1996 (52nd round), 2004 (60th round), 2014
and was later discontinued (Krishnan, 2013). The Rapid (71st round) and 2017–2018 (75th round). The 75th round of
Survey on Children was commissioned by Ministry of NSS provides state- and national-level estimates related to
Women and Child Development (MoWCD) in 2013–2014 to morbidity, reasons for hospitalisation, expenditure on care at
assess the well-being of children below 6 years and their public and private facilities and on MCH. It also provides
mothers on selected indicators across all states. The survey information about aged persons’ distribution, living
was conducted only once and gave information about child arrangements and physical mobility (GoI, 2019).
development, maternal care, early childhood care, pre-school The Global Tobacco Surveillance System (GTSS) adopted
education and status of Integrated Child Development by WHO in 1988 intends to generate better evidence related
Mishra et al. 155

to tobacco use among youths (13–15 years) and adults (15 type of services utilised (Bahuguna et al., 2018). The estimates
years and older). The GTSS proposed four surveys—Global are available at the national level; however, states have limited
Adult Tobacco Survey (GATS), Global Youth Tobacco uptake to produce state health accounts.
Survey (GYTS), Global School Personnel Survey (GSPS) In addition to LASI, India was one of the survey sites for
and Global Health Professions Students Survey (GHPSS) SAGE (Study on global AGEing and adult health), conducted
(Warren et al., 2009). However, GSPS and GHPSS surveys by WHO in six Indian states. The SAGE Wave-1 Report
were later discontinued by WHO. India conducted four (2007) provided information on employment, income and
rounds of GYTS (2003, 2006, 2009 and 2019), two rounds of expenditure, health behaviour, chronic conditions, treatments,
GSPS (2006, 2009), one round of GHPSS (2005) as part of a healthcare utilisation and quality of life among aged
global survey and two rounds of GATS (2009–2010 and populations (He et al., 2012).
2016–2017). GATS provides national and state information The Million Death Study (MDS), conducted in
about prevalence of tobacco use (smoking and smokeless) collaboration with the Registrar General of India between
among adults, exposure to second-hand smoke, cessation 1998 and 2014, covered 2.4 million households across the
efforts, expenditure on tobacco and awareness about harmful country and recorded probable cause for one million deaths
effects of tobacco (Tata Institute of Social Sciences, 2017). from these households through verbal autopsy. The study
The Longitudinal Aging Study in India (LASI) is the first report was published in two parts covering deaths between
nationwide population-based survey conducted in 2020 to 2001 and 2006 (Gomes et al., 2017).
collect information about the consequences of population aging The National Crime Records Bureau (NCRB) compiles
and its health, economic and social determinants. The survey and publishes accidental and suicide death data from all states
covered all states and union territories except Sikkim and in India (NCRB, 2020). This report is annually published
provides information on elderly demographics, employment since 1967; however, the quality and completeness of
status, sources of earnings, the prevalence of diseases and information is inadequate (Ransing et al., 2021).
chronic conditions, the status of physical, mental and functional
health, utilisation of healthcare services and availability of
family and support network (Arokiasamy et al., 2012). Healthcare registries and databases
WHO recommends use of STEPwise approach to NCD
GoI has established multiple databases to address challenges
Risk Factor Surveillance (STEPS) through surveillance of
associated with unique identification of patients, healthcare
key behavioural and biological risk factors (WHO, 2005).
providers and health facilities in the recent past. For example,
India has conducted two rounds of STEPS in 2004 and 2007;
four systems, namely National Identification Number Portal
however, it covered only six centres in 2004 and seven states
under Centre for Health Informatics, Registry for Hospitals in
in 2007 (Deepa et al., 2011). The National Nutrition
Network of Insurance under Insurance Regulatory and
Monitoring Bureau (NNMB), which was established in 1972
Development Authority, National Health Resource Repository
to collect and generate data on diet and nutritional status of
under CBHI and Clinical Establishment Registration System
the communities in urban, rural and tribal areas, had conducted
under Clinical Establishment Act, 2010, intended to build a
three rounds of nutrition surveys between 1975 and 1997
database of facilities by providing them a unique identification
(Brahmam, 2007). In 2015, the NNMB was shut down and
number. However, none of these systems could succeed in
the surveys were discontinued (Krishnan, 2015).
becoming a health facility registry (Mishra & Sahay, 2020). The
National Cancer Registry Programme is one of the oldest disease
registry programmes run by the Indian Council of Medical
Studies and Publications
Research (ICMR) since 1981 (Behera & Patro, 2018). The
The Central Bureau of Health Intelligence (CBHI) publishes Directorate General of Health Services runs the National Injury
a National Health Profile annually, which is compiled by Surveillance and Trauma Registry since 2014 for registration of
collecting data from states and union territories and covers accident and burn injuries and the NOTTO registry since 2015
information on demography, healthcare infrastructure, human for organ donor registration (Vasanthi, 2020).
resources, healthcare financing, socio-economic status and Multiple accreditation councils for physicians (Indian
morbidity and mortality in the community (CBHI, 2020). Medical Registry), nurses (Nurses Registration & Tracking
Rural Health Statistics is an annual publication by MoHFW. System) and practitioners of alternative systems of medicine
It contains data from all states and union territories about the (National Portal of Ayurveda, Siddha & Unani Practitioners)
number and type of health facilities and human resources in have digitised their systems to build unique records of these
rural and urban areas. professionals. These systems have improved the process of
As of now, six rounds of NHA reports have been published registration and record maintenance; however, their utility as a
between 2001–2002 and 2016–2017. The NHA provides provider registry is limited due to data quality and completeness
information about sources of healthcare expenditures, issues. To overcome these challenges, GoI has recently
spending consumers, providers of healthcare services and announced the establishment of digital health infrastructure in
156 Journal of Health Management 24(1)

the country under NDHM to develop registries for facilities, referred for TB screening. Later, based on test details and
patients and healthcare providers (Bajpai & Wadhwa, 2020). treatment suggestions, the patient record is updated, helping
to populate various indicators necessary to monitor
programme performance.
Routine Reporting System The National Anti-Malaria Management Information
System (NAMMIS) was launched in 2003 for reporting
RRSs are the main data sources used for collection and malaria incidences across states. However, the system usage
reporting facility performance with a frequency of data later dwindled due to various technical and capacity issues.
reporting on monthly or weekly basis. Among RRSs, the Later in 2016, HMIS started collecting data on CDs such as
Health Management Information System (HMIS) is the most malaria, dengue, kala-azar and Japanese encephalitis under
comprehensive and was launched to strengthen data collection, the National Vector Borne Disease Control Programme. IHIP
assessment and review capacities at district and state level in is now in process of integrating reporting for all CDs.
2008. HMIS provides data on three sets of forms where However, the uptake is not uniform across states. The
infrastructure, human resources and population data is reported Strategic Information Management System used by the
annually, training for healthcare staff is reported quarterly, and National AIDS Control Organisation (NACO) since 2010
service delivery data is reported monthly. Monthly data is provides data about HIV/AIDS surveillance, targeted
reported from all rural and urban state-level health facilities interventions, capacity building initiatives and awareness
functioning under NHM and provides information on RH, activities from all states.
MCH, immunization, outpatient and inpatient services along
with morbidity, and mortality.
The Integrated Disease Surveillance Project (IDSP) was Programme Management Information Systems
launched in 2004 initially in paper form but later as an online
system to strengthen surveillance of communicable diseases There are a diverse set of PMIS being used in India under
(CDs). IDSP reports surveillance data from all states on 22 various national health programmes and these administrative
diseases/conditions weekly using three sets of forms: form-S systems also collect and generate considerable public health
for syndromic surveillance, form-P for presumptive case data. These range from supply chain and logistics MIS for
reporting and form-L for laboratory confirmed case reporting. drugs, vaccines and blood banks to reporting systems under
The revised surveillance system under the Integrated Health various programmes such as health and wellness centre (HWC)
Information Platform (IHIP) intents to collect line listing MIS and transactions management system under AB-PMJAY,
records of patients on more than 33 health conditions. and systems for collection of patient feedback, appointment
However, the uptake of IHIP has been limited among states scheduling, pharmaco-vigilance, antimicrobial resistance
till date. incidence reporting, and so on. The list is exhaustive and
The Reproductive and Child Health (RCH) portal was almost all different programmes under MoHFW have specific
started as the Mother and Child Tracking System (MCTS) in MIS. These systems are at various levels of implementation:
2011. The MCTS Portal allowed Auxiliary Nurse Midwives for example, AB-PMJAY’s transaction management system
(ANMs) and Accredited Social Health Activists (ASHAs) to for healthcare claims documentation and reimbursement is
track each pregnancy till childbirth and during the postnatal actively being used by states, whereas adoption of antimicrobial
period. It also tracked each new-born from birth until full resistance MIS and blood bank database eRaktkosh is limited
immunisation and beyond to ensure that a child gets all the due to the challenges associated with the data quality, coverage
scheduled vaccines. With the introduction of a new RCH and capacity.
register in 2016, the RCH portal was rolled out with expanded Having briefly described the major healthcare data sources
reporting requirements. Today, it is being used in all states in India, the following section reflects upon some of the gaps
except three—Andhra Pradesh, Gujarat and Rajasthan— and challenges associated with these data sources.
which have a similar state-level system. In addition to
collecting patient-based data in the system, the RCH portal
also works as job aid for the ANMs, providing them with a Reflection on Data Gaps and Challenges
list of due MCH services in their area for the month and
facilitating direct cash transfer to mothers and ASHA workers. Over the years, multiple PHSs and RRSs have been put in
Nikshay is an integrated TB patient management system place to strengthen supply of diverse health information in
launched in 2012 as a patient tracking system. In 2016, it India. Overall, these sources have served us well in the past,
started reporting data from all states across the country. and, as we move into the next phase of building healthcare
Nikshay reports data currently from more than 200,000 data sources, it is important to reflect upon significant gaps
public and private facilities. The system initiates the recording and challenges associated with these to strengthen health
of patient details as soon as the patient is notified or is information availability and quality.
Mishra et al. 157

Availability and Coverage Gap Gaps in Standardisation

Multiple sources currently supply diverse sets of Most PHSs follow a standard structure for the organisation of
information; however, careful review indicates higher surveys and selection of data elements and indicators for
priority to one area over another. For example, four of the RCH components. This helps in the standardisation of data
seven PHSs conducted in the last five years (NFHS-5, elements and their definitions according to globally accepted
NSSO, CNNS, GTSS, NMHS, CovES, LASI) provide standards. However, researchers have reported mismatch of
information related to MCH (NFHS-5, CNNS, NSSO, data elements such as those used for NCD risk factor
CovES) indicating the high priority given to the RCH surveillance with global standards, that is, WHO STEPS
services. Though, with the NMHS, LASI and latest rounds (Dandona et al., 2016).
of NFHS, we see increased interest in reporting information Most of the RRSs do not follow standard definitions used
about emerging diseases and conditions such as NCDs and in surveys, limiting opportunities for triangulation and
their risk factors, elderly and mental health issues. Similarly, validation through survey data. The RRSs and PMISs also do
HMIS has also started collecting data on seven NCD not comply with global nomenclature standards, affecting
conditions (stroke, diabetes, hypertension, acute heart their ability to exchange data. RRSs are designed for single
disease, mental illness, epilepsy and oncology) from programme reporting and cannot be scaled to other programmes
outpatients and one (admissions due to asthma or chronic (Thiagarajan et al., 2012). This pushes programme managers
obstructive pulmonary disease) from inpatients in its to build a new system when a new programme is introduced,
monthly reporting. However, the HMIS form is still RCH leading to multiplicity without convergence.
centric indicating higher priority for information related to
MCH and RH. Data gaps include nutrition and food habit
information for adults similar to what CNNS provides for Lack of Research
children and adolescents, disease specific expenditure (e.g.,
diabetes or stroke) information for hospitalisation and Despite the availability of survey data online for most surveys,
outpatient care, information about environmental pollution the research on these datasets is limited. Often, the survey
and its impact on health and health status information for agency releases the anonymised survey data very late, leading to
vulnerable population groups such as homeless people, loss of opportunity for timely study and critique. There are also
street children and prisoners. limited reviews conducted to assess the quality of data available
In addition, coverage of cause of death reporting is through national health surveys. Similarly, limited research has
abysmally low with only less than one-fourth of registered been undertaken to identify determinates of poor data quality
deaths (21.1%) covered by the MCCD report in 2018 (ORGI, from RRSs and ways to strengthen them (Sharma et al., 2016).
2018). Similarly, the availability and quality of reporting Cost-benefit analysis of different data collection methods in the
suicides and accidental deaths is weak. Indian public health system needs to be conducted to find the
RRSs cover only state-run public health facilities. They most efficient way to collect public health data.
do not capture data from facilities run under national health
programmes (e.g., mental health and TB), hospitals of
other central ministries (e.g., Ministry of Labour and
Lack of Policy Guidance
Employment and Ministry of Education), from central
government hospitals and private sector hospitals. These India does not have a national plan to guide the development
issues limit the usability of this data for policy and of healthcare data sources. In the absence of such guidance,
programme management. multiple agencies are engaged from time to time to conduct
various health surveys, leading to overlap and gaps in key
areas. There is also a lack of coordination among agencies
about sharing resources, tools and technologies to reduce
Data Accessibility Issues
survey cost. RRSs and PMISs are generally developed by
Accessing data for most of the PHSs, studies and publications specific departments and programmes of MoHFW, without
is easy as these reports are available online. However, among any consultation with other systems to bridge data gaps, limit
RRSs, except HMIS and Nikshay, no other system provides duplication and avoid overburdening of health staff.
public access to its data. IDSP also publishes weekly outbreak
reports. However, disaggregated data from facilities is not
available online. None of the PMIS give access to data. Lack Recommendations
of access restricts an opportunity for data users to analyse
and share their feedback for improving the quality of data in Healthcare data sources have evolved and multiplied over
these systems. time, and there is a need to bring coordination among these
158 Journal of Health Management 24(1)

systems to strengthen health information availability in key addition, RRSs facilitate the recording and reporting of
areas. MoHFW needs to develop a comprehensive plan for routine facility data, which is useful for monitoring and
organisation of national health surveys in the country. The management of health goals such as universal health
plan should have a survey calendar, indicating the number coverage and sustainable development goals. Overall, the
and type of surveys and their frequency and type of growth of healthcare data sources has multiplied in recent
information captured. This will bring clarity and reduce years. However, several challenges are associated with
overlap and duplications. In addition, the government should these sources, which affect the quality and utility of health
designate one organisation currently engaged in organising data. Some of these include duplication and multiplicity of
surveys to act as the nodal agency for implementing national data, lack of standardisation in data collection and reporting,
health survey plans in India. The implementation agency may gaps in data availability and lack of coordination among
form expert groups to devise mechanisms for collecting different agencies engaged in health data collection.
healthcare data through multiple surveys. The expert group Availability of a national healthcare data plan and a survey
may also advise on survey tools, technologies and type of calendar would facilitate in bringing clarity about what
information to be covered in each survey and bridge data information will be available and at what time. In addition,
gaps. MoHFW should publish a country health report every the appointment of a nodal survey agency, use of standard
2–3 years, based on the survey findings to ensure information indicator dictionary and increased coordination among
availability in key areas. stakeholders will help bridge data gaps and reduce
To standardise data elements across surveys, there is a need duplication. Use of standard nomenclature, provision of
to publish a dictionary of core indicators to be used by all adequate capacity building for RRSs, sharing of data in
national surveys. The dictionary should be revised from time open platform and research in this area will further help
to time to accommodate new data elements and indicators. strengthen health data sources in India.
Wherever possible, the RRSs should use standard data
elements in line with those used in surveys to maintain Declaration of Conflicting Interests
uniformity and comparability. The authors declared no potential conflicts of interest with respect to
All healthcare data sources should be published in an the research, authorship and/or publication of this article.
online dashboard/portal for easy access. Open Government
Data Platform India (data.gov.in) can be leveraged for this
Funding
purpose. The data may be shared annually in case of surveys
and monthly in case of RRSs and PMISs. The authors disclosed receipt of the following financial support for
Surveillance and reporting for NCDs, their risk factors, air the research, authorship, and/or publication of this article: This
research study was funded by a grant from the Bill and Melinda
pollution and its impact on health and cause of death reporting
Gates Foundation to the ACCESS Health International, Inc. (Grant
should be strengthened to accommodate future needs. In number: INV-009845).
addition, expenditure data on inpatient and outpatient care for
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