Civil Registration System (CRS)
A) Registration of Births and Deaths of Rural and urban areas of the state.

1. The Registration of Births and Deaths activity is carried out with the help of 256 Urban and 43722 Rural Centers. 100% work is expected from these centers (not only registration of Births and Deaths but submission of specific statutory obligated reports also). The efforts are being made to collect reports from all villages for 100% registration in time by contacting the Chief Executive Officer and concerning Block Development Officer in rural area. Multipurpose Health Worker, Auxiliary Nurse Midwife, Anganwadi Workers and Dais are also making attempts successfully in registration of Births and Deaths. The periodical review is taken to know the impact of their assistance in this respect in relation to the qualitative improvement in registration work.
2. An effort had been made by this Bureau to decentralize the computerization of compilation of data at block level, regarding events registered in the jurisdiction of respective block in rural area.
3. Meetings at various levels are conducted in rural as well as urban areas to improve the civil registration system.
   There are two types of meetings:
   1. Routine meetings
   2. Meetings of committees formed according to Government Resolution.
      Routine meetings: Annual Meeting of Chief Registrars at National level, Half Yearly Meeting of District Registrars at State level, Half Yearly Meetings of Statistical Officers of district at State level, Monthly Meetings of Medical Officers and Supervisors of Primary Health Centres at District level. Fortnightly Meetings of Village registrars at Block level.
      Meetings of committees formed according to Government Resolution: Half–yearly meeting of Interdepartmental Co–ordination committee at State level, Quarterly meeting of committee at District, Block and village level to improve Birth and death registration and vital statistics, Quarterly meeting of committee at Corporation level to improve Civil Registration System.
4. Training: Training of newly recruited Statistical Investigators and officers, training of various software’s to health personnel, training of CRS to registration functionaries (as and when grants are available)
5. IEC Activity

B) Medical Certification of Cause of Death (MCCD)
To improve coverage and quality of MCCD following activities are carried out.

1. Meetings,
2. Training
3. Publication of data
   1. Meetings: Half Yearly Civil Surgeons at State level, Monthly of Superintendents of Rural and Cottage Hospitals at District level, Meetings of Private Practitioners and Medical Officers in corporation ares are taken as and when required by the corporation.
   2. Training: Continuous training of Civil Surgeons, Superintendents, Medical officers at Health and Family welfare Training Centres for ICD–10 and MCCD.
   3. Publication of data: Annual Publication is done on the basis of data received through MCCD.

With the help of World Bank Assistance, under Maharashtra Health System Development Project, the training of medical and paramedical personnel has been conducted to improve the quality of MCCD.

C) Survey of Cause of Death (Rural)

• Half yearly Survey: the half yearly surveys are conducted in the villages selected under the scheme for detection of omissions of Births & Deaths event. The survey is expected to conduct by field recorder of respective PHCs.
• To improve the quantitative and qualitative aspect of information collected under Survey of Cause of Death Scheme (Rural), as well as to receive the reports of this scheme in time, the scheme is monitored under Health Management Information System (HMIS). The system is monitored through the following indicators.
  Ind.70(i): Birth Reporting.
  Ind.70(ii): Death Reporting.
  Ind.70(iii): Infant death Reporting.
  Ind 70(iv): Cause of Deaths verified by MOPHC.

Meeting

• Half yearly meeting of Statistical Officer/Statistical Inventigator (SO/SI) to review the performance, instructions, & to prepare plan of action, strategy at state level.
• Monthly meeting of MOPHC & field agents/recorder at district level.

Training

• This is the continues activity. Training is being given to the SI/SO regarding the scheme, as & when required according to availability of grants.
• Training of field agent, field recorder & Mo is being carried out at district level by SO, Medical Officer District Training Team (MODTT), & ADHO.

Publication
The annual data compiled, analyzed & statistical inferences are published through annual report. The bureau is publishing the data through annual report from the year 2001 onwards.

D) Assistance in the work of Epidemiology
To accelerate the surveillance of epidemic disease and study related to epidemiology, the specific individual instructions to the Civil Surgeon and District Health Officers were given. Every month, collection, compilation of the information regarding causes of mortality was started since 1975–1976. The feedback is given to district health personnel, in alarming situation.

E) Health Management Information System (HMIS)
With the intention to keep the vigilance on progress of different health programmes, the Government has introduced the Health Management Information System. Health Management Information System involves information like comparative performance Status, Inter District ranking of performance and status of achievement of various indicators at State level etc.

How the programme is implemented.
Civil Registration System
This is implemented in Rural and Urban area. In case of rural area Gramsewak submits Birth and Death reports of the revenue villages under his jurisdiction to Block Development Officer (BDO). BDO submits consolidated reports to Deputy Chief Registrar, for Births and Deaths Pune In case of Urban area Exe. Health Officer/Health Officer/Chief Officer submits reports of Births and Deaths to Deputy Chief Registrar, Births and Deaths Pune. After receiving reports these are scrutinized, and computerized. At the end of the year Annual Vital Statistics Report is prepared and submitted to Higher Authorities.

Now this process is decentralized at district level. All the rural births and deaths reports will be computerized, in the office of the District Health Officer, of respective Zilla Parishad. The floppy or Compact Disc of the consolidated report will be sent to Dy. Chief Registrar, Births and Deaths Maharashtra State Pune.

Medical Certification of Cause of Death
Hospital incharge in urban area submits these certificates to Deputy Chief Registrar Pune. Recently from 1998 this scheme is extended in Rural Hospitals. After receiving the certificates causes of death are coded as per International Classification of Diseases revision 10 (ICD – X). After coding the information is compiled & analyzed. The report is submitted to Central Bureau of Health Intelligence, New Delhi. From this scheme we can observe medically certified causes of deaths by age sex in urban area.

Monthly Report of Communicable Diseases
The monthly report of 26 communicable diseases is collected from all district level officers – District Health Officers, Civil Surgeons Health officers of Corporations and identified Medical Colleges. After consolidations the report is sent to Director General Health Services Mumbai and Secretary Public Health Department, Mumbai, every month through Health Management Information System. Also this report is sent to Director, Central Bureau of Health Intelligence, New Delhi.

Information on identified 194 diseases
The report of 194 diseases is collected quarterly from all District officers i.e. District Health Officers, Civil Surgeons and identified Medical College Hospitals. After consolidation annual report is sent to Director, Central Bureau of Health Intelligence, New Delhi and Director General Health Services Mumbai. The morbidity pattern of the disease, prevalence in the state is known from this report.

Survey of Causes of Death (Rural)

• The scheme is implemented in 600 villages, which are randomly selected among the 33 districts.
• The scheme covers 12.5 lakhs (rural) population.
• The health worker uses verbal autopsy technique instrument to collect the signs and symptoms of diseased, at the time of death.
• Medical Officer of Primary Health Center writes the cause of death according to signs and symptoms collected by health worker by referring the list of causes based on ICD – X.
• From this scheme, the mortality pattern existing in the rural community is known. The various mortality indicators are calculated from the available data and information.