India has committed to adopting the Sustainable Development Goals (SDGs) for ending poverty, protecting the planet, and ensuring prosperity for all to be fulfilled by year 2030. Goal 3 of SDGs is about ensuring healthy lives with promoting well-being for all. National Institution for Transforming India- (NITI) Aayog had started the Health Index initiative for achieving desirable health outcomes. The key objective of the whole exercise is to track development on health, to develop healthy competition and cross learning among states and UTs. Health Index Scores and rankings are generated to assess Incremental Performance (year-to-year progress) and Overall Performance of state/UT for achievement of health-related Sustainable Development Goals (SDGs) as well as Universal Health Coverage (UHC). This novel study was a cross-sectional retrospective observational epidemiological study. The Health Index consists of a set of indicators in the domains of Health Outcomes, Governance and Information, and Key Inputs/Processes. Health Outcomes are assigned the highest weight, indicators were selected on the basis of their importance and availability of reliable data at least annually from pre- existing data sources such as the Sample Registration System (SRS), Civil Registration System (CRS) and Health Management Information Systems (HMIS). Data on indicators is included for Index calculations only after validation by the IVA.

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The most significant event of birth and death must be certified medically / non-medically to prove or support the evidence of existence of birth and death of a particular person legal existence between the certified date / timings of birth and death. Apart from this legal significance, footage of births and mortality is central basic data required for policy and planning about a population group / country such as provisioning of fundamental requirements like food, cloth, housing, health care, transportation, education etc. The national / state programmes planning, management, implementation can be effectual and triumphant only if this statistical information of birth and death is specific, reliable, timely and correct. Hence, the certification / registration of births and mortality are significant as well as necessity of modern era. We aimed to assess percentage of mortality medically certified among total registered mortality in 36 States & UTs of India during 2018–2020 and COVID-19 mortality age-sex distribution pattern in India during 2020 medically certified due to pandemic in India with available data resources. The mortality data for this cross sectional retrospective observational study were obtained through Civil Registration System of India under the RBD Act, 1969. The data available were obtained on medically certified cause of deaths from States/UTs has been collected, tabulated, analysed in compliance with the ICD - Tenth Revision (1993). The total registered death during 2018 was 6911197 for 2019 it was 7596849 and in 2020 8062070. The figure increased continuously during successive years but there is a question mark on this data. The total RD increased by 685652 numbers in 2019 compared to 2018 whereas despite the COVID-19 PANDEMIC impact the increase in figures during 2020 was 240148 only which are highly questionable? The researcher found that this controversy is also raised by several global highly accredited international organizations like WHO etc. This research study revealed that Bihar which is second most populous state in India ranked lowest in medical certification of cause of death, 2020 which is amazing. Bihar ranked lowest with only 3.4 percent medically certified deaths during 2020 the COVID-19 pandemic era. Hence a large number of mortality during COVID-19 era remains uncertified till date in states like Bihar. This observational research study revealed that the majority of COVID-19 mortality was found in the age group of 45 years and above accounting for 82.7 per cent of total deaths in the group. The percentage of female mortality aged 34 years and below as well as for 55–64 years age group and 65–69 years age group, to total female deaths are greater in comparison to corresponding age groups mortality for male while in other groups male mortality were more than females. Particularly in poor states like Bihar in India the lower socio-economic strata of population may be more affected by low MCCD which is chiefly due to failure of Public Health Management related largely to corruption, posting and other scams. Bihar ranked lowest with only 3.4 percent medically certified deaths during 2020 the COVID-19 pandemic era. Hence a large number of mortality during COVID-19 era remains uncertified till date in states like Bihar. The researcher has found that in states like Bihar the total registered deaths have increased continuously during study period while MCCD decreased continuously during the study period which is due to failure of public health management and corruption, posting scams etc., by which such states are putting highly incapable / untrained person on state programme officer etc vital posts. These irregularities or ignorance have put India’s data credibility in doubt at international level bringing shame to the nation.

India has committed to achieve the Sustainable Development Goals (SDGs) for Goal 3 of SDGs which is about ensuring healthy lives with promoting well-being for all. National Institution for Transforming India- (NITI) Aayog had started the State Health Index initiative for ranking, comparing, states and UTs for achieving desirable health outcomes. The key objective of NITI Aayog is to track development on health, to develop healthy competition and cross learning among states and UTs. Health Index Scores and rankings are generated to assess Incremental Performance (year-to-year progress) and Overall Performance of state/UT of India for achievement of health-related Sustainable Development Goals (SDGs) as well as Universal Health Coverage (UHC). This novel study second was a cross-sectional retrospective observational study. The Health Index consists of a set of indicators in the domains of Health Outcomes, Governance and Information, and Key Inputs/Processes. Health Outcomes are assigned the highest weight in this study; indicators were selected on the basis of their importance and availability of reliable data at least annually from pre- existing data sources such as the Sample Registration System (SRS), Civil Registration System (CRS) and Health Management Information Systems (HMIS). Data on indicators is included for Index calculations only after validation by the IVA.

National Health Policy (NHP) 2017 (Para 11.8) proposed that a multi/interdisciplinary health workforce is necessary for managing programs under National Health Mission. National Health Policy 2017 considered creating Public Health Management Cadre (PHMC) in all States. In the 13th CONFERENCE of CENTRAL COUNCIL OF'HEALTH & FAMILY WELFARE (CCHFW), 2019 under the chairpersonship of Hon’ble central Health Minister of India the decision evolved to establish PHMC in all States by year 2022 . The key objective of establishment of PHMC is best utilization of expertise and talent for ensuring health for all. To segregate clinical and public health functions among cadres with flexibilities as per requirement of the state. Four types of structures and frameworks are only suggestive, and the states have flexibility to modify the structures according to the local situation and context. Medical and Health professionals would form a major part, but professionals from diverse backgrounds like sociology, economics, anthropology, hospital management, communications, etc., who have undergone public health management training would also be considered. States could decide to locate public health managers (medical/non-medical) into same or different cadre streams belonging to Directorates of Health. In states like Bihar where there is lack of Directorates of Health the situation is very worse indicated by NITI Aayog Health Index reports. In such states the researcher found that untrained persons are posted on key public health management posts while the public health trained doctors are not posted for public health management. The specialists are not involved in PHM and it may be due to the fact that there is shortage of specialist at country and state levels. The public health cadre is a misnomer if they will also work for clinical treatments and the key goal of PHMC will be affected particularly in states like Bihar. This is the first ever decision at national level for establishing PHMC and the details of pay structure , transparency etc. are not available and although the objectives are quite clear; the PHMC cadre may be affected in states like Bihar where it seems that lack of Directorate and unscrupulous management have grabbed the health system.