IN order to understand that the problem of statistical deception fully, it is necessary to comprehend how the state gathers information on child births and deaths of children. The most widely used surveys are the National Family Health Surveys and the Sample Registration System. While both have their merits, they cannot be completely relied on because they are based on a small sample of the population. Often they are made available after a considerable time lag, rendering them almost useless for the planning and evaluation needs of districts.
There is also the Civil Registration System, which is operated by the local bodies. But this has proved unreliable in rural areas. Possibly, the system that should be most accountable for correct figures is the Management Information System (MIS) of the State Health and Family Welfare Department. Births and deaths are recorded via a flow of information beginning from the lowest and the most important village-level functionary or the multipurpose field worker. The field worker operates from village-level medical sub-centres and can be in charge of a population of 5,000. He or she is supposed to know each family in his or her area and report their health status to the medical officer at the Primary Health Centre. This information is then passed on to the District Health Officer who sends it on to the Directorate of Health Services.
The MIS is an effectively designed system but, as the Child Death Study and Action Group report showed, it has not delivered. Field workers say they are overburdened and unable to follow up on the huge populations under their care. Anusuya Pawar, a field worker in Jawhar taluk in Thane district, says the lack of facilities is demotivating. "I walk from pada to pada (hamlet). Sometimes they are connected by road and I wait for a bus or someone gives me a lift. The worst part is that when I reach the pada the people are usually out in the fields. So then there is more walking to do. I know their daily schedule but even then it is very difficult to keep track." The incentive of Rs.10 initially offered by the State to field workers for reporting every childbirth or death failed to make a difference to the accuracy of the data collected.
Information-gathering is a delicate business and is best done by field workers like Pawar who belong to the area. But then she says, "After a point they see us as part of the government and distance themselves from us. We try to stop them from using traditional medicines. They share less with us. If there has been a still-birth, they don't bother to tell us."