“I was nervous when they came to ask about my husband's death, but the nurse accompanying the interviewer spoke kindly and explained everything. She said it was to help improve health services. I shared what I knew about his sickness. It felt like someone was listening to our story. I didn’t know such interviews could help the government plan better hospitals or medicines. I hope this helps others like us,” said Ms Shanthi, a 44-year-old widow from Krishnagiri district, in Tamil Nadu, India.
Ms Shanthi had taken part in a verbal autopsy interview, which helps the Government to collect cause-of-death information, and is essential for public health planning, disease surveillance, and evidence-based policy-making.
Her interview was one of 15 000 verbal autopsies that the government has conducted since 2023 to determine the medical causes of all deaths in two districts of Krishnagiri and Karur.
Documenting the cause of every death
Although the state of Tamil Nadu registers nearly all deaths, only 43% have a medically certified cause of death (MCCD). All deaths in institutions are accurately recorded, but home deaths, where over 70% of deaths occur, have significantly lower certification rates of 15 -25%.
Through integrating verbal autopsy methods with MCCD and building capacity at the district level, Tamil Nadu has successfully documented the cause of death for every registered death in the pilot districts.
This integration enabled the analysis of district- and primary care level mortality and led to a dramatic reduction in ill-defined causes of death from 40-50% to just 8-15%.
This effort sets a precedent for scalable mortality surveillance and strengthening of the Civil Registration and Vital Statistics (CRVS) system across the state and beyond.
Promoting UHC through data-driven health planning
The initiative contributes to achieving universal health coverage (UHC) by promoting data-driven health planning and strengthening institutional mechanisms for legal and statistical death registration.
This data is critically important for health planning and policy-making and underscores the value of WHO’s strategic innovation and support to embed systemic change for long-term health gains.
WHO, through the Universal Health Coverage Partnership, provided strategic, financial, and technical support to Tamil Nadu’s CRVS strengthening initiative, including training for field staff and medical officers, implementation guidance, supervision frameworks, data analysis, and report development.
/special-programme-on-primary-health-care-(phc)/workshop-about-crvs.jpg?sfvrsn=a95e2e5a_5 "A workshop about strengthening the District Civil Registration System in Tamil Nadu")
A workshop about strengthening the District Civil Registration System in Tamil Nadu © WHO India
"The District Civil Registration System approach marks a major step forward in Tamil Nadu’s public health strategy. By integrating verbal autopsy and digital tools, we’ve improved the accuracy of mortality data, especially for deaths outside health facilities. The success in Krishnagiri and Karur shows how collaboration and innovation can transform data into action.
“As we expand this model, we remain committed to ensuring every death is counted and every cause is known for a healthier Tamil Nadu," said Dr A. Somasundaram, Director of Public Health and Preventive Medicine, Tamil Nadu.
Paving the way for UHC
This initiative exemplifies how strategic partnerships and community engagement can transform mortality data into actionable insights, paving the way for UHC in India.
Through strategic guidance, resource mobilization, and technical innovation, WHO has helped Tamil Nadu establish a scalable model for data-driven mortality surveillance and CRVS system strengthening. The initiative has now expanded to two other districts of Perambalur and Tirunelveli and is expected to spread further.
“Tamil Nadu’s success in integrating verbal autopsy into CRVS systems is a model for scalable, data-driven health planning. WHO is proud to support this transformative journey,” said Ms Payden, WHO Representative to India a.i.
The UHC Partnership operates in over 125 countries, representing over 3 billion people. It is supported and funded by Belgium, Canada, the European Union, France, Germany, Ireland, Luxembourg, Japan, the United Kingdom of Great Britain and Northern Ireland, and WHO.