Recently, the National Institution for Transforming India (NITI) Aayog has released a comprehensive report entitled 'Healthy States, Progressive India'. The report contains a health index, Performance in Health Outcomes Index, that ranked all the States and the Union Territories (UTs) on the basis of their performance on measurable indicators such as infant mortality rate, sex ratio at birth and functional 24x7 public health centres.
The NITI Aayog has prepared this first-of-its kind index with inputs from World Bank India and the Union Ministry of Health and Family Welfare (MoHFW).
For the benefit of IAS aspirants, we are providing the summary of the 'Healthy States, Progressive India' report. This will be helpful in 2018 Civil Services Preliminary exam, Main exam and the Personality Test.
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Summary of Healthy States, Progressive India
• The report divided States and UTs into three categories, namely, larger States, smaller States and union territories (UTs). Among the largest States, Kerala and Uttar Pradesh are best performed and the worst performed States respectively.
• Among the smaller States, Mizoram and Nagaland are best performed and the worst performed States respectively.
• While Arunachal Pradesh, Goa, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura were categorized as smaller States, all the remaining 21 States were categorized as large States.
• Among UTs, while Chandigarh and Lakshadweep are the top performers, Dadra and Nagar Haveli was the worst performer.
• There is a large gap in overall performance between the best and the least performing States and UTs.
• Among larger states, the Index score for overall performance ranged widely between 33.69 in Uttar Pradesh to 76.55 in Kerala. Similarly, among smaller states, the index score for overall performance varied between 37.38 in Nagaland to 73.70 in Mizoram, and among UTs this varied between 34.64 in Dadra and Nagar Haveli to 65.79 in Lakshadweep.
• As per the report, about one-third of the States registered a decline in their performance in the reference year (2015-2016) as compared to the base year (2014-2015).
• The indicators where most States and UTs need to focus include addressing vacancies in key staff, establishment of functional district Cardiac Care Units (CCUs), quality accreditation of public health facilities, and institutionalization of Human Resources Management Information System (HRMIS). Additionally, almost all Larger States need to focus on improving the Sex Ratio at Birth (SRB).
The MoHFW has linked this index to incentives under the National Health Mission (NHM). This has underlined the importance of such an exercise. The results and analysis in this report provide an important insight into the areas in which States have improved, stagnated or declined.
The health index is also an important aid in understanding the heterogeneity and complexity of the nation’s performance in health. It is the first attempt by the Union Government at establishing an annual systematic tool for measurement of performance across States and UTs on a variety of health parameters within a composite measure.
In its first year, it may not have achieved perfection. However, it does set the foundation for a systematic output and outcome based performance measurement.
The report also calls for urgently improving the data systems in health, in terms of representativeness of the priority areas, periodic availability for all States and UTs, and completeness for private sector service delivery.
Useful concepts explained
The following are some of the terms that are used in the report. The following explanations of important concepts will help aspirants in answering concept-based questions in prelims as well as main examination.
Neonatal Mortality Rate (NMR): It refers to the number of deaths of infants, who are of less than 29 days old, per thousand live births during a specific year. NMR reflects the quality of prenatal, intrapartum, and neonatal care services. This is an important indicator as approximately 68 percent of infant deaths in India occur during the neonatal period. The NMR is available for larger states and is the highest in Odisha and the lowest in Kerala.
Despite reductions, the NMR remains high in many States and concerted efforts need to be made to reach the NMR national policy goal of 16 deaths per 1,000 live births by 2025 and 12 deaths per 1,000 live births by 2030.
Under-five Mortality Rate (U5MR): It refers to the number of deaths of children, who are of less than 5 years old, per thousand live births during a specific year. It depends several factors such as the nutritional status of children, health knowledge of mothers, level of immunization and oral rehydration therapy, access to maternal and child health services, income of the family, and availability of safe drinking water and basic sanitation services.
Kerala and Tamil Nadu have already achieved the National Health Policy 2017 U5MR target for 2025 of 23 deaths per 1000 live births. However, 12 States, namely Uttarakhand, Andhra Pradesh, Gujarat, Jharkhand, Haryana, Bihar, Chhattisgarh, Rajasthan, Uttar Pradesh, Odisha, Assam and Madhya Pradesh, with U5MR above 35 deaths per 1000 live births will require concerted effort to ensure that this target is achieved.
Total Fertility Rate (TFR): It is the average number of children that would be born to a woman if she experiences the current fertility pattern throughout her productive span (15-49 years), during a specific year.
In 2015, 12 of the 21 larger states have achieved the replacement level fertility i.e. TFR ≤ 2.1.
Sex Ratio at Birth (SRB): The number of girls born for every 1,000 boys born during a specific year. In most States, SRB has declined between 2012 and 15), except for Bihar, Punjab and Uttar Pradesh where improvements in SRB were noted.
The report advised States to effectively implement the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 and take appropriate measures to promote the value of the girl child.
Full immunization coverage: It is the proportion of 9-11 months old infants, who have received BCG, 3 doses of DPT, 3 doses of OPV and one dose of measles against the estimated number of infants during a specific year. 19 States and UTs have full immunization coverage of at least 90 percent, the 2025 target specified in the National Health Policy 2017. Importantly, while the average full immunization coverage among the Larger States is 90 percent, it is significantly lower for Smaller States at 84 percent.