The ‘Annual Health Index’ that the NITI Aayog released recently had an unsurprising headline: Kerala topped the charts.
Uttar Pradesh had registered the highest incremental change relative to past performance, among ‘larger states’.
About the Index:
the NITI Aayog calculated the health indicesfor the reference year 2019-2020 against the base year of 2018-2019.
The index is a composite score for each state out of 100.
Parameters
The Health Index score is prepared based on the States’ performance across a large set of indicators that are divided into three broad domains — health outcomes, governance and information, and key inputs and processes.
Health outcomes, for instance, include parameters such as neonatal mortality rate, under-5 mortality rate and sex ratio at birth.
Governance includes institutional deliveries, average occupancy of senior officers in key posts earmarked for health.
Significance:
Cooperative and Competitive Federalism:
Health Index has been developed as a tool to leverage co-operative and competitive federalism to accelerate the pace of achieving health outcomes.
Focus on Health outcomes:
It would also serve as an instrument for “nudging” States & Union Territories (UTs) and the Central Ministries to a much greater focus on output and outcome-based measurement of annual performance than is currently the practice.
Achieve the SDG:
With the annual publication of the Index and its availability on public domain on a dynamic basis, it is expected to keep every stakeholder alert to the achievement of Sustainable Development Goals (SDGs) Goal number 3.
Challenges:
Issue with Grouping:
The problem is that the demographic and epidemiological realities of the ‘larger’ states are not uniform. For example, both states at the top and the bottom of the ranking – Kerala and Uttar Pradesh – are ‘larger’.
Binding states with such disparate health demands together and measuring their performance from the same standpoint wouldn’t yield a correct picture.
Issue with Indicators:
Most indicators in the ‘health outcomes’ domain were concerned with states’ performance on maternal and child health, and to some extent about tuberculosis and AIDS. But the domain didn’t capture states’ performance against non-communicable diseases (NCDs).
According to the National Health Portal, 5.8 million people die of heart and lung diseases, stroke, cancer and diabetes – all NCDs – every year in India. So this is a major oversight.
Incremental Development:
For a state like Kerala, which has already achieved a lot in maternal and child health indicators, there is not as much scope to improve.
With Uttar Pradesh, the baseline is low, hence, the scope of incremental change is the highest.
Way Forward:
The exercise done by NITI Aayog is important and should be continued, But, it needs to be more [reflective] of the health realities.
Re-categorise the states as per their common health needs, and don’t be obsessed about giving overall scores, but rather have indicator-wise ranking.
Relying on Health Management Information System data is lazy – do some state level studies to give the index some meaning.
