NITI Aayog releases Health Index report

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New Delhi : NITI) (National Institution for Transforming India) Aayog on February 9, 2018, released a comprehensive Health Index report titled “Healthy States, Progressive India” at a function in the capital. The report ranks states and Union territories innovatively on their year-on-year incremental change in health outcomes as well as their overall performance with respect to each other.

The report was released jointly by the CEO, NITI Aayog, Amitabh Kant, Secretary, Ministry of Health & Family Welfare Preeti Sudan, and World Bank India Country Director Junaid Ahmad. It is the first attempt to establish an annual systematic tool to measure and understand the heterogeneity and complexity of the nation’s performance in Health. The report has been developed by NITI Aayog with technical assistance from the World Bank, and in consultation with the Ministry of Health and Family Welfare (MoHFW).

States and UTs have been ranked in three categories namely Larger States, Smaller States, and Union Territories (UTs), to ensure comparison among similar entities.

Among the Larger States, Kerala, Punjab, and Tamil Nadu ranked on top in terms of overall performance, while Jharkhand, Jammu & Kashmir, and Uttar Pradesh are the top three ranking States in terms of annual incremental performance. Jharkhand, Jammu & Kashmir, and Uttar Pradesh showed the maximum gains in improvement of health outcomes from base to reference year in indicators such as Neonatal Mortality Rate (NMR), Under-five Mortality Rate (U5MR), full immunization coverage, institutional deliveries, and People Living with HIV (PLHIV) on Anti-Retroviral Therapy (ART), according to a PIB release.

Among Smaller States, Mizoram ranked first followed by Manipur on overall performance, while Manipur followed by Goa were the top ranked States in terms of annual incremental performance. 

Among UTs, Lakshadweep showed both the best overall performance as well as the highest annual incremental performance. 

The Health Index report notes that while States and UTs that start at lower levels of development are generally at an advantage in notching up incremental progress over States with high Health Index scores, it is a challenge for States with high Index scores to even maintain their performance levels. For example, Kerala ranks on top in terms of overall performance but sees the least incremental change as it had already achieved a low level of Neonatal Mortality Rate (NMR) and Under-five Mortality Rate (U5MR) and replacement level fertility, leaving limited space for any further improvements.

However, the incremental measurement reveals that about one-third of the States have registered a decline in their performance in 2016 compared to 2015, stressing the need to pursue domain-specific, targeted interventions. Common challenges for most States and UTs include the need to focus on 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).

Linking this Index to incentives under the National Health Mission by the Ministry of Health and Family Welfare underlines the importance of such an exercise.