Healthy States, Progressive India

“Healthy States, Progressive India”, a comprehensive Health Index report released by NITI Aayog on February 9, 2018; 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. It is the first attempt to establish an annual systematic tool to measure and understand the heterogeneity and complexity of nation’s performance in Health. Health Index is expected to nudge States towards further achieving a rapid transformation of their health systems and population health outcomes. 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.

• “Healthy States, Progressive India” 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
• Health Index is a weighted composite Index, which for the larger States, is based on indicators in three domains, with each domain assigned a weight based on its importance:
  • Health Outcomes (70%);
  • Governance and Information (12%); and
  • Key Inputs and Processes (18%),
• Among Larger State Kerala, Punjab & Tamil Nadu ranked on top in terms of overall performance, and
• Jharkhand, Jammu & Kashmir, and Uttar Pradesh ranked top three States in terms of annual incremental performance showing 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).
• 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. 
• Manipur registered maximum incremental progress on indicators such as PLHIV on ART, first trimester antenatal care (ANC) registration, grading quality parameters of Community Health Centres (CHCs), average occupancy of key State-level officers and good reporting on the Integrated Disease Surveillance Programme (IDSP).
• Among UTs, Lakshadweep showed both the best overall performance as well as the highest annual incremental performance. 
• Lakshadweep showed the highest improvement in indicators such as institutional deliveries, tuberculosis (TB) treatment success rate, and transfer of National Health Mission (NHM) funds from State Treasury to implementation agency.

Common challenges for most States and UTs include:

• 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).
• Almost all Larger States need to focus on improving the Sex Ratio at Birth (SRB).

Health-care delivery is the responsibility of States; the Centre provides financial and policy support. Being able to meet the Sustainable Development Goals over the coming decade depends crucially on the States’ performance.