Health on the agenda
Niti Aayog's healthcare index captures vital data and ought to focus the minds of policymakers
The health index, a comparative assessment of public health in states, released by the Niti Aayog, comes at a time when the Government is planning to roll out its biggest health cover plan for 50 crore people. It lays out the general map and helps in prioritising sectoral fund allocations and implementation of schemes to bring everybody at par with the desired quality of life. The toppers are not entirely unexpected with Kerala, Punjab, Tamil Nadu and Gujarat having consistently maintained their robustness. The laggard states — Uttar Pradesh, Rajasthan, Bihar, Odisha, Madhya Pradesh — seem to continue in the historical classification of BIMARU and despite changed dispensations and nomenclature have not been able to quite break through. The story though lies in the unexpected and the incremental improvements or the quantum of jump that each state has made from the baseline year of 2014-2015. By this measure, the tribal-dominated states of Jharkhand and Chhattisgarh have done very well, having been successful in bringing the marginalised into the fold of medical insurance and basic health entitlements. Their rapid ascension proves that reforms, no matter how radical, if pushed with commitment, can indeed change the growth template of the most backward of districts. The other surprise was Jammu and Kashmir, which climbed up the charts, courtesy its dogged persistence to strengthen the primary health network in the far flung areas and backing that up with improved secondary and tertiary care, inviting its own medical specialists from across the world to contribute to welfare and focussing on senior citizens. In fact, by the measure of incremental performance, Uttar Pradesh too has improved its act though it needs to do much more to rescue itself from a dismal 21st position.
The incremental leap also shows that while Kerala and Tamil Nadu remain at the top, they are holding on account of their historical advantage compared to an aggressive Punjab which invested heavily on public health and managed to knock off Tamil Nadu from its seond position. Smaller states like Mizoram, Manipur and Goa, have taken bigger strides despite resource challenges. The worrisome story, therefore, is that five biggish States have failed in maintaining their last-achieved indicators — Uttarakhand, Haryana, Karnataka, West Bengal and Odisha. While competitive federalism has been proven to drive welfare benefits to the bottom of the pyramid, many may argue that such comparisons label certain states as clichéd clodhoppers that act as a deterrent for proactive approaches in them. It is precisely to negate this argument that the Niti Aayog clarified that this was not a race for numbers but for promoting cross-learning and cooperation to pull everybody out of the morass. For example, the Union Territory of Lakshadweep showed the best overall performance as well as incremental performance, a tall order that could be emulated. The whole point of the ranking is to ensure that State health departments strengthen their primary healthcare systems.
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