Kerala, Punjab, TN in best of health; UP out of reckoning
Kerala, Punjab and Tamil Nadu have ranked top in terms of overall health performance while Uttar Pradesh appeared at the bottom of the Health Index report ‘Healthy States, Progressive India’ released by the NITI Aayog on Friday.
Besides Uttar Pradesh, Rajasthan, Bihar and Odisha are among the States that have performed poorly in the health index indicators such as Neonatal Mortality Rate (NMR), Under-five Mortality Rate (U5MR), full immunisation coverage, institutional deliveries, and People Living with HIV (PLHIV) on Anti-Retroviral Therapy (ART).
While Uttar Pradesh appeared at the bottom among larger States, it has shown improvement in the recent past, as per the index. Among large States, Jharkhand, Jammu & Kashmir and Uttar Pradesh are the top three ranking States in terms of annual incremental performance.
Among small States, Mizoram ranked first, followed by Manipur and Goa. Releasing the report here, NITI Aayog CEO Amitabh Kant said that the Aayog believes that the Health Index will act as a tool to leverage cooperative and competitive federalism, accelerating the pace of achieving health outcomes.
Speaking on the occasion, NITI Aayog member Vinod Paul said that absolute and incremental changes in health outcomes, as measured by the Health Index, promotes cross-learning between States, capturing the very spirit of cooperative and competitive federalism.
“It is also important to rank States on the basis of the improvement they have achieved,” said Kant adding that the next health report on States performance will be released in June this year and district hospitals too would be ranked. “We would take out the ranking of 730 district hospitals based on their performance. We want to encourage the good performers and name and shame those who don’t,” he said.
Among smaller States, Mizoram ranked first followed by Manipur on overall performance, while Manipur followed by Goa were the top ranked States due to 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).
Developed by NITI Aayog, with technical assistance from the World Bank, and in consultation with the Health Ministry, the States and UTs have been ranked on their year-on-year incremental change in health outcomes as well as their overall performance with respect to each other.
“Our job was first to challenge States, secondly to do workshops with States and thirdly to put them in ranking. While historical ranking is important, it is very important for us to capture change per year. Best thing was that the eastern States Jharkhand and Chhattisgarh have done very well. They have come fourth and fifth and have moved up the ladder very fast, banking on radical reforms,” Kant said.
Among Union Territories, Lakshadweep showed both the best overall performance as well as the highest annual incremental performance, with improvement in institutional deliveries, tuberculosis (TB) treatment success rate, and transfer of National Health Mission (NHM) funds from State Treasury to implementation agency.
The Health Index report noted 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 NMR and 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 as 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 institutionalisation of Human Resources Management Information System (HRMIS).
Additionally, almost all larger States need to focus on improving the Sex Ratio at Birth (SRB), the report said.
The report also noted that rich learnings have emerged in the first year and these will guide in refining the index for the coming year and also address some of the limitations. It further emphasised on the need to improve data systems in the health sector, in terms of representativeness of the priority areas, periodic availability for all States and UTs, and completeness for private sector service delivery.
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