Health index: Chandigarh slips to 2nd spot among UTs

Nitin Jain

Tribune News Service

Chandigarh, February 10

Chandigarh has lost its first position to Lakshadweep and has fallen to second position in the ranking of union territories on health outcomes, indicating deterioration in its local systems that led to its decline among the rest.

Healthy States Progressive India, a NITI Aayog and Health Ministry document, has ranked UTs and states on their health status between 2014-15 and 2015-16 to measure improvements and declines.

The 104-page report, which ranks all UTs and states separately, concludes that only two UTs — Lakshadweep and Andaman and Nicobar Islands — improved their position from the base year (2014-15) to the reference year (201516). Lakshadweep went up from second to first and Andaman and Nicobar Islands scaled from fifth to fourth position. Delhi has retained its third position during the period. Similarly, Daman and Diu and Dadra and Nagar Haveli did not change ranks and were placed sixth and seventh, respectively.

Besides Chandigarh, Puducherry also fell by one position (from fourth to fifth) in the rankings.

While Chandigarh and Daman and Diu registered negative incremental change, five UTs — Lakshadweep, Andaman and Nicobar Islands, Dadra and Nagar Haveli, Delhi and Puducherry — registered positive incremental progress. From the base year to the reference year, Chandigarh and Daman and Diu reported negative changes in the Health Index score. Their score declined by 5.22 and 8.67 points, respectively. 

Lakshadweep (ranked at the top) observed the highest incremental performance of 9.56 points. Andaman and Nicobar Islands, Dadra and Nagar Haveli and Delhi saw an increase in the Health Index score of between 2 and 4 points. Puducherry achieved approximately a one-point incremental increase.

Similarly, Chandigarh performed very poorly on first-trimester antenatal care (ANC) registration that fell from 50 per cent in the base year to 37 per cent in the reference year. 

In the domain of health outcomes, all UTs, except for Chandigarh and Daman and Diu, have improved their performance from the base year to the reference year. For the health outcomes domain in the reference year, the range of Index scores is very wide and Lakshadweep scored the highest with 74.37 points compared to Daman and Diu’s lowest 15.89. 

In the case of the key inputs/processes domain, the performance of Chandigarh, Puducherry, Daman and Diu and Andaman and Nicobar Islands has fallen whereas three UTs — Delhi, Dadra and Nagar Haveli and Lakshadweep — showed improvement in their performances. The range is smaller for the key inputs/processes domain. In this domain, Puducherry scored the highest with 52.99 points while Andaman and Nicobar Islands scored the lowest with 26.75 points. Overall, the range of scores is quite low and indicates that all UTs need to focus on this domain.

Among UTs, Lakshadweep showed both the highest annual incremental performance as well as the best overall performance. In the annual incremental performance, Lakshadweep is followed by Andaman and Nicobar Islands. In the terms of overall performance, Lakshadweep is followed by Chandigarh. 

The overall performance based on the Health Index score of UTs for the base year ranged from 31.34 points for Dadra and Nagar Haveli to 57.49 points for Chandigarh.

29% posts of ANM vacant

• Against less that 25 per cent auxiliary nurse midwife (ANM) positions vacant in all other UTs and smaller states, Chandigarh has 29 per cent vacant posts of ANMs.
• Among the UTs, Chandigarh has the highest proportion of vacant medical officer (MO) positions at primary health centres (69 per cent) followed by Andaman and Nicobar Islands (36 per cent) with no reduction from the base year to the reference year. There was no MO vacancy in Lakshadweep while vacancies in the remaining UTs lay in the range of 7 to 17 per cent. 
• In several UTs and states, the specified health worker positions were not sanctioned and/or overlapped with other functions. In Chandigarh, in place of sanctioned positions, the required number of specialists was used for the denominator.

City has no 24X7 PHC

The functioning of 24x7 primary health centres (PHCs) is important for providing a basic package of health services to the community and for reducing the workload at higher-level facilities. While Chandigarh, Kerala, Lakshadweep and Puducherry are yet to operationalise a single 24x7 PHC, Andaman and Nicobar Islands and Dadra and Nagar Haveli have achieved the target of the required number of 24x7 PHCs. Chandigarh also did not have a single district with functional CCUs in public hospitals.

100% INSTITUTIONAL DELIVERIES

Chandigarh and Puducherry were the only two UTs that achieved more than 90 per cent coverage of institutional deliveries in both public and private institutions during 2015-16. Chandigarh, Puducherry and Delhi have achieved 100 per cent registration of births.

Termed Achiever

Based on the composite Index score range for the reference year (2015-16), the UTs are classified into three categories — Aspirants, Achievers, and Front-runners. Chandigarh, Delhi, Andaman and Nicobar Islands and Puducherry are grouped as Achievers and also have significant room for improvement.