Taking note of health

THE Niti Aayog health index report “Healthy States, Progressive India” released on Friday is a wake-up call for states as it helps them identify specific areas of improvement, both in terms of overall performance and year-on-year incremental change. It is an important insight into the areas in which states have improved, stagnated or declined and should help the agencies concerned in better targeting of interventions. This report should propel the states towards undertaking multi-pronged strategies and bring about the much-desired optimal population health outcomes. 

As far as overall performance with respect to each other goes, Kerala, Punjab and Tamil Nadu are ranked on top in the larger states category. The report also reveals a challenge for most top-ranking states. It is seen that despite having been ranked in the top 10, one-third have registered a decline in their health indices in the reference year as compared to the base year. They include Uttarakhand, Himachal, and Haryana. Among the UTs, Chandigarh too has slipped. This is a matter of concern and should nudge it into reviewing and revitalising their programmatic efforts. A worrying factor, though not altogether unexpected, is that almost all large states have a skewed sex ratio at birth. They must focus on improving it, particularly Punjab and Haryana. 

Based on their year-on-year incremental change in health outcomes, among the larger states, Jharkhand, J&K, and UP occupy the top three positions. But they need not rest on the laurels. Going by Kerala’s example, it is a challenge for states at high levels of the index score to even maintain their performance levels. Though placed at the top, Kerala is at the bottom in incremental progress. Why? That’s because it has already achieved a low level of Neonatal Mortality Rate, and Under-five Mortality Rate and replacement level fertility, leaving limited space for further improvement. As indicated in the report, addressing staff vacancies, establishing district cardiac care units, quality accreditation of public health facilities, and institutionalisation of HR Management Information System (HRMIS), should largely help cure the problem. A tall order, but absolutely necessary if India is to improve its health report.