27-Dec-2021: NITI Aayog Releases Fourth Edition of State Health Index

NITI Aayog released the fourth edition of the State Health Index for 2019–20. The report, titled “Healthy States, Progressive India”, ranks states and Union Territories on their year-on-year incremental performance in health outcomes as well as their overall status.

Round IV of the report focuses on measuring and highlighting the overall performance and incremental improvement of states and UTs over the period 2018–19 to 2019–20.

The report was released jointly by NITI Aayog Vice Chairman Dr Rajiv Kumar, CEO Amitabh Kant, Additional Secretary Dr Rakesh Sarwal, and World Bank Senior Health Specialist Sheena Chhabra. The report has been developed by NITI Aayog, with technical assistance from the World Bank, and in close consultation with the Ministry of Health and Family Welfare (MoHFW).

The Findings:

The State Health Index is annual tool to assess the performance of states and UTs. It is a weighted composite index based on 24 indicators grouped under the domains of ‘Health Outcomes’, ‘Governance and Information’, and ‘Key Inputs/Processes’. Each domain has been assigned weights based on its importance with higher score for outcome indicators.

To ensure comparison among similar entities, the ranking is categorized as ‘Larger States’, ‘Smaller States’ and ‘Union Territories’.

On overall ranking based on the composite index score in 2019–20, the top-ranking states were Kerala and Tamil Nadu among the ‘Larger States’, Mizoram and Tripura among the ‘Smaller States’, and DH&DD and Chandigarh among the UTs.

The Mechanism:

A robust and acceptable mechanism is used for measuring performance. Data is collected online through a portal maintained by NITI on agreed indicators. The data is then validated through an independent validation agency selected through a transparent bidding process. The validated data sheets are shared with the states for verification, followed by video conferences with the states for resolving any disagreements or disputes. The final sheets thus settled are shared with the states, and after agreement, the data is finalized and used for analysis and report-writing.

‘States are beginning to take cognizance of indices such as the State Health Index and use them in their policymaking and resource allocation. This report is an example of both competitive and cooperative federalism,’ said VC Dr Rajiv Kumar.

‘Our objective through this index is to not just look at the states’ historical performance but also their incremental performance. The index encourages healthy competition and cross-learning among States and UTs,’ said CEO Amitabh Kant.

The index is being compiled and published since 2017. The reports aim to nudge states/UTs towards building robust health systems and improving service delivery.

The importance of this annual tool is reemphasized by MoHFW’s decision to link the index to incentives under National Health Mission. This has been instrumental in shifting the focus from budget spending and inputs to outputs and outcomes.

18-Sep-2019: 2 of 3 child deaths in India due to malnutrition

Malnutrition was the predominant risk factor for death in children younger than five in every state of India in 2017, accounting for 68.2 per cent of the total under-5 deaths, translating into 706,000 deaths (due to malnutrition). It was also the leading risk factor of loss of health among all age groups.

This was revealed in the state-wide data on malnutrition presented by the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI) and National Institute of Nutrition (NIN).

The prevalence of low birthweight in India in 2017 was 21.4 per cent, child stunting 39.3 per cent, child wasting 15.7 per cent, child underweight 32.7 per cent, anaemia in children 59.7 per cent, anaemia in women 15–49 years of age 54.4 per cent, exclusive breastfeeding 53.3 per cent and overweight child 11.5 per cent.

According to the findings, if the trends estimated up to 2017 for the indicators in the National Nutrition Mission 2022 continue in India, there would be 8.9 per cent excess prevalence for low birthweight, 9.6 per cent for stunting, 4.8 per cent for child underweight, 11.7 per cent for anaemia in children, and 13.8 per cent for anaemia in women relative to the 2022 targets.

The DALY (disability adjusted life years) rate due to malnutrition was found to be highest in Uttar Pradesh, Bihar, Assam, and Rajasthan. The worst effect of child and maternal malnutrition is reflected in neonatal disorders, followed by lower respiratory infections and diarrhoeal diseases in children below 5 years.

Although the all causes under-5 death rate in India decreased from 2,336 per 100,000 in 1990 to 801 per 100,000 in 2017, the proportion of under-5 deaths attributable to malnutrition changed only modestly from 70.4 per cent to 68.2 per cent in 2017. This, is a major concern because this indicates that the malnutrition menace is hardly on the wane in India.

Similarly, the DALY rate in children attributed to all causes declined substantially in these years but DALY rate attributed to malnutrition declined by less than 2 percentage points only.

Low birthweight, the largest contributor to the malnutrition DALYs in India, had a prevalence of 21 per cent in 2017, which showed a modest declining trend. Within child growth failure, the highest contribution to DALYs was from wasting, the prevalence of which declined only moderately in India during 2010–17.

The prevalence of stunting and underweight has been decreasing, however, the prevalence has remained very high in India at 39 per cent and 33 per cent respectively, in 2017. The prevalence of anaemia has been extremely high in India at 60 per cent in children and 54 per cent in women in 2017, with only moderate decline during 2010–17.

The prevalence of overweight children, on the other hand, has increased in India in the past decade, with a prevalence of 12 per cent in 2017.

These findings also raise concern about a host of policies in India which have been in practice since 1990 to tackle malnutrition, the key ones being Integrated Child Development Scheme launched in 1975, the National Nutrition Policy 1993, the Mid Day Meal Scheme for school children 1995, and the National Food Security Act 2013, as the prevalence of stunting, wasting and underweight remains high.

Substantial improvements across malnutrition indicators in the states of India would require an integrated nutrition policy to effectively address the broader determinants of undernutrition across the life cycle. These improvements include providing clean drinking water, reducing rates of open defecation, improving women’s status, enhancing agricultural productivity and food security, promoting nutrition sensitive agriculture, coupled with harmonisation of efforts across ministries and sectors, political will and good governance, and strategic investments in a multi-sectoral approach.