NITI Aayog and Ministry of Health and Family Welfare (MoHFW) has released the 2nd edition of health index "Healthy States, Progressive India" report1, which measures Indian states and union territories on the basis of their year-on-year incremental improvement in health and overall performance. The ranking is categorized as Larger States, Smaller States and Union Territories (UTs), to ensure comparison among similar entities.
The Health Index, developed by the trio group of NITI Aayog, World Bank, and MOHFW, helps in measurement of improvements in health, and will also guides the health agencies in strategizing their interventions to further improve the health outcomes in the coming years.
The Health Index is a useful tool to measure and compare the overall performance and incremental performances across States and UTs over time. The Health Index is a weighted composite index based on 23 indicators grouped into the domains of Health Outcomes, Governance and Information, and Key Inputs/Processes, submitted by States and UTs on the online portal maintained by NITI Aayog excepting 12 indicators which can be pre-filled as per its availability in the public domain. The data is then validated by an Independent Validation Agency (IVA) and is used as an input for the generation of Index values and ranks:
- Ranks - The ranks are generated according to three categories of States (Larger States, Smaller States and UTs) to ensure comparability among similar entities.
- Incremental Performance- Incremental performance measures the change in the Health Index score from Base to Reference Year, which is marked by the year-specific rankings based on the Index score. The States are categorized into four groups based on incremental performance - not improved (<=0 incremental change); least improved (0.01 to 2 points increase); moderately improved (2.01 to 4 points), and most improved (>4 points increase).
- Overall performance: Overall performance is measured using the composite Index scores for Base and Reference Years. The States are also categorized on the basis of Front-runners: top one-third, Achievers: middle one-third, Aspirants: lowest one-third.
Larger States on incremental performance and overall performance:
Among the twenty one (21) Larger States, Kerala, Andhra Pradesh & Maharashtra ranked on top in terms of overall performance, while Haryana, Rajasthan and Jharkhand are the top three ranking States in terms of annual incremental performance from base to reference year in indicators such as Neonatal Mortality Rate (NMR), Underfive Mortality Rate (U5MR), Proportion Low Birth Weight among New-borns, Proportion of districts with functional Cardiac Care Units (CCUs), Proportion of ANCs registered within first trimester, Proportion of CHCs/PHCs with Quality Accreditation Certificates etc. The most significant progress in ranks has been observed in Andhra Pradesh followed by Rajasthan, improving their ranking by six and four positions respectively.
Bihar (ranked at the bottom) registered the most negative incremental change, and this is reflected in the deterioration of most health indicators such as TFR, LBW, SRB, institutional delivery, TB notification rate, TB treatment success rate, ANM and staff nurse vacancies, functional 24x7 PHCs, birth registration.
Smaller States on incremental performance and overall performance:
Among eight (8) Smaller States, Mizoram ranked first followed by Manipur on overall performance, while Tripura, Nagaland followed by Manipur were the top ranked States in terms of annual incremental performance on indicators such as full immunization coverage, institutional deliveries, total Case Notification Rate of Tuberculosis etc. While the remaining four States - Meghalaya, Goa, Sikkim, and Arunachal Pradesh registered a negative incremental change.
The indicators where most Smaller States need to focus include LBW, TB treatment success rate, average occupancy of State-level key positions, functional 24x7 PHCs, first trimester ANC registration and IDSP reporting.
UT on incremental performance and overall performance
Among UTs, Chandigarh and Dadra and Nagar Haveli were ranked on top in terms of overall performance as well as annual incremental performance. These two UTs showed the highest improvement in indicators such as total Case Notification Rate of Tuberculosis, Average Occupancy of an officer (in months) for 3 Key State posts for last 3 years, proportion of ANMs positions vacant at sub-centers, proportion of staff nurses positions vacant at PHCs and CHCs, proportion of MO positions vacant at PHCs, proportion of total staff (regular and contractual) with e-pay slip generated in the IT enabled Human Resources Management Information System etc. Four UTs dropped in the ranking - Lakshadweep from first to third, Delhi from third to fifth, Andaman and Nicobar Islands from fourth to sixth, and Daman and Diu from sixth to seventh.
The indicators where most UTs need to focus include full immunization, average occupancy of State level key positions and District CMOs, filling vacancies of specialists at district hospitals, functional 24x7 PHCs and quality accreditation of public health facilities.
Note - The Health Index helps to understand the variations and complexities of the country's performance in health. The first edition of Health Index had received a great response and initiated many fruitful discussions, including how to improve the data collection system to measure health performance, and how to promote positive competition and learning among the States and UTs. The current edition highlights the areas which require focus from States/UTs to improve their overall health outcomes/performance.
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