Meghalaya and Mizoram have shown maximum annual incremental progress in the health sector among ‘Smaller States’.
This is as per the State Health Index report for 2019–20, released by Niti Aayog yesterday.
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.
Among the ‘Larger States’, in terms of annual incremental performance, Uttar Pradesh, Assam and Telangana are the top three ranking states. Among Union Territories, Delhi, followed by Jammu and Kashmir, showed the best incremental performance.
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 Dadra and Nagar Haveli and Daman and Diu and Chandigarh among the Union Territories.
Mizoram and Telangana were the only two states that demonstrated strong Overall Performance and showed most improvements in the Incremental Performance between the Base Year (2018-19) and Reference Year (2019-20).
Among the ‘Larger States’, Telangana, Maharashtra, Kerala, Tamil Nadu and Andhra Pradesh showed strong Overall Performance and also registered improvements in Incremental Performance. Assam and Uttar Pradesh, though among the bottom one-third performers in Overall Performance, did exceedingly well in Incremental Performance recording the highest progress from Base Year (2018-19) to the Reference Year (2019-20). Rajasthan was the weakest performer both in terms of Overall Performance and Incremental Performance.
In the case of ‘Smaller States’, Mizoram and Tripura registered strong Overall Performance, and at the same time showed improvements in Incremental Performance.
In case of ‘Smaller States’, although Meghalaya was in the category of bottom one-third performers in terms of Overall Performance, it recorded the highest progress from Base Year (2018-19) to the Reference Year (2019-20). None of the Union Territories, emerged as a strong performer in terms of Overall and Incremental Performance.
Although, Delhi, Jammu & Kashmir and Lakshadweep were in the category of bottom one-third performers in terms of Overall Performance, they did exceedingly well in Incremental Performance recording the highest progress from Base Year (2018-19) to the Reference Year (2019-20).
The largest increase in Health Outcomes Index Scores was observed by Assam (7.10 points) among ‘Larger States’, Meghalaya (25.29 points) among ‘Smaller States’ and Delhi (18.88 percentage points) among the ‘Union Territories’. The states and Union Territories with the largest decline in Index Scores in this domain were Chhattisgarh (-2.65 points), Goa (-22.30 points) and Chandigarh (-12.22 points).
There are wide disparities in the Key Inputs and Processes Domain Index Scores across states and Union Territories. Among the ‘Larger States’, the Key Inputs and Processes domain score of the best performing state Tamil Nadu (71.06) was 4.6 times that of the worst performing state of Bihar (15.31). In case of ‘Smaller States’, the Index Score of the best performing state Mizoram (61.90) was 2.6 times that of the lowest performer Manipur (23.46).
Among the Union Territories, the score of the best performer Dadra and Nagar Haveli and Daman and Diu (60.30) was about two times that of the lowest performer Lakshadweep (31.28). The gap between the best and the worst performers has increased among the ‘Larger States’ and ‘Smaller States’ whereas it declined for Union Territories.
The largest increase was observed by Madhya Pradesh (17.54 points) among ‘Larger States’, Meghalaya and Mizoram (10.40 and 10.32 points respectively) among ‘Smaller States’ and Puducherry (6.69 points) among Union Territories. The states/ Union Territories with the largest decline were Assam (-10.13 points), Sikkim (-6.48 points) and Chandigarh (-11.11 points).
The annual Health Index is an enabling tool for the state/ Union Territory governments to identify parameters in which states and Union Territories have improved, stagnated, or declined. The magnitude and direction of change at a composite level; as well as for each of the indicators of the Health Index is provided by the report. Incremental Performance tracking not only helps in nurturing optimism amongst states and Union Territories that have historically lagged in performance and are striving to make substantial improvements, but also reduces complacency among states and Union Territories that have historically done well.
The Health Index is conceptualised as a game changer, as it helps to shift the focus of the states and Union Territories from inputs, outputs and budget spends to health outcomes. It leverages co-operative and competitive federalism and facilitates states and Union Territories in focusing attention on better targeting of interventions and improving the delivery of health services. States and Union Territories with similar characteristics that have demonstrated improvement can learn from each other through sharing of experiences.
The SDG Targets covered in the Index include neonatal mortality rate, under-five mortality rate, maternal mortality ratio, institutional deliveries (proxy to skilled birth attendance) and total case notification of Tuberculosis (proxy to Tuberculosis incidence per 100,000 population).
Goal 3 UHC tracer indicators covered in the Index include percentage of incident TB cases that are detected and successfully treated and percentage of people living with HIV currently receiving antiretroviral therapy. The Index also covers indicators related to child immunisation, pregnancy and delivery care, and health work-force. However, the definitions do not exactly match with those used for tracer indicators due to issues around data availability.
