States and UTs have been ranked in three categories namely, Larger States, Smaller States, and Union Territories (UTs), to ensure comparison among similar entities. The Health Index is a weighted composite Index, which for the larger States, is based on indicators in three domains: (a) Health Outcomes (70%); (b) Governance and Information (12%); and (c) Key Inputs and Processes (18%), with each domain assigned a weight based on its importance.
Among the Larger States, Kerala, Punjab, and Tamil Nadu ranked on top in terms of overall performance, while Jharkhand, Jammu & Kashmir, and Uttar Pradesh are the top three ranking States in terms of annual incremental performance. Jharkhand, Jammu & Kashmir, and Uttar Pradesh showed the maximum gains in improvement of health outcomes from base to reference year in indicators such as Neonatal Mortality Rate (NMR), Under-five Mortality Rate (U5MR), full immunization coverage, institutional deliveries, and People Living with HIV (PLHIV) on Anti-Retroviral Therapy (ART).
Among Smaller States, Mizoram ranked first followed by Manipur on overall performance, while Manipur followed by Goa were the top ranked States in terms of annual incremental performance. Manipur registered maximum incremental progress on indicators such as PLHIV on ART, first trimester antenatal care (ANC) registration, grading quality parameters of Community Health Centres (CHCs), average occupancy of key State-level officers and good reporting on the Integrated Disease Surveillance Programme (IDSP).
Among UTs, Lakshadweep showed both the best overall performance as well as the highest annual incremental performance. Lakshadweep showed the highest improvement in indicators such as institutional deliveries, tuberculosis (TB) treatment success rate, and transfer of National Health Mission (NHM) funds from State Treasury to implementation agency.
The Health Index report notes that while States and UTs that start at lower levels of development are generally at an advantage in notching up incremental progress over States with high Health Index scores, it is a challenge for States with high Index scores to even maintain their performance levels. For example, Kerala ranks on top in terms of overall performance but sees the least incremental change as it had already achieved a low level of Neonatal Mortality Rate (NMR) and Under-five Mortality Rate (U5MR) and replacement level fertility, leaving limited space for any further improvements.
However, the incremental measurement reveals that about one-third of the States have registered a decline in their performance in 2016 as compared to 2015, stressing the need to pursue domain-specific, targeted interventions. Common challenges for most States and UTs include the need to focus on addressing vacancies in key staff, establishment of functional district Cardiac Care Units (CCUs), quality accreditation of public health facilities and institutionalization of Human Resources Management Information System (HRMIS). Additionally, almost all Larger States need to focus on improving the Sex Ratio at Birth (SRB).
Linking this Index to incentives under the National Health Mission by the Ministry of Health and Family Welfare underlines the importance of such an exercise. The report also notes that rich learnings have emerged in the first year and these will guide in refining the Index for the coming year and also address some of the limitations. It notes that there is an urgent need to improve data systems in the health sector, in terms of terms of representativeness of the priority areas, periodic availability for all States and UTs, and completeness for private sector service delivery. This Index is expected to nudge States towards further achieving a rapid transformation of their health systems and population health outcomes.
Health Index has been developed as a tool to leverage co-operative and competitive federalism to accelerate the pace of achieving health outcomes. It would also serve as an instrument for “nudging” States & Union Territories (UTs) and the Central Ministries to a much greater focus on output and outcome based measurement of annual performance than is currently the practice. With the annual publication of the Index and its availability on public domain on a dynamic basis, it is expected to keep every stakeholder alert to the achievement of Sustainable Development Goals (SDGs) Goal # 3.
News Update | 2 January 2018| Cabinet apprised of Progress under NHM
Salient Features and outcomes achieved under the NHM
Decline by 2.7% in the Maternal Mortality Ratio (MMR) to 130 during 2014-16 from 178 during 2010-12;
Decline in the Infant Mortality Rate (IMR) to 34 in 2016 as compared to 44 in 2011.
The annual rate of decline of IMR between 2015 and 2018 was 8.1%;
Decline in the Under 5 Mortality Rate (U5MR) to 39 in 2016 from 55 in 2011.
The U5MR annual rate of decline during 2015-16 was 9.3%;
Decline in the Total Fertility Rate (TFR) to 2.3% in 2016, from 2.3% in 2011.
The percentage annual compound rate of decline in TFR during 2011-16 has been observed as 1.7%
Improvement in diseases-related health indicators under National Health Mission
- In respect of Malaria, the Annual Parasite Incidence (API) declined to 0.84 in 2016 from 1.10 in 2011. In 2017 malaria incidence went down by 30% and deaths due to malaria decreased by 70%;
- The incidence of Tuberculosis (TB) per 1 lakh population has been reduced to 204 in 2017, from 234 in 2013. Incidence of TB per lakh population has been reduced to 204 in 2017 from 211 in 2016. Mortality due to TB per lakh population for India reduced to 21 in 2017 from 32 in 2016;
- The target of prevalence of leprosy <1/one lakh population has been achieved nationally. The number of districts that achieved elimination of leprosy has increased from 554 in 2017 to 571 by March 2018;
- Incidence of Kala Azar was to reduce it to less than 1 case per 10000 population in all blocks. The number of endemic blocks with prevalence of more than 1 case per 10000 population has been reduced to 72 in 2017, from 94 in 2016; and
- Reduction of diseases attributable to Tobacco use, like 4 major Non-Communicable Diseases (NCDs) namely Cancers, diabetes, Stroke and Cardiovascular diseases, and chronic lung diseases has been achieved through measures for bringing down prevalence of tobacco use by 6% average points, to 28.6% in 2016-17 from 34.6% in 2009-10.