Kerala tops Niti Aayog health index report, UP fares worst

Kerala topped the Niti Aayog's health index report, while Uttar Pradesh finished at the bottom among larger states. Among the large states, Kerala was followed by Punjab, Tamil Nadu and Gujarat. Besides Uttar Pradesh, Rajasthan, Bihar and Odisha are among the states that performed poorly.

But, among large states, Jharkhand, Jammu & Kashmir and Uttar Pradesh are in the top three in terms of annual incremental performance. Among small states, Mizoram ranked first, followed by Manipur and Goa.

Traditionally know to have good health systems and an expectation that comes along to maintain it, states like Gujarat, Tamilnadu and Himachal Pradesh have slipped down in yearly index assessment of Niti Aayog in terms of health care delivery systems, a report released by Niti Aayog states. 

Niti Aayog analysed 24 key indicators including infant deaths, immunization, out-of-pocket-expenditure, vacancies in health facilities, functioning cardiac care units, average number of days taken for transfer of funds and so on. 

Comparison between 2014 - 15 and 2015 - 16 data suggests that these states inspite of having better health facilities than other states, have not been able to keep up their performance and have slipped down. 

While Gujarat figures in top 3 states who have good healthcare systems, Bihar falls in the bottom three states with abominable facilities. While after the 2018-19 the nation is vying to get 1.5 lakh health and wellness sub-centres, on ground, realities paint a dismal picture. Human resources to run these centres are sparse. The report noted that Gujarat registered a significant decline in sex ratio at birth (SRB)  from 907 to 854 females per 1000 males that has dragged down its incremental progress. Haryana’s SRB has declined too, from 866 to 831. 

Gujarat reported 28% vacancies in Auxilliary Nurse Midwife (ANM) positions in 2015-16, next only to Bihar, which reported close to 59% vacancies, according to data compiled by Niti Aayog from states.  All other states have reported less than 25% vacancies. Vacancies of nurses have increased from 11.8% to 16% in Tamilnadu, too. 

Even as the top performers have registered a decline in performance, other states which have slipped down are Karnataka, West Bengal, Telangana, Haryana, Uttarakhand, Assam, Odisha. The silver lining is that states like Punjab, Andhra Pradesh, Jammu and Kashmir, Chattisgarh and Jharkhand have registered over-all improvement.

Amitabh Kant, CEO, Niti Aayog lauded states like Jharkhand and Jammu and Kashmir (J&K) who have improved and have a strong public health system in place. Jharkhand has reduced its under-five mortality rate (UMR) from 44 to 39 per 1000 live births while J&K has reduced its UMR from 26 to 20.

Niti Aayog in a unique data analysis effort has mapped average occupancy of an officer for three key posts - Principal Secretary, National Health Mission Director and Director Health Services. In Karnataka, the average occupancy of these three officers was the worst of the lot, barely six months, when they should occupy positions for atleast three years.

Another shocking revealation is that of all states and Union Territories, upto 16 do not have functional cardiac care units (CCUs) in public hospitals. While other states have established CCUs in over 50% of their districts and are progressing, Gujarat’s performance has plummetted, with 57.7% of its CCUs working in 2014-15, which has declined to 48.5% in 2015-16. 

Further, Niti Aayog has also analysed the average number of days it takes for state to transfer money to the implementation agency. Telangana was the worse, with upto 287 days of delay in transfer of funds. 

Union Health Secretary Preeti Sudan said that going forward the Ministry of Health and Family Welfare will use Niti Aayog’s health index data to incentivize states to perform better. “Out-come based monitoring is the only way to measure quality in performance. Fiscal incentives of the NHM funds flexi-pools will be linked to performance. Incase of states that improve performance, their incentives will be hiked from 10% to 20%,” said Sudan.