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Kerala tops NITI Aayog’s ‘Health Index’


Kerala has emerged as the state with the best overall health performance for the fourth consecutive year according to federal think tank NITI Aayog’s fourth Health Index report.


GS-II: Social Justice and Governance (Issues related to Health, Government Policies and Initiatives)

Dimensions of the Article:

  1. About NITI Aayog’s Health Index
  2. Highlights of the NITI Aayog’s Health Index Round IV 2019-20
  3. Way Forwards

About NITI Aayog’s Health Index

  • The health index was developed in 2017 by NITI Aayog, with technical assistance from the World Bank, in consultation with the Ministry of Health and Family Welfare.
  • The Weighted Composite Index score is prepared based on States’ performance across a large set of 24 indicators (in the latest Round 4 as of 2021) that are divided into three broad domains — health outcomes, governance and information, and key inputs and processes.
  • The Health Index covers some of the Sustainable Development Goals (SDG) targets and tracer indicators related to SDG-3 on Good health and Wellbeing.
  • The ranking is done under three categories larger states, smaller states and Union territories (UTs) to ensure comparison among similar entities.
  • The learnings from the previous three rounds of the Health Index were taken into account to develop the Health Index Round IV 2019-20 –
    • Maternal Mortality Ratio (MMR),
    • the proportion of pregnant women who received four or more antenatal care checkups (ANC) and
    • level of registration of deaths.

Range of Indicators

  • Health outcomes, for instance, includes parameters such as neonatal mortality rate, under-5 mortality rate, sex ratio at birth.
  • Governance includes parameters such as institutional deliveries, average occupancy of senior officers in key posts earmarked for health.
  • The ‘key inputs’ domain consists of proportion of shortfall in health care providers to what is recommended, functional medical facilities, birth and death registration and tuberculosis treatment success rate.

Highlights of the NITI Aayog’s Health Index Round IV 2019-20

All about the ranks

  • For the fourth year in a row, Kerala has topped a ranking of States (larger states) on health indicators.
  • Among the larger states, Kerala and Tamil Nadu ranked first and second in terms of overall performance – However, in incremental performance, the two ranked 12th and 8th respectively.
  • Uttar Pradesh is ranked in the bottom of the Health Index in overall performance.
  • Ten States including Kerala, Tamil Nadu, Maharashtra, Chhattisgarh, Haryana, Jharkhand, Rajasthan, Madhya Pradesh, Bihar and Uttar Pradesh retained their rank while four States improved their rankings from the base year-to-reference year. Five states saw a decline in their ranking, with Odisha recording the steepest (two spots) and Andhra Pradesh, Himachal Pradesh, Karnataka and Uttarakhand slipping one each.
  • Mizoram emerged as the best performer, overall as well as incremental, among the smaller states. Nagaland was at the bottom.

What the indicators say?

  • 47% of States showed the highest performance in health outcomes and governance and information domains and only one State showed the highest performance in the key inputs and processes domain.
  • A review of the incremental performance across indicators/sub-indicators revealed that a vast majority of the larger states registered improvement in performance across the key health outcome indicators — ‘neonatal mortality rate’, ‘under-five mortality rate, ‘sex ratio at birth’ and ‘maternal mortality rate’.
  • The better performing States such as Kerala, Tamil Nadu, Telangana, Andhra Pradesh and Maharashtra performed comparatively better on the health outcomes domain, but performed badly on key inputs and processes.
  • Based on the reference year values for NMR, U5MR and MMR, the states were classified in three categories, i.e., aspirants, achievers and frontrunners.
  • In case of NMR and U5MR, five states qualified for the ‘frontrunner’ category — Himachal Pradesh, Kerala, Maharashtra, Punjab and Tamil Nadu — and the NMR in these states ranges between 5 and 13 neonatal deaths per 1,000 live births.
  • Kerala and Tamil Nadu have already reached the Sustainable Development Goals (SDG) NMR target, recording 12 neonatal deaths per 1,000 live births, while Himachal Pradesh, Maharashtra and Punjab, with 13 neonatal deaths per 1,000 live births, are likely to hit the target soon.
  • Among the larger states, the highest percentage of institutional deliveries was recorded by Kerala in 2014-15 (96 per cent) and Telangana in 2019-20 (96.3 per cent).
  • The lowest percentage of institutional deliveries was registered in Uttar Pradesh, both in 2014-15 (43.6 per cent), and in 2019-20 (60.8 per cent).

Report doesn’t include Covid impact

  • The indicators are selected on the basis of their importance and availability of reasonably reliable data at least annually from existing data sources such as the Sample Registration System, Civil Registration System and Health Management Information Systems.
  • The report, however, does not incorporate the impact of Covid-19 on health outcomes or any of the other indicators as the index performance relates to base year (2018-19) and reference year (2019-20), largely the pre-Covid period.
  • For the fourth edition of the health index report, all states and UTs participated except West Bengal. Ladakh was not included due to non-availability of data.

Way Forwards

  • Several States are significantly better in one domain suggesting that there was scope to improve their performance in the other domains with specific targeted interventions.
  • Intra-State inequalities in health performance have to be addressed.
  • Both the Centre and the States have to scale up their investment on health as a percentage of their budgets.
  • 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
    • institutionalization of Human Resources Management Information System (HRMIS).
  • The index could be linked to incentives offered under the National Health Mission by the Ministry of Health and Family Welfare.

-Source: The Hindu

December 2023