GS2: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.


What is the issue?

  • The second edition of NITI Aayog’s Health Index was recently released in its report titled ‘Healthy States, Progressive India: Report on Rank of States and UTs’.


  • The report has been developed by NITI Aayog, with technical assistance from the World Bank, and in consultation with the Ministry of Health and Family Welfare (MoHFW).
  • The report ranks states and Union territories innovatively on their year-on-year incremental change in health outcomes, as well as, their overall performance with respect to each other.
  • It aims to establish an annual systematic tool to measure and understand the heterogeneity and complexity of the nation’s performance in Health.
  • The Index ranks the States and Union Territories based on 23 health-related indicators which include –
    • neonatal mortality rate
    • under-five mortality rate
    • proportion of low birth weight among new-borns
    • progress in treating tuberculosis and HIV
    • full immunisation coverage
    • improvements to administrative capability and public health infrastructure
    • proportion of districts with functional Cardiac Care Units
    • proportion of specialist positions vacant at district hospitals
  • The report has ranking in three categories – larger States, smaller States and Union Territories, to ensure comparison among similar entities.
  • The Health Index does not capture other related dimensions, such as non-communicable diseases, infectious diseases and mental health.
  • It also does not get uniformly reliable data, especially from the growing private sector.


Need for the health Index

  • 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 number 3.

Highlights of the report

  • Kerala continued to top the list for the best performing State in the health sector among the 21 large States.
  • Kerala was followed by Andhra Pradesh, Maharashtra, Gujarat and Punjab, Himachal Pradesh, Jammu and Kashmir, Karnataka and Tamil Nadu.
  • Andhra Pradesh and Maharashtra have had the additional distinction of making incremental progress from the base year.
  • Uttar Pradesh retains the worst performer tag in the index.
  • Uttar Pradesh continued to be at the bottom of the list with its score falling to 28.61; Kerala got a score of 74.01.
  • Other States at the bottom of the list are Bihar (32.11), Odisha (35.97) and Madhya Pradesh (38.39).
  • Among the UTs, Chandigarh jumped one spot to top the list with a score of (63.62).
  • It is followed by Dadra and Nagar Haveli, Lakshadweep, Puducherry, Delhi, Andaman and Nicobar and Daman and Diu (41.66).
  • Overall, only about half the States and UTs showed an improvement in the overall score between 2015-16 (base year) and 2017-18 (reference year).
  • Among the 8 Empowered Action Group States, only 3 States (Rajasthan, Jharkhand and Chhattisgarh) showed improvement in the overall performance.

Concerning issues on Health

  • Even though Kerala is the topper, its performance has slumped form the last year.
  • Some States and Union Territories are doing better on health and well-being even with a lower economic output.
  • In contrast, others are not improving upon high standards, and some are actually slipping in their performance.
  • In the assessment during 2017-18, a few large States showed less encouraging progress.
  • This reflects the low priority their governments have accorded to health and human development since the first edition of the ranking for 2015-16.
  • The disparities are very evident in the rankings, with the populous and politically important Uttar Pradesh being in the bottom of the list.

Criticism over the index

  • States like Tamil Nadu points to the inherent inconsistencies and contradictions in the NITI Aayog’s health index.
  • Some of the methodologies used in the Health Index are questioned for its parity with other similar tools.
  • There is also criticism over the purposeful degrading of certain states by the NITI Aayog in the current index.
  • Niti Aayog’s health index is less helpful for state governments, than it should have been.
  • A single set of indicators used for comparison across all states is a very simplistic proposition considering the vast differences in socio economic contexts, histories and complexities across states.
  • some of the most vital goals of health systems, like the reduction of catastrophic health expenditures and impoverishment due to healthcare, which have been addressed through very high profile initiatives, are not included in the list though data is available.

Way forward

  • For the Health Index concept to encourage States into action, public health must become part of the mainstream politics.
  • The Centre has paid attention to tertiary care and reduction of out-of-pocket expenses through financial risk protection initiatives such as Ayushman Bharat.
  • But several States lag behind when it comes to creating a primary health care system with well-equipped PHCs (Primary Health Centres) as the unit.
  • Neglect of such a reliable primary care approach affects States such as Bihar where infant and neonatal mortality and low birth weight are high.
  • Special attention is needed to raise the standards of primary care in low performing states such as Odisha, Madhya Pradesh, Uttarakhand, Rajasthan, Assam and Jharkhand.
  • State governments now have greater resources at their command under the new scheme of financial devolution.
  • So States, in partnership with the Centre, must use the funds to upgrade and transform the primary health care.

# Practice Question

  1. Niti Aayog’s health index is found less helpful for state governments, than it should have been. Explain (150 words)