Some states are making headway but good news is drowned out by bad
In quantifying the outcomes of efforts to improve the public health system, Niti Aayog’s Health Index which ranks states for best performance and incremental improvements is an important initiative. Such rankings, even when methodology and data collection practices can improve, offer a comparative framework to understand the strengths and weaknesses of states. Kerala again topped the table. Andhra Pradesh, Haryana, Jharkhand and Rajasthan lead among 12 big states showing incremental improvement. But the big worry is that Uttar Pradesh and Bihar, among India’s most backward states, are showing marked deterioration.
The index has measured 23 wide-ranging health indicators. These include outcomes like neonatal mortality rate, under-5 mortality rate, sex ratio at birth, immunisation coverage and institutional deliveries, as well as governance inputs like stability of tenure for top medical officers, vacancy positions in public health facilities, proportion of accredited health facilities and time taken for NHM fund transfer. Such indicators tell their own story, especially at a time when the leader, Kerala, and one of the laggards, Bihar, found their systems under test.
After last year’s Nipah outbreak in which 17 out of 18 infected patients died, although a strong public health response stopped the infection from spreading, Kerala prepared well for the virus’s second coming and there has been no casualty or contagion this time. In dire contrast, failure to learn from repeated outbreaks in Muzaffarpur over two decades has left over 150 young children dead due to acute encephalitis syndrome this month. JD(U) has enjoyed 14 uninterrupted years in power and must account for the hundreds of crores of NRHM and NHM funds given to Bihar over this period, without matching improvement in public health infrastructure to show for them.
Where states show improvement, a lot of it comes from improving basic primary healthcare. Rajasthan and Haryana have attributed their 40% decline in proportion of low birth weight newborns to early registration of pregnancies and early detection/ management of high risk pregnancies. In Chhattisgarh and Jharkhand, institutional deliveries increased by over 10 percentage points. These gains wouldn’t have been possible without institutional will at the political or bureaucratic levels and may be replicable. Some southern states today have more doctors than WHO norms of 1 doctor per 1,000 people. Backward states with doctor shortages must offer better service conditions to woo such doctors away from their home states. Robust sharing of best practices and resources is the way to go.
This piece appeared as an editorial opinion in the print edition of The Times of India.