Kerala Ranks First in Overall Health Index

  • Kerala has once again ranked first in overall health index ranking, released by NITI Aayog  titled “Healthy States, Progressive India: Report on Rank of States and UTs”.  Uttar Pradesh is the worst performing state, as per the Report.
  • Among the smaller states, Mizoram has ranked first in overall performance while among Union territories, Chandigarh has ranked first.
  • The report ranks states and Union Territories based on their overall performance and incremental improvement in the States and the UTs for the period 2015-16 (base year) and 2017-18 (reference year).
  • This is the second edition of the Report. The first edition of the report had come out in February 2018, which measured the annual and incremental performances of States and UTs for period 2014-15 (base year) to 2015-16 (reference year).
About Health Index Report
  • The report has been prepared by NITI Aayog in collaboration with the Ministry of Health and Family Welfare with technical assistance from the World Bank.
  • The health index is a composite measure of States and Union Territories based on 23 health indicators including neonatal mortality rate, under-five mortality rate, proportion of low birth weight among new-borns, proportion of districts with functional Cardiac Care Units, full immunisation coverage and proportion of specialist positions vacant at district hospitals. 
  • Besides outcomes in several health indicators, it also take into account governance and impact of policy decisions.
  • The ranking was done under three categories — larger states (21), smaller states (8) and Union territories (7)  to ensure comparison among similar entities.
State of the States 
  • Kerala (overall score: 74.01), Andhra Pradesh (overall score: 65.13) and Maharashtra (overall score: 63.99) have emerged as the first, second and third in terms of overall health performance respectively.
  • Haryana, Rajasthan and Jharkhand are the top three states in terms of incremental performances (among larger states).
  • In the first edition of report published in 2018, Kerala, Punjab, and Tamil Nadu had ranked on top in terms of overall performance, while Jharkhand, Jammu and Kashmir, and Uttar Pradesh were the top three ranking states in terms of annual incremental performance.
  • The changes in ranking come as Andhra Pradesh and Maharashtra have improved in indicators like low birth weight and full immunization coverage while Punjab and Tamil Nadu have deteriorated.
  • The report added that among the eight Empowered Action Group States, only three States — Rajasthan, Jharkhand and Chhattisgarh — showed improvement in the overall performance. The other five states -Bihar, Uttar Pradesh, Uttarakhand, Madhya Pradesh, and Odisha  -showed decline in overall performance because of deterioration in various parameters.
  • Uttar Pradesh continued to be at the bottom of the list with its score falling to 28.61. Other States at the bottom of the list were Bihar (32.11), Odisha (35.97) and Madhya Pradesh (38.39).
  • Uttar Pradesh and Bihar remain the worst performing as they have fared badly in indicators such as sex ratio, success rate of treatment of TB cases and time taken for transfer of funds under National Health Mission.

The Report noted that the health outcomes of some States are comparable to that of some upper middle-income countries and high income countries (for example, Neonatal Mortality Rate in Kerala is similar to that of Brazil or Argentina), while some other States have health outcomes similar to that in the poorest countries in the world (for example, NMR in Odisha is close to that of Sierra Leone).

Changes in Sex Ratio
  • The Sex Ratio at Birth (SRB) measures the number of girls born for every 1,000 boys born.
  • The sex ratio at birth is now the highest in Chhattisgarh at 963, which has now overtaken Kerala. Kerala’s sex ratio at birth has fallen from 967 to 959.
  • Kerala and Chhattisgarh are the only two States with a Sex Ratio at Birth (SRB) of more than 950.
  • Haryana has the worst sex ratio at 832 although this is a slight improvement from 831.
  • UP has also improved a bit from 879 to 882.

Other Parameters
  • The Neonatal mortality rate is the number of children under 28 days of age who die per 1,000 births in that year and the Under-5 mortality rate is the number of children under the age of 5 who die per 1,000 births.
  • UP, Bihar, Odisha and Madhya Pradesh have the poorest rates among both neonatal as well as under-5 mortality rates and Kerala ranks best in both categories.
  • With regard to Sustainable Development Goals, Kerala and Tamil Nadu have already reached the 2030 target for Neonatal Mortality Rate — at 12 births per 1000.
  • Kerala, Tamil Nadu, Maharashtra and Punjab have already achieved the SDG target related to Under-Five Mortality Rate (U5MR) — at 25 deaths per 1,000, according to the report.
Concerns for Kerala
  • Despite having a high overall score of 74.01%, when it comes to incremental performance, Kerala falls in the “not improved” category.
  • The overall performance score of the State has also gone down slightly from 76.56 in the first Health Index in 2015-16 to 74.01 in 2017-18.
  • Also when compared to the scores in the base year (2015-16), Kerala seems to have actually gone down slightly on many counts in the reference year (2017-18).
  • In the Health Outcomes domain, Kerala has gone down slightly by 2.99 points, while it is 5.7 points down when it comes to performance in Key Inputs/Processes domain.
  • Kerala’s Sex Ratio at birth (SRB) has shown a decline from 967 in 2013-15 to 2014-16. It reflects the extent to which gender discrimination leads to sex-selective abortion.
  • The proportion of fully immunised children between nine and 11 months of age in Kerala shows an increase from 94.6 % in 2015-16 to 100 % on 2017-18.
  • The proportion of institutional deliveries in the State during the same period has shown a decline from 92.6 % to 90.9 %.
  • TB total case notification rate in Kerala declined from 139 (per one lakh population) to 67 between 2016 and 2017.

Way Forward
  • The report stated that even the top-ranking states could further benefit from improvements in certain indicators as the highest observed Index score of 74.01 is well below 100. 
  • Vinod Kumar Paul, member of NITI Aayog also opined that the country will need to spend at least 2.5% of its gross domestic product on health. The state governments should also scale up their health spends from an average of 4.7% to 8% of their budget.
Read Dr. B. Iqbal’s article on NITI Aayog Report
Download NITI Aayog Report “Healthy States, Progressive India” 

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