Healthy States, Progressive India Report

"Healthy States, Progressive India" is a comprehensive Health Index report released by the NITI Aayog. 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. 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).

Salient features

• States and UTs have been ranked in three categories namely, Larger States (21), Smaller States (8), and Union Territories (UTs)(8), to ensure comparison among similar entities.
• The Health Index is a weighted composite Index, which for the larger States, is based on indicators in three domains: (a) Health Outcomes (70%); (b) Governance and Information (12%); and (c) Key Inputs and Processes (18%), with each domain assigned a weight based on its importance. The Index includes 23 indicators which are used to calculate the composite index score and generate overall performance ranks and incremental ranks.
• Indicators selected based on importance and availability of reliable data from existing data sources (at least annually)
• The composite index score is calculated for a Base Year , which largely covers the 2014 - 15 period and a Reference year. The process of index refinement involved inputs from the States and UTs, national and international sector experts, and development partners. Data submitted by the States & UTs was validated by an Independent Validation Agency, following which index values and ranks were generated on the web portal (http://social.niti.gov.in), and certified by the Independent Agency.
• The web portal (http://social.niti.gov.in) provides all the details of the index – about index, guidebook on performance on health outcomes, state/UT category wise overall, incremental and domain - wise results (in form of tables, graphs etc.), indicator wise data (options available for download of data and results) and the health index report.

Utility

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.

Fourth Edition

Round IV of the report focuses on measuring and highlighting the overall performance and incremental improvement of states and UTs over the period 2018–19 to 2019–20.

Key results

• Among the ‘Larger States’, in terms of annual incremental performance, Uttar Pradesh, Assam and Telangana are the top three ranking states.
• Among ‘Smaller States’, Mizoram and Meghalaya registered the maximum annual incremental progress.
• Among UTs, Delhi, followed by Jammu and Kashmir, showed the best incremental performance.
• On overall ranking based on the composite index score in 2019–20, the top-ranking states were Kerala and Tamil Nadu among the ‘Larger States’, Mizoram and Tripura among the ‘Smaller States’, and DH&DD and Chandigarh among the UTs.

To access the complete report, click here.

Second Edition

The Round II report focuses on measuring and highlighting the overall performance and incremental improvement over a two year period (2016-17 and 2017-18) in the States and UTs.

Key results

• Among the Larger States, Kerala, Andhra Pradesh & Maharashtra ranked on top in terms of overall performance, while Haryana, Rajasthan and Jharkhand are the top three ranking States in terms of annual incremental performance. Haryana, Rajasthan and Jharkhand showed the maximum gains in improvement of health outcomes from base to reference year in indicators such as Neonatal Mortality Rate (NMR), Under-five Mortality Rate (U5MR), Proportion Low Birth Weight among New-borns, Proportion of districts with functional Cardiac Care Units (CCUs), Proportion of ANCs registered within first trimester, Proportion of CHCs/PHCs with Quality Accreditation Certificates, full immunization coverage, institutional deliveries, Proportion of Specialist positions vacant at District Hospitals and Proportion of total staff (regular and contractual) with e-pay slip generated in the IT enabled Human Resources Management Information System.
• Among Smaller States, Mizoram ranked first followed by Manipur on overall performance, while Tripura followed by Manipur were the top ranked States in terms of annual incremental performance. Manipur registered maximum incremental progress on indicators such as full immunization coverage, institutional deliveries, total Case Notification Rate of Tuberculosis, Average Occupancy of a District Chief Medical Officer for last three years and Completeness of IDSP reporting of P and L forms.
• Among UTs, Chandigarh and Dadra and Nagar Haveli were ranked on top in terms of overall performance (Chandigarh-1 and Dadra and Nagar Haveli-2) as well as annual incremental performance (Dadra and Nagar Haveli-1 and Chandigarh-2).  These two UTs showed the highest improvement in indicators such as total Case Notification Rate of Tuberculosis, Average Occupancy of an officer (in months) for 3 Key State posts for last 3 years, Proportion of ANMs positions vacant at Sub Centres, Proportion of Staff Nurses positions vacant at PHCs and CHCs, Proportion of MO positions vacant at PHCs, Proportion of total staff (regular and contractual) with e-pay slip generated in the IT enabled Human Resources Management Information System, Proportion of facilities functional as FRUs, Proportion of districts with functional Cardiac Care Units (CCUs),  Proportion of ANCs registered within first trimester, Completeness of IDSP reporting of P and L forms, and transfer of National Health Mission (NHM) funds from State Treasury to implementation agency.

First Edition

The composite index score is calculated for a Base Year, which largely covers the 2014-15 period and a Reference year, which largely covers the 2015-16 period.

Key results

• Among the Larger States, Kerala, Punjab, and Tamil Nadu ranked on top in terms of overall performance, while Jharkhand, Jammu & Kashmir, and Uttar Pradesh are the top three ranking States in terms of annual incremental performance. Jharkhand, Jammu & Kashmir, and Uttar Pradesh showed the maximum gains in improvement of health outcomes from base to reference year in indicators such as Neonatal Mortality Rate (NMR), Under-five Mortality Rate (U5MR), full immunization coverage, institutional deliveries, and People Living with HIV (PLHIV) on Anti-Retroviral Therapy (ART).
• Among Smaller States, Mizoram ranked first followed by Manipur on overall performance, while Manipur followed by Goa were the top ranked States in terms of annual incremental performance. Manipur registered maximum incremental progress on indicators such as PLHIV on ART, first trimester antenatal care (ANC) registration, grading quality parameters of Community Health Centres (CHCs), average occupancy of key State-level officers and good reporting on the Integrated Disease Surveillance Programme (IDSP).
• Among UTs, Lakshadweep showed both the best overall performance as well as the highest annual incremental performance. Lakshadweep showed the highest improvement in indicators such as institutional deliveries, tuberculosis (TB) treatment success rate, and transfer of National Health Mission (NHM) funds from State Treasury to implementation agency.

The Health Index report notes that while States and UTs that start at lower levels of development are generally at an advantage in notching up incremental progress over States with high Health Index scores, it is a challenge for States with high Index scores to even maintain their performance levels. For example, Kerala ranks on top in terms of overall performance but sees the least incremental change as it had already achieved a low level of Neonatal Mortality Rate (NMR) and Under-five Mortality Rate (U5MR) and replacement level fertility, leaving limited space for any further improvements.

However, the incremental measurement reveals that about one-third of the States have registered a decline in their performance in 2016 as compared to 2015, stressing the need to pursue domain-specific, targeted interventions. 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 and institutionalization of Human Resources Management Information System (HRMIS). Additionally, almost all Larger States need to focus on improving the Sex Ratio at Birth (SRB).

Source : NITI Aayog