India’s Health Index

General Studies – Paper II (Health)

NITI Aayog Health Index 2018 report

• Report given by NITI Aayog + World Bank + Ministry of Health and Family Welfare.
• 1st Report (2018) – Healthy States Progressive India 2018 (includes 23 Indicators )
• 2nd Report in June 2019 – Kerala tops with a score of 74.01 and Uttar Pradesh last with a score of 28.61.
• The states were ranked in two ways: on the overall or historical performance and on the incremental performance.

2019 Report Includes :

1.  States have made progress towards achieving SDG goals in this index.
2. Kerala and Tamil Nadu have already achieved their 2030 target of having less than 12 Neo Natal Deaths in every 1000 live births.
3. Uttar Pradesh, Bihar, Odisha show worst performance.
4. Sikkim and Arunachal Pradesh have decreased performance.
5. NITI Aayog focuses on outcome rather than other infrastructural indicators e.g. decreasing mortality rates, process for evaluation etc.

 2018 Vs 2019.
Decline in performance of Uttar Pradesh, Bihar, Odisha, Madhya Pradesh, Uttarakhand.

Methodology used by NITI Aayog.

• Promotes cooperation between States and Union Territories.
• Transformative Action
• Annual Systematic Tool
• Multi pronged approach for improvement of health sector.
• Frames 2015-16 as base year
• 2017-18 as reference year for comparative study of improvement in health sector.

23 indicators grouped into 3 main domains.
1- Health outcome.
2- Governance and Information.
3- Key inputs and process.

States are divided into

• Larger States (Maharashtra, Andhra Pradesh, Kerala, Gujarat, Punjab, Himachal Pradesh),
• Smaller States (Mizoram, Tripura)
• Union Territories (Chandigarh, Dadra and Nagar Haveli).

Main indicators include child birth rate, sex ratio, NABH ( National Accreditation Board for Hospitals & Healthcare Providers) accreditation available, funds transfer, govt policy’s penetration etc.

Limitations
Critical areas such as infectious diseases, non-communicable diseases, mental health, governance and financial risk protection could not be fully captured in the index due to non availability of acceptable quality of data on annual basis.

India spends only 1.4% of GDP on health sector (India Spent Report). WHO suggests to invest at least 4-5% on health sector.India is reaching maternal and child healthcare target much before 2030.Regional differences are created due to lack of accessibility, Infrastructure, Technology and Services.

Government steps :

• Health is fastest growing sector in India.
• Will reach 280 billion in 2020.
• It is diversified and full of opportunity.
• September 23, 2018 pradhan Mantri jan arogya yojana.
  Cashless health Insurance cover upto 5 lakh covering 500 million poor citizens every year.

1. August 2018 Ayushman Bharat – National Health Protection Mission.
   Centrally sponsored scheme contributed both by center and state governments.
   Ratio of 60:40 for all states, 90:10 for hilly North-East states.
   Provides health care facilities to 10 crore urban and rural families.
2. Mission Indradhanush – Provides coverage of immunization in the country.Government reached 32 Million children and 8.4 Million pregnant woman over the last three years.No of vaccines increased from 7-12.
3. To address malnutrition among children Poshan Abhiyan.
4. Rastriya Bal Swastiya Karayakram provided 800 Million health check-ups and free referral treatments to 20 million children in 4 years.
5. Pradhanmantri Matru Vandana Yojana. – Expected to benefit 50 million pregnant women and lactating mothers.Enable DBT to compensate wage loss, adequate nutrition and adequate rest before and after delivery.
6. 2014- Pradhanmantri Surakshit Matrita Abhiyaan.
   Doctors pledge to give one day of service per month to this campaign.16 Million pre-natal care checks performed.

• India has improved in health care access from 1990 onwards.
• According to Global Burden on Diseases Study, released by Lancet Journal (famous global medical journal) India ranked 156/195 (1990) and improved to 145/195 (2016) in medical quality and accessibility.
• Though these indicators show increment in health sector, India lags behind it’s neighbors such as China, SriLanka, Bangladesh etc.
• Health care researchers say India obtained a score of 41.2 (2016) from 27.4 (1990).
• Despite improvement in score, India stand below an average score of 54.4

Health Care Access and Quality (HAQ)

When it comes to world rankings, India was ranked 145^th among 195 countries on Healthcare Access and Quality (HAQ) index in 2016.

• The index is based on 32 causes of death considered preventable with effective medical care.
• It assigns a 0-100 score to each of the 195 countries and territories assessed.

1. Goa and Kerala are toppers with increment of 60 points.
2. Delhi -56.2 , Himachal Pradesh – 51.7
3. India stand worse than Sudan, Equitorial Guinea,Namibia, and other sub-saharan African countries.
4. Highest performers are Norway, Netherlands, Finland, Luxembourg, Australia.

Health Care Delivery system in India.

• The healthcare system is categorised into two major components: public and private.
• The public healthcare system is made up of secondary and tertiary care institutions in key cities and provides basic healthcare facilities in the form of Primary Healthcare Centres in rural areas.
• The private sector provides the majority of secondary, tertiary, quaternary care institutions with a major concentration in metros, Tier-1 and Tier-2 cities.
• India’s healthcare industry is one of the fastest growing sectors and is expected to reach 280 billion by the year 2020.
• India is also one of the leading destinations for high end diagnostics services with tremendous capital investment for advanced diagnostic facilities.