Why in News?

• For the fourth year in a row, Kerala has topped a ranking of States on health indicators; Uttar Pradesh has come in at the bottom.

About the Health Index:

• In 2017 the National Institution for Transforming India (NITI Aayog) in collaboration with the Ministry of Health and Family Welfare (MoHFW) and the World Bank initiated an annual Health Index for tracking Overall Performance and Incremental Performance across all states and Union Territories (UTs).
• In the current round of Health Index, three new indicators were added. These are Maternal Mortality Ratio (MMR), proportion of pregnant women received 4 or more ANCs and level of registration of deaths.
• The Health Index is a weighted Composite Index based on select indicators in three domains: (a) Health Outcomes; (b) Governance and Information; and (c) Key Inputs and Processes.
• The indicators have been selected based on their importance and availability of reliable data at least annually from existing data sources.
• The Health Index covers some of the SDG Targets and tracer indicators related to Goal 3 on Good Health and Well Being.

Key Findings of Health Index 2021:

• Nearly half the states and UTs did not reach the half way mark in the Composite Overall Index Score, and despite good performance, even the top ranking states and UTs could benefit from further improvements.
• The Health Index Score for the Reference Year (2019-20) revealed wide disparities in Overall Performance across the Larger States.
• Despite Good Performance, even the best performing states have significant room for improvement as the highest observed Overall Index Score was 82.20 for Kerala which is some distance from the frontier (maximum potential score is 100).
• There is large inter-state variation in Neonatal Mortality Rate (NMR), Under-five Mortality Rate (U5MR),
• Maternal Mortality Ratio (MMR) and Sex Ratio at Birth (SRB), the four key Health Outcome indicators.

State Specific Findings of Health Index 2021:

• Among the Larger States, Kerala, Tamil Nadu and Telangana emerged among the best three performers in terms of Overall Performance.
• Uttar Pradesh with the lowest Overall Reference Year (2019-20) Index Score ranked at the bottom (Rank 19) in Overall Performance, however, it ranked at the top in terms of Incremental Performance by registering the highest incremental change from the Base Year (2018-19) to Reference Year (2019-20).
• On the other hand, Kerala and Tamil Nadu were top two performers in terms of Overall Performance with the highest Reference Year (2019-20) Index Scores but ranked twelfth and eight respectively in terms of Incremental Performance.
• Telangana performed well both in terms Overall Performance as well as Incremental Performance and secured the third position in both instances.
• For the fourth consecutive round Kerala emerged as the best performer in terms of Overall Performance.
• Among the Smaller States, Mizoram emerged as the best performer in Overall Performance as well as Incremental Performance
• Among UTs, Delhi and Jammu & Kashmir ranked among the bottom UTs in terms of Overall Performance but emerged as the leading performer in terms Incremental Performance.
• The report found that 14 out of 19 larger states, four out of eight smaller states, and five out of seven Union Territories showed an improvement in the health index score between 2019 and 2010 as compared to the base year.
• Kerala had the lowest neonatal mortality rate of five per 1,000 live births, while Madhya Pradesh had the highest rate at 35 per 1,000 live births.
• The state also had the lowest under-Five mortality rate and the highest number of sex ratio at birth (measured as numbers of Female children born per 1,000 male children).
• Himachal Pradesh showed the most Improvement in terms of neonatal mortality and under-five mortality. Punjab was ranked as the most improved state in terms of sex ratio at birth.

What are the Concerns?

• All Larger States had shortage of required Specialists at the district hospitals.
• In majority of the states, the LaQshya certification of DHs for Labour Room and Maternity OT was below 20 percent level.
• According to the available data, half the states registered a decline in state government Health Expenditure to total state expenditure from 2015-16 to 2016-17.

Way Forward:

• The Health Index is a useful tool to measure and compare the Overall Performance and Incremental Performance across states and UTs over time and nudging the states and UTs to shift the focus from inputs and outputs to outcomes.
• The Health Index has strengthened the culture of use of data at the state/UT level to monitor performance and is contributing to the agenda of improving availability, quality and timeliness of data.