The state performed worse than last time and those with a not-so-good overall score showed improvement
Niti Aayog’s second ‘Healthy States, Progressive India’ report, which rates the performance of states on 23 health parameters crucial to meeting the Sustainable Development Goals, has provided a dismal picture.
Despite economic growth, health status indicators have not improved, according to the report released on June 25, 2019. The planning body divided all states in two categories —large and small — and the Union territories made the third category.
The best states scored more than 2.5 times more than the worst performing states, found the report. While Kerala got 74.01, Uttar Pradesh’s score was 28.61. But among the smaller states, Mizoram had a score of 74.97, more than that of Kerala.
The more crucial question here is if the states are improving. As this is the second such report, Niti Ayog has also had a base year to compare — 2015-2016 to 2017-18.
This comparison showed that Haryana, Rajasthan and Jharkhand, which do not have a good overall score, improved the most. This is when Kerala, which topped the index, has not performed as good as it did two years ago.
The problem is here: performance of the bottom five states — Uttar Pradesh, Bihar, Odisha, Madhya Pradesh and Uttarakhand — slumped.
Bihar, which at present is dealing with an Acute Encephalitis Syndrome outbreak, is a case in point. The state registered the most negative incremental change.
The Niti Ayog attributes this to the deterioration of health indicators such as high total fertility rate, low birth weight, skewed sex ratio at birth, fewer institutional delivery, low tuberculosis notification rate resulting it a poor treatment success rate, high numbers of ANM and staff nurse vacancies, lack of functional 24x7 public health centres, poor reporting of disease and non-availability of quality and accredited health facilities.
This is despite the fact that Bihar is part of the Empowered Action Group states which receive special support from the government.
Can understanding Bihar’s failure help the country device better health policies? In 2016, an analysis of National Sample Survey Office data by Brookings India showed that the state has the highest dependence of private health care and the lowest government spending on health. This means that people have to pay out of their pockets for the smallest of health issues.
But, the Niti Aayog’s latest report indicated that things have worsened. Proportion of district hospital, sub-district hospital, community health centres and primary health centres has reduced between the two reports. Other programmes, such as immunisation of children and treatment of TB where the government has a role to play, have also deteriorated.
The performance of the state health machinery too has taken a hit. There are not enough auxiliary nurse midwives, staff nurses at health centres and even the number of medical officers at prime healthcare centres has declined.
There can be no better example than Bihar of how poor public health system can pull a state back. It is also a fact that the state is incapable of spending the available money.
In response to a question asked in the Lok Sabha in March 2018, it was revealed that of Rs 124.05 crore approved for hospital strengthening and new construction, renovation and setting up under National Health Mission, only Rs 45.02 crore were spent in 2016-17.
Instead of improving the public health system, the government has decided to depend more on the private health system. Even its insurance schemes, like the Ayushman Bharat, promote private health providers.
This goes against what people want. People in Bihar want improved public health systems, highlighted a study by Brookings India published in April 2019. In this survey, people were voted against direct cash benefits if it came at the cost of improved public health and nutrition services. The same group of respondents preferred direct benefit transfer to benefits of other services such as roads.
The Niti Aayog’s index is yet another proof that public health system needs to be improved. Kerala, where incremental performance has gone down by 2.55 points, has deteriorated in key public health interventions such as availability of accredited community and primary health centres.
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