The Second Edition of “Healthy States, Progressive India” Report released by NITI Aayog

On June 25, 2019, The National Institution for Transforming India (NITI) Aayog released the Second Edition of “Healthy States, Progressive India” Report. It ranked States and Union territories (UTs) innovatively on their year-on-year incremental change in health outcomes and their overall performance. It was developed by NITI Aayog with technical assistance from the World Bank in consultation with the Ministry of Health and Family Welfare (MoHFW).

Key Points:

• The Round II report focused on measuring and highlighting the overall performance and incremental improvement over a two year period- 2016-17 and 2017-18.
• It was released jointly by Vice Chairman of NITI Aayog Dr. Rajiv Kumar, Member of NITI Aayog Dr. VK Paul, Chief Executive Officer (CEO) of NITI Aayog Amitabh Kant and the Secretary of Ministry of Health & Family Welfare Preeti Sudan.
• The states were categorized as Larger States, Smaller States and Union Territories (UTs) to ensure comparison among similar entities.
• The Health Index was based on 23 indicators grouped into the domains of Health Outcomes, Governance and Information, and Key Inputs/Processes. Each domain was assigned weights based on its importance and was equally distributed among indicators.

Categorization
i. The States were categorized on the basis of reference year Index score range-

• Front-runners: top one-third
• Achievers: middle one-third
• Aspirants: lowest one-third

ii. They were categorized into four groups based on incremental performance-

• Not improved (<=0 incremental change)
• Least improved (0.01 to 2 points increase)
• Moderately improved (2.01 to 4 points)
• Most improved (>4 points increase)

Categorization of Larger States on incremental performance and overall performance
i. Among Larger States, Kerala, Andhra Pradesh and Maharashtra topped the list in terms of overall performance in the NITI Aayog’s Health Index 2019.
ii. Haryana, Rajasthan and Jharkhand emerged as the top three ranking States in terms of annual incremental performance. They 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 Community Health Centres (CHCs)/Primary Health Centres (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 (Information Technology) enabled Human Resources Management Information System.

Categorization of Smaller States on incremental performance and overall performance
i. In terms of overall performance, Mizoram was ranked first followed by Manipur.
ii. Tripura followed by Manipur were the top ranked States in terms of annual incremental performance.
iii. 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 the last three years and Completeness of IDSP reporting of P and L forms.

Categorization of Union Territories (UTs) on incremental performance and overall performance
i. In terms of overall performance, Chandigarh and Dadra and Nagar Haveli were ranked first and second respectively.
ii. In terms of annual incremental performance, Dadra and Nagar Haveli was ranked first and Chandigarh was ranked second.
iii. 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 the last 3 years, Proportion of Auxiliary Nursing Midwifery (ANM) positions vacant at Sub Centres, the Proportion of Staff Nurses positions vacant at PHCs and CHCs, Proportion of MO (Medical Officer) 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 (First Referral Units), Proportion of districts with functional Cardiac Care Units (CCUs), Proportion of ANCs registered within first trimester, Completeness of IDSP (Integrated Disease Surveillance Project) reporting of P and L forms, and transfer of National Health Mission (NHM) funds from State Treasury to implementation agency.

About NITI Aayog:
♦ Headquarters: New Delhi
♦ Formation: January 1, 2015