States must improve their health spending
There is room for improvement, including in the high-performing onesUpdated: Jun 26, 2019 19:40 IST
The overall health index score of India’s best-performing state is two-and-a-half times that of the worst, found the NITI Aayog’s State Health Index report, which recorded scores ranging from 74.01 in Kerala to 28.61 in Uttar Pradesh. The neonatal mortality rate (NMR) in Kerala is similar to that of Brazil or Argentina, but NMR in other states remains comparable with the world’s poorest nations (NMR in Odisha, for instance, remains close to that of Sierra Leone in sub-Saharan Africa). The outcomes of poor public health delivery are starkly evident when outbreaks occur, with Kerala clinically controlling a potential outbreak of the dangerous Nipah virus disease, while Bihar has been struggling to prevent deaths from the annual acute encephalitis syndrome outbreaks.
There is no indication that the massive disparities between the best and worst performing states is decreasing against the base year 2014-15. The health index scores, which are a measure of 23 indicators grouped under the domains of health outcomes, governance and information, and key inputs/processes in public health care delivery, have increased marginally in 12 states, but have slipped in many, including Kerala. There is room for improvement across all states, including the high performing ones. Some top performers score significantly better in some domains but lag in others, which must be seen as an opportunity to design targeted interventions to improve overall scores in the underperforming areas.
Most states need to focus on improving sex ratio at birth; tuberculosis treatment success rate; vacancies among auxiliary nurse midwife (village health worker); functional 24x7 primary health centres; birth registration; and fund-transfer delays to improve healthcare delivery. All states also need to raise public health spending to at least 8% of their GDP to meet the National Health Policy 2017 goal of raising India’s public health spending from the current national average of 1.4% to 2.5% of the GDP by 2025.