NITI Aayog's Health Index 2019 has several takeaways for the country in its bid to strengthen the health sector and coverage. The second edition of 'Healthy States, Progressive India' report, recently released by NITI Aayog ranked all states and UTs in three categories for rational comparison of states. Unsurprisingly, Kerala topped the list but was classified as a "not improved" state despite the first position and laudable work in achieving UN sustainable development goals on infant mortality rate and under-five mortality rate way ahead of the deadline – 2030. Tamil Nadu followed on similar lines as Kerala and due to government's formula for computing performances, both states will be allocated a lesser share of India's health funding – National Health Mission (NHM). Since the Ministry of Health has linked NHM with the performance of states in this health index, states like Kerala and Tamil Nadu, whose performance deteriorated in 2017-18 as compared to 2015-16 are entitled to the lowest share of the Rs 34,000 crore NHM fund. While it is important that such an index is developed to identify areas of improvement and conduct a comprehensive analysis, such gaps where states may end up not benefitting much from the Central fund is a matter of concern. It is not like the poorer states will benefit much either. UP and Bihar have again taken the bottom position and it is important to note how performance in parameters has deteriorated signalling lesser share to them despite in grave need. For a minute, if Kerala can still end up managing health expenditure with little share from NHM, Uttar Pradesh and Bihar can't. But being tagged as "not improved", similar to Kerala, means even they will not be getting the major chunk of NHM irrespective of the fact that they really need it. And, this is not only a computation lacuna but rather poor performance on an average. Bihar and UP have abysmal readings of various parameters that NITI Aayog takes into consideration for developing such an index. Consistently appalling performance has led them to where they are in the index. Even so, efforts can be directed to change the 'not improved' status and put these needy states in the trajectory of registering positive shift in parameters and entitled for a bigger share of the NHM. The index grossly shows a snapshot of health in Indian states. The Hindi heartland states of UP, Bihar, Uttarakhand, Odisha, Madhya Pradesh show a similar trend of poor performance. Interestingly, this is the belt which also houses a higher percentage of children with stunted growth, malnutrition and poor health delivery in general. Bihar is a case in point following the dangerous AES epidemic that has claimed over 100 lives alone this year besides being a persistent problem for over a decade now. While novel governance is required to take these states out of the poverty shadow they reel under, extending government support for identifying and utilising state-sponsored schemes remain necessary. Many a time people are unaware of facilities that they can avail and suffer due to lack of knowledge. Ayushman Bharat, though in effect, is yet to be understood by a large populous of poor people, for whom it is targetted, simply because they cannot understand how to avail it. Such gaps need to be filled at the grassroots for a grand health scheme like Ayushman Bharat to work in full effect. While it is only the beginning year of Ayushman Bharat and much has to be done before it gets reflected in the health index, analysing the gaps will ensure reinforced attention towards implementation hereafter.
NITI Aayog's health index is a good way to identify poor performing states and accordingly adjust schemes, conduct extensive research and initiate steps to ameliorate the situation. For instance, Bihar now has effectively allowed the entire country, and perhaps the world, to criticise its poor implementation of government measures amidst administration failures which have collectively combined to give rise to AES outbreak. Medical science will take its own path in solving the encephalitis conundrum but administration has nothing to hide from. Likewise, all states will now have to focus on implementation since basic parameters will now define how much funds these states get from the Central fund. In essence, the government's logic of linking NHM with the health index is not faulty since the only way right now to ensure state commitment in doubling efforts in the health sector is to outrightly award a fitting status – for poorer performers it should be the commitment to rise and for the better ones it should be that to excel. The latter can be role models for the former as a combined effort – shared learning and administrative advice – will ensure the healthy development of all states progressing to achieve the nation's dream in health coverage and delivery!