Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

[op-ed snap] Health outcomes index: nudging India to progressop-ed snap


Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the index

Mains level: Very important newscard. The creation of the index is one of the most important step taken by the government(in health sector).


“Healthy States, Progressive India” report

  1. The report has spurred a vibrant debate on the status and future of India’s health sector
  2. Through this report, the focus has been on the performance and annual progress of states and Union territories on a myriad of health indicators
  3. This index(Health outcomes index by the NITI Aayog) will help nudge states towards improving their health sector outcomes in the spirit of cooperative and competitive federalism
    State-wise performance
  4. Kerala is the leader among large states, closely followed by Punjab and Tamil Nadu
  5. Uttar Pradesh, Rajasthan and Bihar are the least-performing states

Goal of the Health outcomes index

  1. The goal of the index is not just to rank the states based on their historical performance, but also on their incremental performance
  2. The attempt is to capture the change made during the course of the year
  3. For example, Jharkhand, Jammu and Kashmir, and Uttar Pradesh are ranked first, second and third in their incremental performance ranking

Making of the “Performance On Health Outcomes” index

  1. The “Performance On Health Outcomes” index is made up of 24 indicators in three different domains—health outcomes, governance and information, and key inputs and processes
  2. The “health outcomes” account for 70% of the weight, and the other two domains weighs 12% and 18%, respectively
  3. The “health outcomes” domain has indicators such as total fertility rate (TFR), neonatal mortality rate (NMR), sex-ratio at birth (SRB), etc.
  4. The governance and information domain measures the quality of data (data integrity indicator) and the average occupancy in important health-related posts such as principal secretary (health), chief medical officer, etc.
  5. Key inputs and processes measure the current status of healthcare professional vacancies, infrastructure at district hospitals, and the speed of financial governance in the states

What are the key results that emerge from the health index?

  1. First, First, there are large gaps between states
  2. The gap between the best-performing states and the least-performing states is worrisome—Kerala and Uttar Pradesh are separated by 42.86 points
  3. Second, incremental performance reveals that there has been a decline in performance on some states
  4. Six states’ scores have declined—Kerala, Haryana, Gujarat, Karnataka, Himachal Pradesh, and Uttarakhand
  5. Third,  India has made significant strides in achieving the goals set out under the UN-SDG and our own National Health Policy
  6. Some of our states have already met or exceeded the goals a decade ahead of 2030

What are the lessons that emerge from the health outcomes index? 

  1. First, an exercise of this kind requires data on health outcomes
  2. The effort did show us significant gaps in the availability of such data, especially for the smaller states
  3. We need robust programmatic data than can be used for continuous monitoring
  4. Second, incentives need to be linked to performance
  5. The linking of the health index with incentives under the National Health Mission will further push states to improve outcomes

The way forward

  1. NITI Aayog is creating a framework to track the performance of government hospitals based on outcome metrics
  2. Together with the upgrading and setting up of health and wellness centres under the Ayushman Bharat Scheme and the National Health Protection Scheme
  3. these measures will help us realize the goal of “good health and well-being”( one of the UN-SDG) for all citizens
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