NITI Aayog Releases the Second Edition of “Healthy States, Progressive India” Report

Kerala, Andhra Pradesh & Maharashtra ranked on top in terms of overall performance

Haryana, Rajasthan and Jharkhand ranked top three States in terms of annual incremental performance

NITI Aayog released the Second Edition of “Healthy States, Progressive India” today. The report ranks states and Union territories innovatively on their year-on-year incremental change in health outcomes, as well as, their overall performance. The Round II report focuses on measuring and highlighting the overall performance and incremental improvement over a two year period (2016-17 and 2017-18) in the States and UTs

The report was released jointly by Vice Chairman, NITI Aayog, Dr. Rajiv Kumar , Member NITI Aayog Dr. VKPaul, CEO, NITI Aayog; Amitabh Kant and the Secretary, Ministry of Health & Family Welfare; Preeti Sudan The report has been developed by NITI Aayog, with technical assistance from the World Bank, and in consultation with the Ministry of Health and Family Welfare (MoHFW).

The report is an annual systematic performance tool to measure the performance of the States and UTs. It ranks states and union territories on their year on year incremental change in health outcomes, as well as, their overall performance with respect to each other. The ranking is categorized as Larger States, Smaller States and Union Territories (UTs), to ensure comparison among similar entities. The Health Index is a weighted composite Index based on 23 indicators grouped into the domains of Health Outcomes, Governance and Information, and Key Inputs/Processes.  . Each domain has been assigned weights based on its importance and has been equally distributed among indicators.

Among the Larger States, Kerala, Andhra Pradesh & Maharashtra ranked on top in terms of overall performance, while Haryana, Rajasthan and Jharkhand are the top three ranking States in terms of annual incremental performance. Haryana, Rajasthan and Jharkhand showed the maximum gains inimprovement 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 CHCs/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 enabled Human Resources Management Information System.

The States are categorized on the basis of reference year Index score range: Front-runners: top one-third), Achievers: middle one-third, Aspirants: lowest one-third. The States are 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), and most improved (>4 points increase).

Categorization of Larger States on incremental performance and overall performance

Incremental PerformanceOverall Performance
Aspirants AchieversFront-runners
Not improved(0 or less)Madhya PradeshOdishaUttarakhandUttar PradeshBiharWest Bengal KeralaPunjabTamil Nadu 
Least Improved(0.01-2)__ Chhattisgarh GujaratHimachal Pradesh
Moderately Improved(2.01-4.0)     MaharashtraJammu & KashmirKarnatakaTelangana
Most Improved(more than 4.0)Rajasthan HaryanaJharkhandAssamAndhra Pradesh 

Among Smaller States, Mizoram ranked first followed by Manipur on overall performance, while Tripura followed by Manipur were the top ranked States in terms of annual incremental performance. Manipur registeredmaximum 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 last three years and Completeness of IDSP reporting of P and L forms. 

Categorization of Smaller States on incremental performance and overall performance

Incremental PerformanceOverall Performance
Aspirants Achievers Front-runners 
Not improved(0 or less)Arunachal PradeshSikkimMeghalayaGoa
Least Improved(0.01-2)Nagaland  Mizoram
Moderately Improved(2.01-4.0)Tripura Manipur
Most Improved(more than 4)

Among UTs, Chandigarh and Dadra and Nagar Haveli were ranked on top in terms of overall performance (Chandigarh-1 and Dadra and Nagar Haveli-2) as well as annual incremental performance (Dadra and Nagar Haveli-1 and Chandigarh-2).  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 last 3 years, Proportion of ANMs positions vacant at Sub Centres, Proportion of Staff Nurses positions vacant at PHCs and CHCs, Proportion of MO 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, Proportion of districts with functional Cardiac Care Units (CCUs),  Proportion of ANCs registered within first trimester, Completeness of IDSP reporting of P and L forms, and transfer of National Health Mission (NHM) funds from State Treasury toimplementation agency.

Categorization of UT on incremental performance and overall performance:

Incremental PerformanceOverall Performance
AspirantsAchieversFront-runners
Not improved(0 or less)Andaman and Nicobar DelhiLakshadweep 
Least Improved(0 or less)   
Moderately Improved(0 or less) Puducherry 
Most Improved(0 or less)Daman and Diu ChandigarhDadra and Nagar Haveli
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The hindu says

Uttar Pradesh retains the worst performer tag in the NITI Aayog index.

Kerala continued to top the list for the best performing State in the health sector among the 21 large States, while Uttar Pradesh retained the worst performer tag, according to the second edition of NITI Aayog’s Health Index released on Tuesday.

Kerala, which got an overall score of 74.01, was followed by Andhra Pradesh (65.13), Maharashtra (63.99), Gujarat (63.52) and Punjab (63.01), Himachal Pradesh (62.41), Jammu and Kashmir 62.37, Karnataka (61.14) and Tamil Nadu (60.41).

Fall in score

Uttar Pradesh continued to be at the bottom of the list with its score falling to 28.61. Other States at the bottom of the list were Bihar (32.11), Odisha (35.97) and Madhya Pradesh (38.39).

The report ‘Healthy States, Progressive India: Report on Rank of States and UTs’ has ranking in three categories — larger States, smaller States and Union Territories “to ensure comparison among similar entities.”

Among the UTs, Chandigarh jumped one spot to top the list with a score of (63.62), followed by Dadra and Nagar Haveli (56.31), Lakshadweep (53.54), Puducherry (49.69), Delhi (49.42), Andaman and Nicobar (45.36) and Daman and Diu (41.66).

The Index ranks the States and Union Territories based on 23 health-related indicators, including neonatal mortality rate, under-five mortality rate, proportion of low birth weight among new-borns, proportion of districts with functional Cardiac Care Units, full immunisation coverage and proportion of specialist positions vacant at district hospitals.

The report stated that only about half the States and UTs showeds an improvement in the overall score between 2015-16 (base year) and 2017-18 (reference year).

The report added that among the eight Empowered Action Group States, only three States — Rajasthan, Jharkhand and Chhattisgarh — showed improvement in the overall performance.

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