Context: India conducts numerous health surveys, most prominent of which is NFHS. Lately, there have been various additions into NFHS which have made it disoriented and lacking any specific policy purpose. 

• There is need for selected comprehensive surveys that can broadly cover major public health themes for a complex country like ours.

Issues with existence of multiple surveys

• NFHS is the only major survey that India has a record of doing regularly and one does not know if and when the other surveys will be repeated.
• Multiple surveys also raise the problem of differing estimates due to sampling differences in the surveys. 
• For instance, there is a wide divergence in sex ratio at birth reported by the NFHS and the Sample Registration System (SRS).

Challenges in aligning multiple surveys

• Previous attempts to align these surveys have failed as different survey proponents have different demands and push for inclusion of their set of questions.
• The Department of Planning, Statistics and Programme Monitoring lacking the technical capacity succumbs to pressures from multiple quarters and ends up accepting all requests.
• The household which is selected for the survey have no power of negotiation.

Road map for public health data architecture for India

• National surveys: There is a need to identify a set of national-level indicators and surveys that will be done using national government funds at regular intervals.

Staggered approach: National surveys can be done every 3-5 years in a staggered manner such as 

• A concise NFHS focusing on Reproductive and Child Health (RCH) issues,
• A Behavioral Surveillance Survey (focusing on HIV, NCD, water sanitation and hygiene (WASH)-related and other behaviours)
• A nutrition-biological survey (entails collection of data on blood pressure, anthropometry, blood sugar, serology, etc.)

State participation: A national-level sample for such surveys can be taken and States can be asked to invest in conducting focused State-level surveys. States have to become active partners including providing financial contributions to these surveys.

• Specific studies: Important public health questions can be answered by specific studies conducted by academic institutions on a research mode based on availability of funding.
• Transparency of data: It is very important to ensure that the data arising from these surveys are in the public domain. This enables different analyses and viewpoints to be presented on the same set of data enriching the discussion thus unlocking the full potential of the survey.