Context: Recently, NITI Aayog has released the fourth edition of the State Health Index for 2019–20 with report, titled “Healthy States, Progressive India”.

• The report has been developed by NITI Aayog, with technical assistance from the World Bank, and in close consultation with the Ministry of Health and Family Welfare (MoHFW).

State Health Index

• It ranks states and Union Territories on their year-on-year incremental performance in health outcomes as well as their overall status.

Components of the index

• It is a weighted composite index based on 24 indicators grouped under the domains of ‘Health Outcomes’, ‘Governance and Information’, and ‘Key Inputs/Processes’.
• Health outcomes: It includes parameters such as neonatal mortality rate, under-5 mortality rate, and sex ratio at birth.
• Governance: This includes institutional deliveries, average occupancy of senior officers in key posts earmarked for health.
• Key inputs: It consists of the proportion of shortfall in healthcare providers to what is recommended, functional medical facilities, birth, and death registration, and tuberculosis treatment success rate.

Key Inputs/Processes

• Each domain has been assigned weights based on its importance with higher score for outcome indicators.

To ensure comparison among similar entities, the ranking is categorized as:

• Larger States
• Smaller States
• Union Territories

The index is being compiled and published since 2017.
Key Findings of the Report
Among the larger states

• Kerala has emerged as the best state in terms of overall health performance among larger states while Uttar Pradesh is the worst.
• Uttar Pradesh, Assam and Telangana are the top three ranking states in terms of annual incremental performance.

Among smaller states

• Mizoram emerged as the best performer in overall performance.
• Mizoram and Meghalaya registered the maximum annual incremental progress.

Among UTs

• Delhi, followed by Jammu and Kashmir, showed the best incremental performance.

Significance of the Index
Policymaking

• States use it in their policy making and resource allocation.
• This report is an example of both competitive and cooperative federalism.

Healthy Competition

• The index encourages healthy competition and cross-learning among States and UTs.
• The aim is to nudge states/UTs towards building robust health systems and improving service delivery.

Helpful in Achieving SDGs

• The exercise is expected to help drive state and union territories' efforts towards the achievement of health-related Sustainable Development Goals (SDGs) including those related to Universal Health Coverage (UHC) and other health outcomes.

Role in National Health Mission

• The importance of this annual tool is reemphasized by MoHFW’s decision to link the index to incentives under the National Health Mission.

Limitations of the Index
Not Covered Critical Areas

• Some critical areas such as infectious diseases, noncommunicable diseases (NCDs), mental health, governance, and financial risk protection are not fully captured in the Health Index due to non-availability of acceptable quality of data on an annual basis.

Limited Data

• For several indicators, the data is limited to service delivery in public facilities due to paucity and uneven availability of private sector data on health services.
• For outcome indicators, such as Neonatal Mortality Rate, Under-five Mortality Rate, Maternal Mortality Ratio and Sex Ratio at Birth, data are available only for Larger States.

Without any Field Verification

• For several indicators, Health Management Information System (HMIS) data and programme data were used without any field verification due to the lack of feasibility of conducting independent field surveys.