Healthy States, Progressive India Report 2019

Healthy States, Progressive India is an annual report of Niti Aayog ranks states and Union territories innovatively on their year-on-year incremental change in health outcomes, as well as, their overall performance with respect to each other.

The report has been prepared by Niti Aayog in collaboration with the Ministry of Health and Family Welfare and technical assistance from the World Bank.

Categories and Ranking of States

The report ranks the states and Union territories based on the health index in the following three categories to ensure comparison among similar entities:

• Larger States.
• Smaller States.
• Union Territories (UTs).

The health index is a composite index based on indicators in three domains with weightage as listed below:

• Health Outcomes (70%).
• Governance and Information.
• Key Inputs and Processes (18%).

The index score is calculated against a base year.

Findings of the 2019 Report

The Healthy States, Progressive India Report 2019 is the second edition of the report and focuses on measuring the overall performance and incremental improvement over a two-year period viz. 2016-17 (Base Year) and 2017-18 (Reference Year) in the states and UTs. The important findings of the report are:

• Kerala has again topped the latest health ranking report in the category of large states. Kerala was followed by Andhra Pradesh and Maharashtra in the rankings.
• Gujarat, Punjab and Himachal Pradesh stood at fourth, fifth and sixth spots.
• Punjab which was at the second rank last year was pushed to the fifth spot and Tamil Nadu which was third was pushed to ninth spot.
• Andhra Pradesh and Maharashtra improved their score in indicators like low birth weight and full immunization coverage while Punjab and Tamil Nadu have deteriorated.
• Uttar Pradesh remained the worst in the health rankings at 21. Bihar’s ranking shifted from 19th to 20th whereas Odisha’s ranking has dropped from 18th to 19th.
• Uttar Pradesh and Bihar fared badly in indicators such as sex ratio, the success rate of treatment of TB cases and time taken for transfer of funds under National Health Mission.
• Chhattisgarh with the sex ratio at birth at 963, which has overtaken Kerala to be the highest in the country.
• The sex ratio at birth of Kerala has fallen from 967 to 959.
• Haryana which has the worst sex ratio at 832 witnessed a slight improvement from 831 and UP has also improved a bit from 879 to 882.
• UP, Bihar, Odisha and Madhya Pradesh fared poor among indicators of both neonatal as well as under-5 mortality rates and Kerala was ranked best in both categories.
• Mizoram has ranked first in overall performance among smaller states followed by Manipur and Tripura in the second and third positions respectively.
• Among Union territories, Chandigarh has ranked first.

The ranking under index is important to states since incentives up to 40 per cent under the National Health Mission are linked with the performance of the states under the index.

Objections by Tamil Nadu

Tamil Nadu which is considered as one of the best states in the country in quality and affordable healthcare has slipped six places to ninth in the rankings. The state has alleged discrepancies in the assessment and further called the index to be based on wrong methodology and indicators.

• Tamil Nadu expressed unhappiness over complete disregard for Maternal Mortality Ratio (MMR) which is one of the most important health indicators.
• The index also ignored the Infant Mortality Rate (IMR). Tamil Nadu has performed exceedingly well than Gujarat and Andra Pradesh.
• There was no assessment of average expenditure on health in the state, public health delivery system, and status of the state in crucial sectors such as non-communicable diseases
• Tamil Nadu further argued that real-time data captured by Tamil Nadu through its Pregnancy and Infant Cohort Monitoring and Evaluation System shows 9.4 lakh live births and correlating this with the state’s Mother and Child Tracking System and Civil Registration System, would have put institutional delivery at 99.8% against 80.5% as in the report.

NITI Aayog has brushed aside these objections by stating that the index was framed as a standard base for the states given the diversity of the country and it is impossible to satisfy every state on every issue in a big and diverse country like India. Further, it reasoned that indictors like MMR were not considered since MMR data was available for three years whereas the report was an annual exercise.