THE MINISTER OF HEALTH AND FAMILY WELFARE
(DR MANSUKH MANDAVIYA)
(a) to (g) A Statement is laid on the Table of the House.
STATEMENT REFERRED TO IN REPLY TO LOK SABHA
STARRED QUESTION NO. 154* FOR 11TH FEBRUARY, 2022
(a) & (b) NITI Aayog, in collaboration with the Ministry of Health & Family Welfare (MoHFW) and the World Bank has published Health Index Round IV 2019-20 (Healthy States, Progressive India – Report on the Ranks of States and UTs).
The Health Index is a useful tool to measure and compare the overall performance and incremental performance across States/UTs over a period of time and is an important instrument in understanding the variations in performance on 24 indicators across three domains: (i) Health Outcomes; (ii) Governance and Information; and (iii) Key Inputs and Processes. Each domain is assigned weights, based on its importance, with the Health Outcomes carrying the highest weightage across different categories of States/UTs. Within a domain or sub-domain, the weight is equally distributed among the indicators in that domain or sub-domain. A Composite Index is calculated to measure the state of health in each State/UT for a Base Year (2018-19) and a Reference Year (2019-20). The Composite Score of Reference Year (2019-20) provides the Overall Performance while the change in the Index Score of each State/UT from the Base Year (2018-19) to the Reference Year (2019-20) measures the Incremental Performance of each State/UT. States/UTs are grouped in three categories to ensure comparability among similar entities, namely 19 Larger States, 8 Smaller States, and 7 UTs (West Bengal (Larger State) did not participate in the Health Index exercise. UT of Ladakh not included due to non-availability of data). The details of indicators are given in Annexure-I.
Major Findings
Amongst the Larger States, Kerala, Tamil Nadu and Telangana emerged as the best three performers in terms of Overall Performance. Uttar Pradesh ranked at the top in terms of Incremental Performance by registering the highest incremental change from the Base Year (2018-19) to Reference Year (2019-20). Telangana performed well both in terms Overall Performance as well as Incremental Performance and secured the third position in both instances. For the fourth consecutive round, Kerala emerged as the best performer in terms of Overall Performance.
Among the Smaller States, Mizoram emerged as the best performer in Overall Performance as well as Incremental Performance while among UTs, Delhi and Jammu & Kashmir emerged as the leading performer in terms of Incremental Performance.
(c) & (d) No. The Health Index is a useful tool to measure and compare the Overall Performance and Incremental Performance across States/UTs over time, and is an important instrument in understanding the variations in performance across various parameters including health outcomes, governance and data integrity, key inputs and processes. It measures the annual performance of States/UTs and ranks States/UTs on the basis of incremental change or the data that captures annual progress within the overarching context of the overall performance of the States/UTs.
The health status and health services have shown a positive increment in majority of States/ UTs in terms of indicators which are used in the report. The performance of States/UTs is, however, assessed through State Health Index (SHI) report and Conditionality Framework so that the desired objectives are achieved. The category wise list of States/UTs in terms of the positive and negative incremental performance is as under:
Category Positive Incremental Performance Negative Incremental Performance
Larger States (19)* (5.52) Uttar Pradesh
(4.34) Assam
(4.22) Telangana
(3.60) Maharashtra
(3.38) Jharkhand
(3.35) Madhya Pradesh
(1.74) Punjab
(1.62) Tamil Nadu
(1.14) Gujarat
(1.07) Andhra Pradesh
(0.76) Bihar
(0.60) Kerala
(0.58) Uttarakhand
(0.13) Odisha (-1.37) Karnataka
(-0.55) Haryana
(-0.25) Rajasthan
(-0.09) Chhattisgarh
(-0.06) Himachal Pradesh
Smaller States (8) (18.45) Mizoram
(17.70) Meghalaya
(3.43) Nagaland
(0.19) Tripura (-12.68) Goa
(-5.73) Manipur
(-1.54) Arunachal Pradesh
(-0.72) Sikkim
UTs (7) (9.68) Delhi
(9.55) Jammu & Kashmir
(7.72) Lakshadweep
(1.58) Puducherry
(0.14) Andaman & Nicobar (-10.85) Chandigarh
(-3.53) DH & DD
*Among the Larger States, West Bengal did not participate in this round and data for UT of Ladakh was not available
Note: Figure in parentheses indicate Incremental Performance Score, i.e., change between the Composite index Score of Base Year (2018-19) and Reference Year (2019-20)
(e) As Public Health and Hospitals is a State subject, the primary responsibility of strengthening public healthcare system lies with the respective State/UT Governments. However, the Ministry of Health and Family Welfare provides the technical and financial support to the States/UTs to strengthen their public healthcare system based on the requirements posted by States/UTs in their Programme Implementation Plans (PIPs) and within the overall resource envelope.
Further, the annual resource envelope of a State is decided based on its population and a weight-age factor which depends on areas of the State, health lag/ socio economic backwardness.
Since FY 2012-13, 10% of the total allocation under RMNCH+A and Health System Strengthening Flexible Pool of NHM is linked to performance of the States/UTs, which was increased to 20% of the total Government of India allocation in F.Y 2018-19.
Apart from the support under NHM, following financial support has been extended to States/ UTs to strengthen their health infrastructure.
• Under India COVID-19 Emergency Response and Health System Preparedness Package (ECRP-I), an amount of Rs. 1113.21 crore & Rs. 8147.28 crore have been released during FY 2019-20 & 2020-21 respectively.
• ECRP Phase-II with Rs. 23,123 crores (with Rs. 15,000 Cr as Central Component &Rs. 8,123 Cr as State component) has also been approved and allocated.
• PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) with an outlay of Rs. 64,180 crores support over a period of 5 years from 2021-22 to 2025-26 envisages increased investments in public health and other health reforms to safeguard against future resurgences of COVID-19, if any, and future public health emergencies.
• The total grants-in-aid supported of Rs. 70,051 Cr – through local governments spread over a period of 5 years from 2021-22 to 2025-26 have been approved under 15th Finance Commission to the health sector over the award period.
(f) The details on performance of indicators of each State/UT are placed at Annexure F (pg. 112-181) of the said Report. The report is available at the website of NITI Aayog i.e. https://www.niti.gov.in at the Uniform Resource Locator (URL)as under:
https://www.niti.gov.in/sites/default/files/2021-12/NITI-WB_Health_Index_Report_24-12-21.pdf
(g) The compilation and publication of the said report has started since 2017. These Health Index Report aims to nudge the States/ UTs towards building robust health systems and improving service delivery. The importance of this annual tool is re-emphasized to link this Health Index to incentives under NHM and this has been instrumental in shifting the focus from budget spending, inputs, and outputs to outcomes.
States/UTs are incentivized/dis-incentivized based on the score on conditionalities. 20% of the resource envelope of NHM for the States/UTs is given based on State’s/UT’s performance on agreed conditionalities. The States/UTs could lose or gain up to 20% of funding under NHM based on the conditionality score. The State Health Index (SHI) score has a weightage of 40% in conditionality framework scoring.
Details of status of health index of States/ UTs since 2014 along with year on year incremental changes in the health outcomes/ performance may be seen at Annexure-II.
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