Health index: Visible north-south divide

Among southern states, Karnataka disappoints

The NITI Aayog’s health index report for 2019-20, like its previous editions, ranks all states on a weighted composite score and gives a useful picture of the relative state of health and healthcare across the country. The score is based on 24 indicators and covers three broad domains —health outcomes, governance, and information. It gives a more rounded view of health because factors like the availability of medical facilities and personnel, use of contraceptives, success rate of government programmes, etc., are also taken into account. The states are ranked in three categories — large and small states, and UTs. Kerala and Tamil Nadu are the top two states in overall performance. Uttar Pradesh stands last. Southern states generally lead the index; the northern states figure at the bottom. Karnataka has gone down from the 8th position to the 9th in the overall index and from the 16th position to the 19th in the incremental index. The state’s overall score slipped from 59.29 to 57.93.

While the rankings are on expected lines, there is a lot of information that gives a detailed picture and should help action in future. UP ranked first in incremental performance while Kerala and Tamil Nadu are ranked 12th and 8th, respectively, among the larger states. But it should be noted that UP had a low base and so could make a big jump from the previous year, without achieving a major outcome. Several smaller states and UTs also have higher incremental scores than UP. Some experts have questioned the classification of states and have felt that a single category would be more useful for comparison. Others have noted that the index did not cover mental health and non-communicable diseases. These could be considered in the coming years.

The index covers the year before the pandemic broke out. The state of health could be worse now because much of the attention in the last two years has been to fight the pandemic. But the pandemic has underlined the importance of public health and its social and economic value. The states will have to study their weaknesses and frame health policies accordingly. Karnataka has much to do in many areas, to not only stop its slide but to improve its performance. It should also be noted that the position of most states is below the desired level of health and healthcare. Only the southern states, except Karnataka, have scored above 70 points on a possible 100. Even Kerala’s overall score is only 82.2, while UP’s score is 30.57. All states need to improve their performance.

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