Bihar, UP Rank Lowest Yet Again in Government’s Latest Health Index

Kerala took the top spot among larger states for overall performance on health indicators in the NITI Aayog report.

New Delhi: Indian healthcare is in disarray.

In the east, Bihar is struggling with children dying from what is suspected to be encephalitis. West Bengal’s doctors went on strike to protest poor security for health workers. Doctors around the country joined them even while health care for the public began to collapse further.

In Kerala, the state struggled but prevailed over a fresh scare of Nipah.

And almost half of the country is facing a water crisis which compounds their health ailments.

At this juncture, the government has released data and it shows predictably that Bihar and Uttar Pradesh are the worst-off states in India on a range of health indicators.

The NITI Aayog has released its health index, titled “Healthy States Progressive India”, which ranks states and union territories. It has been produced with the Union health ministry and the World Bank.

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While the government’s usual release of data is slow and with lag, the NITI Aayog has started collecting and releasing targeted data as an “annual systematic tool to focus the attention of the States/UTs on achieving better health outcomes”.

The health ministry has also linked the disbursal of funds based on progress made on this index. This report looks at progress made in between 2015-2016 and 2017-2018.

Children showing symptoms of Acute Encephalitis Syndrome (AES) being treated at a hospital in Muzaffarpur, Thursday, June 20, 2019. Photo: PTI

States remain unequal

“There is no indication that the gap between poorest performing state and best-performing state is narrowing,” says the report.

Among big states overall, UP has scored the lowest, and Bihar is second lowest. In fact, in 2017-2018, they have performed worse than the base year of 2015-2016. So in 2017-2018, the states scored 28.61 and 32.11 respectively, while they were better in 2015-2016 with a score of 33.69 and 38.46. Their incremental change has been negative, at -5.08 and -6.35 respectively.

Again unsurprisingly, Kerala tops the list, with a score of 74.01 in 2017-2018, dropping from 2015-2016 when they had scored 76.55. The least performing states are UP, Bihar, Madhya Pradesh, Uttarakhand and Rajasthan. These are all also known as Empowered Action Group states by the government, and they receive special attention on account of this.

Why is UP and Bihar so badly of on health care?

Bihar has not just got a low score but is marked as having “deteriorated.” The state has the highest number of indicators which have fallen in the category of ‘Deteriorated’ and ‘Most Deteriorated’.

The report says that the primary reasons which weighed Bihar down is their poor performance on total fertility rate, low birth weight, sex ratio at birth, TB treatment success rate, quality accreditation of public health facilities, and time-taken for fund transfers from National Health Mission.

In the case of UP, the deterioration is linked to their performance on low birth weight, TB treatment success rate, average tenure of key positions at state and district level and level of birth registration.

So take for example, the neonatal mortality rate. The 2030 Sustainable Development Goal target for neonatal mortality rate is 12 neonatal deaths per 1000 live births. Kerala and Tamil Nadu have already achieved it. But Bihar has 27 deaths and Uttar Pradesh has 30 deaths per 1000 live births, in 2017-2018.

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On institutional deliveries, again, UP is the worst and Bihar is second worst, with just 50.6% and 56% of deliveries happening at medical facilities. Telangana has the highest score at 91.7%.

And when babies are born, Bihar has the lowest level of registration of these births with just 60.7% of births being formally registered.

Bihar has a real crisis of health care workers as well. Among big states, Bihar has the highest number of auxiliary nurse midwife positions that were vacant, with 59.5% vacancy. Bihar has the second highest vacancies of staff nurses at primary health centres and community health centres with more than 40% vacancy of staff. UP has surprisingly reported no vacancy of staff nurses, along with Odisha. None of Bihar’s health staff, either regular or contractual, have their pay-slips generated and logged in the government’s technology management system for this.

The funds to get all of this done is also delayed, and Bihar has the slowest transfer of funds from the central National Health Mission into the state government’s treasury to the final implementation society. The average time for this transfer in Bihar, which is the slowest in the country, is 191 days. UP is only slightly better at 118 days.

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Bihar has the highest fertility rate among all big states, at 3.3. UP is a close second at 3.1. Less than 50% of Bihar’s population of people living with HIV who are on anti-retroviral therapy, again making it one of the worst performing states.

A few areas of progress for UP and Bihar

Some areas in which Bihar and Uttar Pradesh are not at the bottom of the pile are on low birth weight, sex ratio at birth and immunisation.

So with low birth weight, a term which describes babies who are born with a weight of less than 2500 grams, Bihar and UP are not the worst offenders, with a proportion of 9.2 and 11.2 of their babies being born with low weight. Odisha is the worst, with a proportion of 18.2.

With full immunisation, Bihar is at 89.7 % coverage and UP is 84.7%. Odisha is the worst off in this area, with poor coverage of 59.8%.