Healthy competition

The NITI Aayog’s report, Healthy States, Progressive India , made public earlier this month tells us much of what we already know: that overall, Kerala has the best set of indicators comparable with the developed world and Uttar Pradesh, the worst. That the BIMARU States are at the bottom of the pile along with Odisha. BIMARU refers to Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh; the acronym was originally coined to refer to their economic conditions in the 1980s rather than the social indicators. But the objective of the report and the index constructed by the NITI Aayog is to foster competition among States to rapidly improve their health indicators. This is not the first time the Government has introduced rankings to get States to compete — over the past few years it has created an index to measure improvement on ease of doing business at the State level, another to rank cities on cleanliness, and more recently one to measure efforts being made to create an ecosystem for startups. Undoubtedly, rankings help accelerate change — but much of this could be short-sighted and focused on improving scores rather than delivering sustainable results. For instance, just increasing the number of 24x7 primary healthcare centres is insufficient if there are not enough doctors and nurses to run them.

There is no one solution for what ails India’s healthcare system, nor are there any quick fixes. The challenges that Kerala faces are very different from those facing Uttar Pradesh, given the widely different demographic profile, and education and income levels of their people. Kerala’s achievements are the result of years of commitment to improving literacy and healthcare by successive governments and dedicated non-government institutions. And, so the State’s neonatal mortality rate is just six per 1,000 live births, the under-five years mortality rate is 13, sex ratio at birth is 967, and 92.6 per cent of deliveries are institutional. In comparison, neonatal mortality rate in Uttar Pradesh is 31, under-five mortality rate is 51, sex ratio at birth is 879, and just 52.4 per cent of deliveries are institutional. The challenge lies not in mapping the gap between the two States, but in bridging it.

The NITI Aayog report has correctly identified that health of the population is central to the nation’s well-being and productivity, and that the country’s progress on this count is grossly inadequate. India accounts for the largest share of the world’s malnourished people. Better health is a result of multiple factors — intake of more nutritious food, access to primary healthcare for free or at very low cost, clean air and water, good sanitary conditions and good hygiene. While there are multiple government schemes to address each of these problems individually, what would deliver better results is a cohesive integration of these schemes and learning from successes achieved within the country.

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