NITI Aayog has said that it can consider Tamil Nadu’s objections to its poor ranking on the ‘Healthy States Progressive India Report (2017-18)’, released on June 26, only next year.
Tamil Nadu, considered one of the best states in the country in quality and affordable healthcare, had been placed ninth in the ranking, slipping six places since the 2015-16 report. A top consultant with the National Health Mission said Tamil Nadu could end up losing funds as a result, with allocation of 40 per cent of incentives to states based on this ranking.
The states were judged on parameters such as institutional deliveries and immunisation coverage, and functional 24X7 Public Health Centres. Kerala, Andhra Pradesh, Maharashtra and Gujarat were among the top-ranking states.
Tamil Nadu has alleged discrepancies in NITI Aayog’s assessment and called it based on wrong methodology and indicators. It has also said that a senior state officer had reported these errors to NITI Aayog CEO Amitabh Kant during consultation and preparation of the draft report.
While Kant was not available for comment, Alok Kumar, Advisor (Health), NITI Aayog said they had to frame a standard base for the states given the diversity of the country.
He added that CEO Kant had held a video conference with principal secretaries of all states and examined their recommendations following a first-round report last year. “Some of their (views) were accepted and some were not… For the second report’s preparation, every state was given details of the parameters used for ranking them,” he said, adding, “Once you agree on certain rules of the game, you cannot change them midway. In a country like India, it is impossible to satisfy every state on every issue… Where do we end up if… each and every state starts to disagree with denominators and insists on its own?”
About Tamil Nadu’s demand for “corrections”, Kumar said a committee under the Health Ministry would consider and accept all the “genuine demands” in next year’s report.
Why rank counts
The NITI Aayog health index has been evolved to also steer government investments towards states more efficient and innovative in meeting targets. But the incremental ranking has come as a negative for traditionally “better” states as it is usually more difficult to traverse the last mile on health indices.
Following the release of the report, both Tamil Nadu Chief Secretary Girija Vaidyanathan and Health Minister C Vijayabaskar had written to NITI Aayog laying down the state’s stand. Vijayabaskar had also held a press meeting accusing the panel of ignoring the state’s “outstanding” performance in public health.
A senior state health officer told The Indian Express, “We raised (objections) during the consultation stage itself. And those representations to make NITI Aayog understand about our public health network and services were at the highest level, in a letter sent by the Chief Secretary to the CEO of NITI Aayog. Unfortunately, they ignored us and released a report with discrepancies and approximate figures instead of accurate data, and based on wrong methodologies.”
Senior state officers and health experts listed following examples of alleged discrepancies, “wrong methodology” and “inaccurate data” in the report:
* Why was Maternal Mortality Ratio (MMR), “one of the most important health indicators”, not taken into consideration? As per the state’s Sample Registration System, its MMR is 16, while Andhra Pradesh, that came second in the health ranking, has an MMR of 32 and Gujarat, fourth in the report, an MMR of 30. Tamil Nadu has also cited its low Infant Mortality Rate (IMR), 2, compared to Kerala’s 1, and Andhra Pradesh and Gujarat’s 13 and 11 respectively, and said the report ignored the state’s live data in this regard.
NITI Aayog advisor Kumar said MMR data was not considered as theirs was an annual report while MMR data was for three years.
* Why was average expenditure on health in the state, public health delivery system, and status of the state in crucial sectors such as non-communicable diseases and trauma care not assessed?
* Officers say real-time data captured by Tamil Nadu through its Pregnancy and Infant Cohort Monitoring and Evaluation System shows 9.4 lakh live births. They add that using actual live birth data, and correlating the same 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.
* In a letter to Union Health Minister Harsh Vardhan, state Health Minister Vijayabaskar said NITI Aayog had failed to consider the state’s unique public health cadre system. Unlike other states that have only a Chief Medical Officer in districts, the state has an officer in each district who is a public health expert with a medical degree, who monitors all national programmes and public health challenges locally. The state also cites its “unique” secondary healthcare network, including a separate directorate and one secondary care hospital in every taluk, with a network of 278 such hospitals.