An analysis of the NITI Aayog’s ‘Healthy States, Progressive India’ report released on June 25 shows that the usage of estimated figures in place of reported numbers, to calculate certain health indicators, has adversely impacted the final index score of certain States while boosting that of others.
Skewed result
The report had used an estimated number of births and deliveries to calculate two key health outcome indicators — “full immunisation coverage” and “proportion of institutional deliveries” — which carried high weightage in the calculation of the final index score. The use of estimated numbers instead of the reported figures resulted in a skew.
For instance, in the case of Tamil Nadu, which had secured a composite index score of 63.38 for the base year 2015-16, using reported number of deliveries and births instead of estimated figures would have resulted in an increase of 2.17 points for that year.
On the other hand, using reported numbers would have resulted in a decrease of 2.99 points and 3.34 points from the final index scores of Gujarat and West Bengal.
The data for both the reported and estimated number of deliveries for 2015-16 is available in the Health Management Information System (HMIS), a statistical arm of the Ministry of Health and Family Welfare.
There is a difference in the number of institutional deliveries recorded in the NITI Aayog’s report based on the estimated number of deliveries, and what is recorded in the HMIS database based on reported number of deliveries for the year 2015-16. However, the degree of variation is high in certain States.
In Tamil Nadu, according to the NITI Aayog report, institutional deliveries were pegged at 81.82% in 2015-16, whereas in the HMIS database, it is 100 % — a difference of more than 18% points. However, in the case of Gujarat, the indicator was almost similar in both datasets (98% in HMIS, 97.78% in NITI Aayog).
Similar variations were also seen in “full immunisation coverage”. In Tamil Nadu, according to the NITI Aayog report, 82.66 % of infants were fully immunised, whereas, according to the HMIS database, it is 104.9 %, that is, more than a 22% point difference. In Gujarat, the indicator was almost same in both the datasets (90.55% in NITI Aayogand 93.9% in HMIS).
Index score impacted
In the case of bigger States, both the indicators — immunisation of children and institutional deliveries — carry a weight of 50 each. The weighted scores of all the 23 indicators are then added to form the final index score.
Calculation of the weighted score for the base year 2015-16 using reported figures from the HMIS instead of the estimated figures used by the NITI Aayog report, increases the final index score of certain States and decreases the numbers for others.
When the final index was recalculated using the HMIS’ reported figures, Madhya Pradesh’s score increased by 2.78 points and Tamil Nadu’s by 2.17 points while West Bengal’s and Gujarat’s decreased by close to 3 points each.
A similar analysis for the year 2017-18, for the institutional deliveries indicator, shows that usage of reported deliveries would have increased the final score of Madhya Pradesh by 2.3 points while it decreased the score of Gujarat by -0.09 points. As the data for 2017-18 immunisation coverage was not publicly available in the HMIS website, a similar analysis could not be done for that indicator in that year.
‘Inherent problems’
It is necessary to use the estimated number of births to determine the level of registration of births. However, the same cannot be said about full immunisation coverage and proportion of institutional deliveries.
A senior official with the NITI Aayog, who was involved in the drafting of the report on condition of anonymity, said, “The reported number of births can vary [from the actual figures]... Because, there are some inherent problems [with the Civil Registration System] and experts have expressed reservations about using them. Ideally, the reported numbers should come from the Civil Registration System but because of these issues, we have not used it.”
