Tamil Nadu slips 6 places in health index

Officials register objections with NITI Aayog, cite data discrepancies

Tamil Nadu has slipped six places in the health index released by NITI Aayog. The State has registered the largest decline in its ranking, from third in 2015-16 to ninth in 2017-2018. However, government officials claim they have registered their objections with NITI Aayog, citing data discrepancies and interpretation of indicators.

Tamil Nadu, with a composite index score of 60.41, is among nine States that saw a decline in their position in the rankings from base (2015-16) to reference (2017-18) year. Punjab and Uttarakhand dropped three and two places, respectively, while the remaining six States saw a decline of one point each, according to the report, ‘Healthy States Progressive India’.

The decline in the overall index score — weighted composite index based on 23 indicators — was largely attributed to the decline in several health outcome indicators, the report said.

So what went wrong for T.N., normally an ace performer in many health indicators? According to the report, the State’s “most deteriorated” indicators are: proportion of low birth weight among newborns, integrated disease surveillance programme reporting, proportion of community health centres (CHC) with a grading of four points and more and the proportion of CHCs/Primary Health Centres (PHC) with quality accreditation certificates.

The performance declined in full immunisation coverage, institutional deliveries, tuberculosis case notification and treatment success rate, vacancies of medical officers in PHCs and percentage of functional 24/7 PHCs. The State made negative incremental progress (-2.97) from 2015-16 to 2017-18, bringing itself under the category of ‘Not Improved’ States. This incremental performance measures the change in health index score from base to reference year on the basis of the progress made.

But the State has done well in reducing the Neonatal Mortality Rate (NMR) and Under-five Mortality Rate. It has made significant improvements by establishing at least one cardiac care unit for every two districts and created specialist positions in district hospitals and has achieved 100% registration of births.

2030 development goal

Kerala and T.N. had already reached the 2030 Sustainable Development Goal (SDG) target for NMR — 12 neonatal deaths per 1,000 live births. Similarly, the two States, along with Maharashtra and Punjab have achieved the SDG target related to Under-five Mortality Rate, which is 25 deaths per 1,000 live births. The government had objected to the draft prepared by NITI Aayog around six months ago. For instance, officials said NITI Aayog’s denominator for calculating full immunisation coverage and institutional deliveries was the estimated number of births (11 lakh), instead of actual live births (9.47 lakh).

“This is based on a wrong denominator. The report says T.N. has 80% institutional deliveries, and the remaining 20% deliver at home. The immunisation coverage is less than 80%. If this is the case, how did the State reduce its IMR to 16 per 1,000 live births? This is illogical,” an official said.