An Inter-Agency and Expert Group on Sustainable Development Goal Indicators (IAEG-SDGs), consisting of representatives from 28 countries including India, recently met in Geneva to finalise the categorisation of indicators across the 17 global Sustainable Development Goals (SDGs). The UN Statistical Commission’s 48th session in March 2017 will take it forward. In India, the NITI Aayog and other government agencies are involved in a consultative process to prepare a 15-year vision, a seven-year strategy, and a three-year action plan defining the country’s development trajectory ahead. India has already accepted the SDGs as the guiding framework for this exercise, and how it fares in achieving the targets will determine its global success.
The health-nutrition lag
Health and nutrition are two areas where India’s achievements have not been quite up to the mark during the previous era of Millennium Development Goals (MDGs), particularly given the high economic growth in the last decade. A health SDG index released in September by The Lancet ranked India at 143 among 188 countries. In the Global Hunger Index published by the International Food Policy Research Institute in October, India is ranked 97th among a total of 118 countries, signifying a high level of hunger and undernutrition. At the same time, India is undergoing simultaneous transitions. The epidemiological transition involves a double burden of communicable (tuberculosis, malaria, AIDS, leprosy, dengue, diarrhoeal diseases, etc.) and non-communicable diseases (heart and lung diseases, stroke, cancer, diabetes, etc.). In parallel, a nutritional transition is happening — earlier, India was characterised by a high prevalence of undernutrition, but this era has also brought a double burden of undernutrition as well as overnutrition.
Overweight and obesity contribute to the increasing burden of non-communicable diseases in a big way. The scale of the problem is not discussed prominently in the media. Latest data from the National Family Health Survey 2015-16 (NFHS-4) show that in most of the States for which data is available, overweight men and women far outnumber underweight ones, in some instances double the number. The scale of the malnutrition and disease burden differs across States and districts, and there is a need to customise policy and planning to match ground-level requirements. More reliable and frequent data need to be collected and analysed to inform initiatives by the government.
Streamlining data
The SDG era offers an opportunity to improve India’s data systems. A recent report of the Observer Research Foundation (ORF), a leading think tank — “Tracking health and nutrition targets: four recommendations for India” — identifies gaps and makes four recommendations to improve tracking of health and nutrition targets. The report points out that the first definitive report on State-level strength of the health workforce in India, published this year by the World Health Organisation, has very limited policy relevance as it is based on the 2001 Census. There are no plans so far to analyse the 2011 Census data by the government agencies.
First, there is a need to transform civil registration and vital statistics (CRVS) systems in India. India relies on sample registration and surveys to track mortality-related goals because of inadequate coverage of its Civil Registration System (CRS). Eight States/Union Territories have achieved the target of 90 per cent in both birth and death registration, with 17 having reached 100 per cent birth registration and 11, 100 per cent death registration.
Overall, birth and death registrations in India stood at 85.5 per cent and 70.7 per cent, respectively, in 2013. Inter-State differences are sharp: for example, if Bihar and Uttar Pradesh are excluded from the analysis, the national coverage of registration of births is at 96.8 per cent and that of deaths at 85.2 per cent. Ensuring universal registration of births and deaths by the year 2020, promised in the “Vision 2020” plan announced in 2014, is a policy imperative.
Second, the existing sample surveys that collect data at the national level should be assessed for their comprehensiveness and better streamlined. Unit-level data from India’s sample surveys are an underutilised resource, and unfortunately, some data that are collected spending vast amounts of tax money are not available for public use at all. The National Sample Survey’s (NSS) ‘State sample’ data are a case in point. Pooling of Central and State samples will enhance the policy relevance of NSS data, as the data can then be used to arrive at district-level estimates.
It should be a high policy priority to conduct a comprehensive assessment of existing surveys with the aim of streamlining a set of health and nutrition indicators to continuously track the national targets. Overall surveys can also be strengthened, keeping in mind India’s double burden of communicable and non-communicable diseases.
Third, the national Health Management Information System (HMIS), which serves as the backbone for monitoring results of the National Health Mission, needs reform. Learning from the District Information System for Education (DISE), which seamlessly integrates public and private sectors into a comprehensive management information system, the HMIS needs to be expanded to integrate the vast private healthcare delivery system in order to enhance policy relevance; the HMIS currently captures only 12.7 per cent of the annual estimated infant deaths and 24.8 per cent of the annual estimated maternal deaths in the country.
Last, the ORF report recommends setting up of a national forum on health and nutrition statistics in line with the Federal Interagency Forum on Child and Family Statistics of the U.S. This mechanism will comprise of Central government agencies and ministries which currently collect, store, analyse and distribute different sets of health and nutrition data. Its mission should be to foster coordination and collaboration and to enhance consistency in the collection and reporting of health and nutrition data.
Hopefully these recommendations would be looked at and discussed by policymakers in their consultative process. Just like Make in India, staying healthy in India should be the goal as well for our nation’s future.
Priyanka Chaturvedi is a National Spokesperson of the Congress party.
