NITI Aayog, National Institution for Transforming India, Government of India

Health

Despite significant economic growth over the past decades in India, our achievements in population health have not been commensurate. The National Development Agenda, unanimously agreed to by all the State Chief Ministers and Lieutenant Governors of Union Territories in 2015, had, inter alia, identified Health, Nutrition, Education, Women and Children as priority sectors. In order to achieve the National Development Agenda, it is imperative to make rapid improvement in these sectors. While the responsibility in this regard is shared between the Centre and the States, Health being a State subject, implementation is largely done by the States.

India along with other countries has committed to the adoption of Sustainable Development Goals (SDGs) to end poverty, protect the planet, and ensure prosperity for all as part of a new global sustainable development agenda to be achieved by 2030. There is renewed commitment in India, to accelerate the pace of achievement of the SDGs including Goal 3 related to ensuring healthy lives and promoting well-being for all at all ages.

In this regard, in order to rapidly bring about transformative action in achieving the desirable outcomes, a priority for NITI Aayog and Ministry of Health & Family Welfare is to prompt States towards improvements in outcomes in the coming years.In this context, NITI Aayog and MoH&FW are spearheading the Health Index initiative, to measure change in performance over the years.

It is anticipated that this framework will assist in State level monitoring of performance and improvement in health outcomes and will thereby meet the citizens’ expectations.
Final Health Index


S. No

Indicator

Definition

Data Source

Base Year (BY) & Reference Year (RY)

Remarks

DOMAIN 1 – HEALTH OUTCOMES

SUB-DOMAIN 1.1 - KEY OUTCOMES (Weight - Larger States – 500, Smaller States & UTs – 100)

1.1.1

Neonatal Mortality Rate
(NMR)

Number of infant deaths of less than 29 days per thousand live births during a specific year.

Sample Registration System [Pre-filled]

BY:2014
RY:2015

Indicators 1.1.1, 1.1.2, 1.1.3, and 1.1.5 are not applicable for category of Smaller States and UTs

1.1.2

Under-five Mortality Rate (U5MR)

Number of child deaths of less than 5 years per thousand live births during a specific year.

Sample Registration System [Pre-filled]

BY:2014
RY:2015

1.1.3

Total Fertility Rate (TFR)

Average number of children that would be born to a woman if she experiences the current fertility pattern throughout her reproductive span (15-49 years), during a specific year.

Sample Registration System [Pre-filled]

BY:2014
RY:2015

1.1.4

Proportion of Low Birth Weight among newborns
(LBW among infants)

Proportion of low birth weight (<=2.5 kg) newborns out of the total number of newborns weighed during a specific year born in a public health facility.

Health Management Information Systems (HMIS)

BY:2014-15
RY:2015-16

1.1.5

Sex Ratio at Birth
(SRB)

The number of girls born for every 1,000 boys born during a specific year.

Sample Registration System [Pre-filled]

BY:2012-14
RY:2013-15

SUB-DOMAIN 1.2 - INTERMEDIATE OUTCOMES (Weight: Larger & Smaller States – 300, UTs – 250)

1.2.1

Full immunization coverage (%)

Proportion of infants 9-11 months old who have received BCG, 3 doses of DPT, 3 doses of OPV and one dose of measles against estimated number of infants during a specific year.

HMIS

BY:2014-15
RY:2015-16

 

1.2.2

Proportion of institutional deliveries

Proportion of deliveries conducted in public and private health facilities against the number of estimated deliveries during a specific year.

HMIS

BY:2014-15
RY:2015-16

1.2.3

Total Case Notification Rate of TB

Number of new and relapsed TB cases notified (public + private) per 100,000 population during a specific year.

Revised National Tuberculosis Control Programme (RNTCP) MIS, MoHFW
[Pre-filled]

BY:2015
RY:2016

1.2.4

Treatment success rate of new microbiologically confirmed tuberculosis (TB) cases

Proportion of new cured and their treatment completed against the total number of new microbiologically confirmed tuberculosis cases registered during a specific year.

RNTCP MIS, MoHFW
[Pre-filled]

BY:2014
RY:2015

1.2.5

Proportion of people living with HIV (PLHIV) on antiretroviral therapy (ART)

Proportion of PLHIVs receiving ART treatment against the number of estimated PLHIVs who needed ART treatment for the specific year

Central MoHFW Data
[Pre-filled]

BY:2014-15
RY:2015-16

Indicator not applicable for category of UTs.

1.2.6

Out of pocket expenditure per delivery in public health facility (in INR).

Average out of pocket expenditure per delivery in public health facility (in Rupees).

NFHS – 4
[Pre-filled]

RY: 2015-16

Indicator applicable only for reference year ranking. Not considered for incremental ranking.

DOMAIN 2 – GOVERNANCE AND INFORMATION

SUB-DOMAIN 2.1 – HEALTH MONITORING AND DATA INTEGRITY (Weight: 70)

2.1.1

Data Integrity Measure:

a. Institutional deliveries

b. ANC registered within first trimester

Percentage deviation of reported data from standard survey data to assess the quality/integrity of reported data for a specific period.

HMIS and NFHS-4

BY &RY: 2015-16 (NFHS)

BY &RY: 2011-12 to 2015-16 (HMIS)

The NFHS data were available only for Reference Year and the data for this was repeated for the Base Year and Reference Year.

SUB-DOMAIN 2.2 – GOVERNANCE (Weight – 60)

2.2.1

Average occupancy of an officer (in months), combined for following three posts at State level for last three years
1. Principal Secretary
2. Mission Director (NHM)
3. Director- Health Services

Average occupancy of an officer (in months), combined for following posts in last three years:
1. Principal Secretary
2. Mission Director (NHM)
3. Director- Health Services

State report

BY: April 1, 2012-March 31 March 2015

RY: April 1, 2013-March 31, 2016

 

2.2.2

Average occupancy of a full-time officer (in months) in last three years for all Districts- District Chief Medical Officers (CMOs) or equivalent post (Heading District Health Services)

 

 

Average occupancy (in months) of a CMO in last three years for all the Districts

State report

BY: April 1, 2012- March 31, 2015

RY: April 1, 2013-March 31, 2016

DOMAIN 3 – KEY INPUTS / PROCESSES

SUB DOMAIN 3.1 – HEALTH SYSTEMS / SERVICE DELIVERY (Weight – 200)

3.1.1

Proportion of vacant health care provider positions (Regular + Contractual) in public health facilities

Vacant healthcare provider positions in public health facilities against total sanctioned health care provider positions for following cadres (Separately for each cadre) during a specific year:

a. ANMs at Sub-Centres (SCs)
b. Staff nurse at Primary Health Centres and Community Health Centres (PHCs & CHCs)
c. MOs at PHCs
d. Specialists at DH (Medicine, Surgery, Obstetric and Gynae, Pediatrics, Anesthesia, Ophthalmology, Radiology, Pathology, ENT, Dental, Psychiatry)

State report

BY: As on March 31, 2015

RY: As on March 31, 2016

 

3.1.2

Proportion of total staff (regular + contractual) for whom an e-pay slip can be generated in the IT enabled Human Resource Management Information System (HRMIS).

Availability of a functional IT enabled HRMIS measured by the Proportion of staff (Regular + Contractual) for whom an e-pay slip can be generated in the IT enabled HRMIS against total number of staff (Regular + Contractual) during a specific year.

State Report

BY: As on March 31, 2015

RY: As on March 31, 2016

3.1.3

a.  Proportion of specified type of facilities functioning as First Referral Units (FRUs)

Proportion of public sector facilities conducting specified number of C-sections* per year (FRUs) against the norm of 1 FRU per 500,000 population during a specific year

HMIS

BY:2014-15
RY:2015-16

Indicator definition modified

 

b. Proportion of functional 24x7 PHCs

Proportion of PHCs providing all stipulated healthcare services** round the clock against the norm of one 24x7 PHC per 100,000 population during a specific year

State Report

BY:2014-15
RY:2015-16

3.1.4

Proportion of Districts with Functional Cardiac Care Units (CCU)

Proportion of Districts with functional CCU [with desired equipment (ventilator, monitor, defibrillator, CCUs   bed, portable   ECG   machine, pulse oxymeter etc.), drugs, diagnostics and desired staff as per programme guidelines] against total number of districts

State Report

BY: As on March 31, 2015

RY: As on March 31, 2016

3.1.5

Proportion of ANC registered within first trimester against total registrations

Proportion of pregnant women registered for ANC within 12 weeks of pregnancy during a specific year.

HMIS

BY:2014-15
RY:2015-16

3.1.6

Level of registration of births (%)

Proportion of births registered under Civil Registration System (CRS) against the estimated number of births during a specific year.

Civil Registration System (CRS)
[Pre-filled]

BY:2013
RY:2014

3.1.7

Completeness of IDSP reporting of P and L form (%)

Proportion of Reporting Units (RU) reporting in stipulated time period against total Reporting Units, for P and L forms during a specific year.

Central IDSP, MoHFW Data
[Pre-filled]

BY:2014
RY:2015

3.1.8

Proportion of CHCs with grading above 3 points

Proportion of CHCs that are graded above 3 points against total number of CHCs during a specific year.

HMIS

BY:2014-15
RY:2015-16

3.1.9

Proportion of public health facilities with accreditation certificates by a standard quality assurance programme (NQAS /NABH/ISO/AHPI)

Proportion of specified type of public health facilities with accreditation certificates by a standard quality assurance programme against the total number of following specified type of facilities during a specific year.

1. DH-SDH
2. CHC-Block PHC

State Report

BY: As on March 31, 2015

RY: As on March 31, 2016

3.1.10

Average number of days for transfer of Central NHM fund from State Treasury to implementation agency (Department/Society) based on all tranches of the last financial year

Average time taken (in number of days) by the State Treasury to transfer funds to implementation agencies during a specific year.

Centre NHM Finance Data#
[Pre-filled]

BY:2014-15
RY:2015-16

*Criteria for fully operational FRUs: SDHs/CHCs - conducting minimum 60 C-sections per year (36 C-sections per year for hilly and North-East States except Assam); DHs - conducting minimum 120 C-sections per year (72 C-sections per year for hilly and North-East States except Assam).

**Criteria for functional 24x7 PHCs: 10 deliveries per month (5 deliveries per month for hilly and North-East States except Assam)

#Centre NHM Finance data includes the RCH Flexi pool and NHM-Health System Strengthening Flexi pool data (representing a substantial portion of the NHM funds) for calculating delay in transfer of funds.

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