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The death of over 130 children in Bihar due to acute encephalitis syndrome has once again put the spotlight on the state of the healthcare sector in the country. The Supreme Court took cognizance of the matter and said the deaths are a matter of “grave concern” and directed the Centre and the Bihar government to file their response on medical care facilities within a week. A study conducted by the Indian Medical Association found that the deaths could have been prevented had a health awareness campaign been conducted and correct information provided to the families. Meanwhile Niti Aayog released the 2nd edition of its report ‘Healthy States, Progressive India’. Kerala, Andhra Pradesh, and Maharashtra emerged as the top ranking states based on historical performance across health indicators while Haryana, Rajasthan and Jharkhand topped the index based on incremental performance; Chhattisgarh was the worst performing state on this parameter. Bihar and Uttar Pradesh emerged as the worst performing states in the country.


Acute Encephalitis Syndrome:

Acute encephalitis syndrome (AES) is a serious public health problem in India.

It is characterized as acute-onset of fever and a change in mental status (mental confusion, disorientation, delirium, or coma) and/or new-onset of seizures in a person of any age at any time of the year.

The disease most commonly affects children and young adults and can lead to considerable morbidity and mortality.

Viruses are the main causative agents in AES cases, although other sources such as bacteria, fungus, parasites, spirochetes, chemicals, toxins and noninfectious agents have also been reported over the past few decades.

Japanese encephalitis virus (JEV) is the major cause of AES in India (ranging from 5%-35%).

Nipah virus, Zika virus are also found as causative agents for AES.


NITI Aayog’s Health Index:

NITI Aayog has released its second edition of comprehensive Health Index report titled, “Healthy States, Progressive India”.

What you need to know about the report?

The report has been developed by NITI Aayog, with technical assistance from the World Bank, and in consultation with the Ministry of Health and Family Welfare (MoHFW).

The report ranks states and Union territories innovatively on their year-on-year incremental change in health outcomes, as well as, their overall performance with respect to each other.

It aims to establish an annual systematic tool to measure and understand the heterogeneity and complexity of the nation’s performance in Health.


States and UTs have been ranked in three categories namely, Larger States, Smaller States, and Union Territories (UTs), to ensure comparison among similar entities.

How are states ranked?

The Health Index is a weighted composite Index, which for the larger States, is based on indicators in three domains: (a) Health Outcomes (70%); (b) Governance and Information (12%); and (c) Key Inputs and Processes (18%), with each domain assigned a weight based on its importance.


Health Index has been developed as a tool to leverage co-operative and competitive federalism to accelerate the pace of achieving health outcomes.

It would also serve as an instrument for “nudging” States & Union Territories (UTs) and the Central Ministries to a much greater focus on output and outcome-based measurement of annual performance than is currently the practice.

With the annual publication of the Index and its availability on public domain on a dynamic basis, it is expected to keep every stakeholder alert to the achievement of Sustainable Development Goals (SDGs) Goal number 3.

Performance of various states:

  • Kerala has emerged as the top-ranking state in terms of overall health performance.
  • Uttar Pradesh is the worst when it comes to overall health performance.
  • Gujarat, Punjab and Himachal Pradesh stood at fourth, fifth and sixth spots.
  • Kerala, Andhra Pradesh and Maharashtra have emerged as the top ranking states based on historical performance across health indicators.
  • Haryana, Rajasthan and Jharkhand top the index based on incremental performance.
  • Among the UTs, Chandigarh jumped one spot to top the list with a score of (63.62), followed by Dadra and Nagar Haveli (56.31), Lakshadweep (53.54), Puducherry (49.69), Delhi (49.42), Andaman and Nicobar (45.36) and Daman and Diu (41.66).
  • Only about half the States and UTs showed an improvement in the overall score between 2015-16 (base year) and 2017-18 (reference year).
  • Among the eight Empowered Action Group States, only three States — Rajasthan, Jharkhand and Chhattisgarh — showed improvement in the overall performance.


Problems in India’s healthcare system:

  • A weak primary healthcare sector

a) expansion of public services has been inequitably distributed

b) The care provided in these facilities is also not up to the mark.

c) Lack of intensive care units and issues like sanitation and drainage.

  • Unequally distributed skilled human resources

a) There aren’t enough skilled healthcare professionals in India despite recent increases in MBBS programmes and nursing courses.

b) Shortage is compounded by inequitable distribution of these resources.

c) India does not have an overarching national policy for human resources for health.

d) The dominance of medical lobbies such as the Medical Council of India

  • Large unregulated private sector

a) The National Sample Survey Office (NSSO) numbers show a decrease in the use of public hospitals over the past two decades

b) Significant portion of these private practitioners may not be qualified or are under-qualified.

c) Many new institutions set up in the past decade encouraged by commercial incentives, have often fuelled corrupt practices and failed to offer quality education.

  • Low public spending on health

a) Economically weaker states are particularly susceptible to low public health investments.

b) Many state governments also fail to use allocated funds

c) This might simply reflect structural weaknesses in the system and that need to be addressed with more resources.

d) The 14th finance commission recommendations, which will transfer a greater share of central taxes to states, offer an opportunity for the latter to increase investments in health.

  • Fragmented health information systems

a) Getting quality, clean, up-to-date data is difficult in the health sector

b) Data is incomplete (in many cases it excludes the private sector) and many a time, it’s duplicated

  • Irrational use and spiralling cost of drugs

a) Costs of medical treatment have increased so much that they are one of the primary reasons driving people into poverty

b) Jan Aushadhi campaign to provide generic drugs at affordable prices, but their implementation has been patchy and varied in different states

c) Corruption also increases irrational use of drugs and technology.

d) Kickbacks from referrals to other doctors or from pharmaceutical companies lead to unnecessary procedures such as CT scans, stent insertions and caesarean sections

  • Weak governance and accountability

a) Many of the new laws have not been widely implemented

b) Missing trust and engagement between various healthcare sectors

c) Poor coordination between state and central governments as the main constraints why universal healthcare is not assured in India

d) Unwillingness on the part of the state to prioritize health as a fundamental public good, central to India’s developmental aspirations, on par with education.

  • India continues to lag several health indicators such as mortality rates and malnutr


Strategies for Future Planning:

  • Need of public health system which is backed by public health cadres consisting of public doctors, public health para professionals, public health nurses down upto primary healthcare level
  • Concerted efforts have to be made by the government and the community for improving the quality of life of people.
  • For sustainable development, therefore, stabilisation of population is the first and foremost
  • Location of health services and facilities should be such that these are easily accessible and available to people, especially the under-privileged sections
  • Human resource planning, human resource development would ensure a motivated workf
  • Strengthening of health promotion and protection by development of an integrated education and health promotion programme.
  • Implementation of preventive and promotive health activities in an integrated and comprehensive manner.
  • Making health as an integral part of the development programme along with strict and effective enforcement of legislation related to health
  • Identification and specification of the role of public and private sectors in health should be encouraged.
  • Effective involvement of the indigenous systems of medicine in provision of health care services
  • Area specific comprehensive health care approach to cover all the major health problems in a given geographical area with linkages with other related sectors would avoid duplication and wastage of resources.
  • Developing and using an appropriate health technology so as to have locally relevant health technologies which fit into the local socio-cultural milieu.
  • Strengthening of international partnership in health by integrated involvement of international organisations
  • sharing experiences and expertise in health among various countries especially in the South East Asian countries


India needs a holistic approach to tackle problems in healthcare industry. This includes the active collaboration of all stakeholders public, private sectors, and individuals. Amore dynamic and pro-active approach is needed to handle the dual disease burden. A universal access to health makes the nation fit and healthy, aiding better to achieve the demographic dividend.


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