NITI Aayog will come out with a set of indicators by October this year to monitor progress across national development goals, according to Professor Bibek Debroy, Member, NITI Aayog. He was delivering the inaugural address at the kick-off event of ORF Health Forum held at the Taj Mahal Hotel, New Delhi on July 25, 2016. The event was organised as part of Observer Research Foundation’s work on the Sustainable Development Goals (SDGs).
Professor Debroy focussed on how the national development agenda will aim to improve Indian lives. With a 15-year vision, a seven-year strategy, and a three-year action plan, social sectors, physical connectivity, law and order and security are going to be important components of the agenda. Professor Debroy emphasised that NITI Aayog has not yet finalised its views on its approach towards health indicators. Different data sources give different conclusions and there is barely any data at the sub-regional level. While the indicators will be finalised soon, the availability of data for some may still be an issue. Silos within the health sector lead to inefficiencies in the public health expenditure. These need to be overcome.
Earlier, delivering the welcome remarks, Ashok Malik, Distinguished Fellow, ORF, highlighted the key challenges related to monitoring progress that India will face on the road to achieving SDG targets in health and nutrition. He spoke of the mixed health achievements in India and the data bottlenecks affecting rigorous tracking. He emphasised that effective policy decisions can only be made with data collected at district and sub-district levels and that effective statistical tracking is contingent on timeliness and robustness of data.
The technical session began with Oommen C. Kurian, Fellow at ORF, outlining some broad questions that need to be addressed by policy: How to get disaggregated district level data? Can universalisation of civil registration be a starting point? Are we asking the right questions in our national surveys? Is there a mechanism to ensure data from the private sector?
The framing presentation was followed by a special address delivered by Sunil Nandraj, Advisor, Ministry of Health & Family Welfare, who focused on the private health sector in the context of SDGs, and an Indian approach to data. He emphasised that scarcity of private sector data is a huge problem. Non-availability of private sector data on morbidity due to diseases like TB, malaria, etc, and on mortality rates for lifestyle diseases mentioned in Indicator 3.4.1 is an issue that needs attention. The Clinical Establishment Act, which could solve a lot of the data gap issues has only been adopted by nine states and Union Territories and since health is a state subject, mandating its adoption is not possible. He called for using better surveillance systems, analysis and triangulation of existing data that could help generate models for the future.
Dr. Krishna Kumar, Deputy Director General, Ministry of Statistics & Programme Implementation, delivered the keynote address and shared his experiences from the global indicator formulation process of the SDGs. He highlighted certain categories in which indicators went beyond the scope of the target or did not fully capture the essence of the target, or were based on perception surveys which lacked proper methodology. He pointed out that India has the capacity to produce data for only 23 out of the 231 indicators, adding that if some more investment is done, India can produce the data for at least 50-60 indicators.
The technical session was followed by a panel discussion moderated by Dr. Charu Garg, Advisor, National Health Systems Resource Centre.
Dr. Garg, in her opening remarks, stressed the need for data availability, analytics, and converting the analysis into information and knowledge. She then gave a brief overview of availability of data for the global indicators. Raising a very important point about the Universal Health Care (UHC) indicator — number of persons covered by health insurance — being an ineffective indicator, she stressed a need to identify what indicators are relevant for the country. Reiterating the issues of periodicity, disaggregation and standardisation of data, she recommended focusing on specific data sources for indicators and reaching a consensus on how it is measured and monitored.
Anjali Nayyar, Senior Vice President, Global Health Strategies India, focussed on the private sector and identified two major challenges: financing innovation and cooperation between various stakeholders and drawing strong political leadership in states to create a strong bind between state and centre. She also noted that the global dialogue taking place between the United Nations (UN) and the private sector doesn’t get reflected in India. Recounting several global initiatives that work towards tracking SDGs, she emphasised the need to learn from them, and to look towards the private sector for innovation, technology and resources.
Dr. Karanvir Singh, Chief Medical Information Officer, Apollo Hospital and Member, Electronic Medical Record Standardisation Committee, MoHFW/FICCI, spoke against the notion that private sector suffers from data unavailability. He emphasised that the dividing line is not between the public and private sector, but rather between individuals and organisations, or organised and unorganised sector.
Private practitioners and clinics do not supply data freely — due to issues of patient confidentiality. He also mentioned the Integrated Health Information Platform (IHIP) that plans to design data elements that all private and public establishments have to feed in order to create a central network of electronic data. Emphasising that ‘money talks,’ he also spoke of plans to use the health insurance industry as a means to hasten the registration of institutions under the Clinical Establishment Act.
Professor Kulkarni, leading demographer, highlighted key issues related to identifying measurable indicators for SDG tracking. He elaborated how sampling errors are a huge challenge in survey data. He also raised some thought provoking questions: are adequate funds being allocated to conduct large surveys? Are there competent people to carry out the surveys? If not surveys, can we use an improved administrative statistical system to get valid estimates for rare events? Can surveillance systems be improved for estimates on disease specific morbidity or cause specific mortality?
Ratna Anjan Jena, Advisor, Ministry of Women and Child Development (WCD), discussed the important role of gender in achievement of SDGs. Emphasising that health needs to be gender-sensitive, she listed various governments schemes and programmes running under WCD that shared similar values to the SDGs. Data available from these programmes like the Integrated Child Development Services (ICDS) could help in monitoring the SDGs by ensuring information flow from anganwadis through a digital rapid reporting system.
Priyanka Saksena, Technical Officer, World Health Organisation, brought up some pertinent questions with regard to the use of survey data as against routine data. Inadequate coverage of administrative data systems results in selective capturing of data, thus compromising its quality. Priyanka Saksena spoke of the importance of creating integrated systems for capturing data and also of the need for caution while using quantitative data.
The floor was then opened to questions. To a question regarding the quality of large survey data, Dr. Kumar responded that bad quality data can also be due to the respondent’s reluctance in answering a lengthy schedule. Two similar questions about the government mandating a Health Information Exchange Act for data sharing in the private sector were put forward. Dr. Singh clarified that creating a country-wide requirement would be difficult as health was a state subject. Moreover, in the private sector, money incentivises stakeholders. A mandate would need private clinics to be digitised, and health insurance rules could nudge them in that direction.
He also addressed a question about non-availability of private sector data, acknowledging that private organisations help researchers only when they too can gain from the research. Nandraj emphasised that researchers do not want access to medical records of individuals, but to aggregate data and trends.
Dr. Vikrom Mathur, Senior Fellow at ORF, closed the event with the announcement that ORF will soon host a series of multi-stakeholder consultative meets exploring different aspects of SDG implementation in detail.
This report is prepared by Rhea Colaco, Research Intern, Observer Research Foundation, New Delhi.
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