Author : Oommen C. Kurian

Originally Published 2017-01-06 09:48:35 Published on Jan 06, 2017
What gets measured gets done

Data released by the Registrar General of India last week shows that India’s Infant Mortality Rate (IMR) as of 2015 has come down to 37- with 41 in the rural areas and 25 in urban areas.

While this is better than what was previously predicted by the Ministry of Statistics, India is still way off the mark, and we have now officially failed in achieving the MDG target of 27.

Interestingly, the SRS bulletin has given gender disaggregation of Rural Urban IMR only for 21 “Bigger States”.  It has stated that “due to inadequate sample size, the infant mortality rate by sex, separately for rural and urban areas (for smaller states and Union Territories) is not given”. Most of the national media platforms have yet to start reporting on the latest infant mortality numbers.

When the Prime Minister made his post-demonetisation address to the nation on the New Year eve, a key initiative on maternity benefits - part of the National Food Security Act’s yet unimplemented provisions- got termed by prominent sections of the English media as part of mere poll-time “sops”.

Read | < style="color: #960f0f">Overcoming data challenges in tracking India’s health and nutrition targets

At least part of the reason behind the apparent insensitivity of the media is lack of understanding the intensity of maternal and infant mortality issues and the positive impact that maternity benefits can have on maternal and infant health. Again, along with lack of general media interest, the other apparent reason behind dearth of understanding  the scale of problem is lack of regular, reliable and disaggregated data.

In May 2016, health secretaries of the States and Union Territories of India gathered in the capital and issued “The Delhi Commitment on Sustainable Development Goals (SDGs) for Health”.

Among others, the document acknowledged the need to invest in health data collection, analysis and research so that these can properly inform government policies and strategies necessary to address the various challenges facing India’s healthcare. Such commitment is imperative, given that the success of global SDGs over the next 15 years will largely depend on India’s performance. Measuring progress closely to ensure mid-course corrections when needed should be key to India’s health strategy.

Read | < style="color: #960f0f">Establishing a global framework for follow up and review of SDGs

In this context, Observer Research Foundation recently came out with a set of four broad recommendations in a report titled “Overcoming data challenges in tracking India’s health and nutrition targets” , on how national SDG implementation can be used as an opportunity to streamline and build on the existing national health statistical infrastructure to facilitate a health data revolution.

Although for tracking health parameters, India predominantly uses sample surveys, there is a need to improve civil registration and vital statistics (CRVS) systems in India. India started relying solely on sample surveys because of the inadequate coverage of its Civil Registration System (CRS), but over time, the “interim” measures have become the primary focus. With most states showing very good progress – barring perhaps Bihar and Uttar Pradesh - ensuring universal registration of births and deaths by the year 2020, promised in the “Vision 2020” plan announced in 2014, is a possibility, which can improve the quality and reach of our basic demographic data many times over. Focussed initiatives are required on this front.

Secondly, the existing sample surveys that collect data at the national level should be assessed for their comprehensiveness in a way that will improve disaggregated tracking of national goals. Unit-level data from India’s sample surveys remain an underutilised resource but data such as the National Sample Survey’s (NSS) ‘State sample’ that are collected spending vast amounts of tax money are often not used at all. Pooling of Central and State samples and the ability to calculate district-level estimates across socio-economic categories will enhance the policy relevance of NSS data.

Read | < style="color: #960f0f">Tracking health and nutrition targets: Four recommendations for India

Given India’s twin double burdens of communicable and non-communicable diseases as well as under-nutrition and over-nutrition, a comprehensive assessment of existing national surveys should be conducted with the aim of streamlining and strengthening them, and to arrive at set of health and nutrition indicators which reflects the epidemiological reality of the country.

Thirdly, the national Health Management Information System (HMIS), which currently covers only the public system and serves as the backbone for monitoring results of the National Health Mission comprising of the urban and rural sub-missions, needs extensive reform bringing along the vast private healthcare delivery system. With a majority of patients approaching the private sector across the country, lack of data on the private sector is unjustifiable. In this context, the unique health identification numbers (UHID) initiative at the India Institute of Medical Sciences (AIIMS) and the suggestion to integrate UHID and Aadhaar – perhaps as part of the broader Integrated Health Information Platform (IHIP) offers a very promising, if somewhat controversial approach, given the debates around Aadhaar in the country.

Lastly, setting up of a national Forum on Health and Nutrition Statistics in line with the Federal Inter-agency Forum on Child and Family Statistics of the U.S may help facilitate efficient coordination between the numerous agencies and government arms who collect, analyse and disseminate data. If India is aiming to improve the quality, availability and timeliness of data necessary to track national health goals, it has to address the core issue of fragmentation of efforts. Routine monitoring systems of the flagship schemes may not be attuned to provide reliable data.

Read | < style="color: #960f0f">MDGs to SDGs: Reproductive, maternal, newborn and child health in India

Although several government departments and ministries collect data across institutions and other stakeholders, these are not in line with standard definitions. This calls for systematic efforts at the central level, taking state governments and departments on board, in the form of a national forum.

Such a national forum can standardise definitions, streamline collection of data, triangulate existing data, and avoid duplication in order to bring out a comprehensive set of indicators every year which will track health and nutrition progress across the country at the sub-district level, across different attributes. Policy lessons can be derived from what the India HIV/AIDS Resource Centre has undertaken in terms of triangulation of data–analysing from behavioural studies, epidemiological studies, and other health system datasets to arrive at a district situational analysis. The Forum can also take up initiatives such as pooling of NSS central and state samples, so that currently under-utilised NSS datasets can be of use to policymakers, academics, researchers and frontline workers.

These initiatives, if undertaken, will no doubt tremendously help improve India’s ability to track progress in the health and nutrition domains at the very least on an annual basis, facilitate mid-term corrections, and ensure success of India’s health and nutrition strategy.

This commentary was originally published in Health Analytics.

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Oommen C. Kurian

Oommen C. Kurian

Oommen C. Kurian is Senior Fellow and Head of Health Initiative at ORF. He studies Indias health sector reforms within the broad context of the ...

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