Health Index is a weighted composite score incorporating 24 key indicators

Are 'Bimaru' states of the yore still sick on the developmental front? No, not quite, at least on the health front. As per latest health index report released by the Niti Aayog last month, most of these states are catching up with the developed states, even as they threw some mixed results of performance on several key health indicators.

Bihar, the first part of the unflattering sobriquet, has actually forged ahead with 34.4 per cent increment change for better in the last five years. Though it still occupies 18th rank, next only to Uttar Pradesh with 19th place among as many large states set aside of comparison.

But there is a caveat. Jharkhand, the separated cousin of Bihar, is smashing ahead in improvement on the healthcare front with 97.71 per cent incremental change in the last five years. And Jharkhand has also bailed itself out, from being ranked a "worst performer" of years 2014 and 2015 to the "best performer" this year. It maintains a 13th position among 19 largest states in the healthcare.

The term 'Bimaru' was coined by Prof Ashish Bose, a prominent demographer and economic analyst in 1980s for the states of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh, owing to his observation that the economy of these states was always in state of sickness, putting a big drag on the GDP.

Apparently, the thrust on multifarious healthcare schemes pushed by Yogi-government in Uttar Pradesh seems to have started paying off with the state emerging as top ranking in betterment of healthcare last year with 5.52 score on scale of "Incremental Change." Though it has maintained a steady progress since 2014 with 12.54 per cent change on key health indices, yet, it continues to occupy the lowest overall rank of 19 among the large states.

Rajasthan slipped down a notch from 16 to 17 with 0,25 per cent change in minus compared to the last time. But it has maintained a steady progress since 2014 with 19.71 per cent improvement in the health trajectory.

Interestingly, the home state of Gujarat of Chief Minister-turned Prime Minister Narendra Modi, showcased often as a model of development, saw a 4.5 per cent decline in key health outcomes from 2014 to 2018 and fell in the category of "Worst Performer." However, it picked up in the this year and climbed to the sixth rank among large states.

The report titled “The Healthy States, Progressive India” of NITI Aayog made three categories for comparison in progress – Large States, Small States, and Union Territories.

As per analysis, the states of Telangana, Kerala, Tamil Nadu emerged top rankers in overall health, and Rajasthan the weakest. Uttar Pradesh continued to sit at the bottom of the list but topped in the efforts.

"Among the larger states, Kerala, Tamil Nadu and Telangana emerged among the best three performers in terms of overall performance. Uttar Pradesh with the lowest Overall Reference Year (2019-20) Index Score ranked at the bottom (Rank 19) in Overall Performance, however, it ranked at the top in terms of Incremental Performance by registering the highest incremental change from the Base Year (2018-19) to Reference Year (2019-20)," the report said.

"On the other hand, Kerala and Tamil Nadu were top two performers in terms of overall performance with the highest Reference Year (2019-20) Index Scores but ranked twelfth and eight respectively in terms of Incremental Performance. Telangana performed well both in terms Overall Performance as well as Incremental Performance and secured the third position in both instances," report said.

For the fourth consecutive round Kerala has emerged as the best performer in terms of Overall Performance.

Among the smaller states, Mizoram emerged as the best performer in Overall Performance as well as Incremental Performance while among UTs, Delhi and Jammu & Kashmir ranked among the bottom UTs in terms of Overall Performance but emerged as the leading performer in terms Incremental Performance over the last year.

In another surprise, clean city Chandigarh ranked worst in overall performance in health among Union Territories, slipping by a whopping 10.85 points in terms of incremental change over the last year.

Chandigarh was joined Goa which ranked worst among the small states, slipping down by 12.68 points

The states were also assessed on the key outcomes sub-domains Neonatal Mortality Rate (NMR), Under-5 Mortality Rate (U5MR), and Sex Ratio at Birth (SRB).

Kerala continued to be the best performing state with the lowest NMR of 5 per 1000 live births in 2018. All states registered a reduction in NMR or its level remained the same during 2014 to 2018, except Chhattisgarh, where the number of neonatal deaths per 1000 live births increased from 28 to 29.

All larger states recorded a reduction in U5MR between 2014 and 2018, a critical indicator for child survival. Between 2014 and 2018, the SRB (number of girls born for every 1000 boys) improved only in five Larger States (Andhra Pradesh, Assam, Jharkhand, Punjab and Uttar Pradesh), while remaining 14 states registered a decline. The highest increase in SRB was observed in Punjab (2.3 percent) and the highest decline was observed in Gujarat (-4.5 percent).

"NITI Aayog believes in the mantra ‘what gets measured gets done. As a part of cooperative & competitive federalism, NITI Aayog and the Ministry of Health and Family Welfare work to continuously nudge states and UTs towards improvements in health outcomes," NITI Aayog said in a statement.

"Health Index is a weighted composite score incorporating 24 indicators covering key aspects of health performance. The domains covered in the report are Health Outcomes, Governance and Information, and Key Inputs and Processes. These Health Index Reports aims to nudge the States and UTs towards building robust health systems and improving service delivery," it said.

"The importance of this annual tool is reemphasized by health ministry's decision to link this Health Index to incentives under National Health Mission. This report has tried to shift the focus from budget spending, inputs, and outputs to outcomes," it added.