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Are India's districts achieving their health goals? It looks otherwise, says Harvard analysis


NEW DELHI: A large number of Indian districts continue to have a “high prevalence of undernutrition”, the burden of anemia among women and children remains “very high”, sex ratio imbalances, and disparity in coverage of routine immunization among children, according to the latest analysis by experts from the Harvard University.

Using NFHS-4 (2015-16) and NFHS-5 (2019-20) data from the National Family Health Survey (NFHS) Policy Tracker for Districts, experts at the Geographic Insights Lab, Harvard University analyzed the performance of five major national programs currently sponsored by the Government of India on some key performance indicators (KPIs) in each category.

These include Anemia Mukt Bharat (AMB) which aims to reduce anemia prevalence to 32 percent nationwide by 2022, Beti Bachao Beti Padhao (BBBP), Intensified Mission Indradhanush (IMI) to achieve more than 90 percent child immunization against vaccine-preventable diseases, POSHAN Abhiyaan and Pradhan Mantri Matru Vandana Yojana (PMKVY) that provides direct financial subsidies to pregnant lactating women to tackle undernourishment.

Anemia Mukt Bharat (AMB)

The burden of anemia among women and children is very high and it requires a continuum of care approach with a greater focus on curbing anemia prevalence during pregnancy and its transmission to the next generation.

Kerala, Manipur, and Goa are among the best performing states while Bihar, Tripura, and Jharkhand are at the bottom of the state-level rankings. The highest burden of anemia is concentrated in certain endemic regions of Bihar, Jharkhand, Gujarat, Uttar Pradesh, and Chhattisgarh.

The extremely high burden of anemia prevalence in Ladakh and selected districts of Jammu and Kashmir requires a priority focus for reviewing local dietary factors and IFA supplementation efforts for women and children, noted the analysis.

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POSHAN Abhiyan

A large number of districts continue to have a high prevalence of undernutrition. An enhanced focus on achieving a faster reduction in high-burden districts is necessary. Manipur, Mizoram, and Kerala are among the best performing states in the POSHAN Abhiyan while Gujarat, Bihar, and Jharkhand are the worst.

The experts found that seven out of the top ten districts are from the Northeastern states of Manipur, Mizoram, and Arunachal Pradesh. Notably, four of the top ten districts are from Manipur. In contrast, six of the ten poorest-performing districts are in Gujarat.

Beti Bachao Beti Padhao

Wide inter-state and inter-district variations of the BBBP program are notable features emerging from NFHS 2019–21. Kerala, Goa and Mizoram are among the best performing states while Bihar, Jharkhand, and Nagaland are at the bottom list.

Even among the best performing states, such as Kerala, almost one-fourth of females do not report enrolment matriculation (10+ years of schooling).

Any identified imbalances in sex ratio should be reviewed carefully, especially at the block and village levels. For instance, the highly female-biased sex ratio at birth in the Alappuzha district (1485) of Kerala and the highly male-biased sex ratio at birth of Satna district (658) in Madhya Pradesh should be of equal concern in gender development. They should be examined at the sub-district level.

Pradhan Mantri Matru Vandana Yojana

More than 10 percent of the districts have more than 25 percent home-based births and are thus lagging in covering institutional deliveries (women giving birth in a health facility instead of at home) and the availability of skilled attendants at birth. The scheme should be targeted for strategies to better understand and improve these deficiencies.

Intensified Mission Indradhanush

The plan of action under IMI still needs comprehensive implementation. North-eastern states need targeted attention, as they not only place at the bottom of the KPI index rankings but have also not shown any improvement since the last survey round. The majority of the poorest performing districts are from the North-eastern states.

Odisha, Himachal Pradesh, and West Bengal are among the best performing states.