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The 50 districts with the poorest health outcomes in India

Prime Minister Narendra Modi with (L-R) MoS for Civil Aviation Jayant Sinha, Union Health Minister JP Nadda, Jharkhand Governor Droupadi Murmu and CM Raghubar Das during the launch of Ayushman Bharat in Ranchi. Photo: PTI

New Delhi/Mumbai: Over the past decade, India has made significant strides in bringing down rates of child undernutrition and infant mortality. Yet, several parts of India continue to be weighed down by some of the worst health outcomes in the world, with rates of undernutrition and infant mortality much higher than some of the poorest parts of Sub-Saharan Africa.

A Mint analysis of the National Family Health Survey (NFHS) data released earlier this year shows a stark gap in health outcomes between the north and the south. Most districts with a high health deficit score are clustered in the middle and the northern parts of the country.

Most districts with better health outcomes are clustered in the extreme south.

The health deficit score is a normalized score that is based on five indicators—infant mortality rate (IMR, per 1,000 live births), share of underweight children, shares of adult men and women with low body mass index (BMI), and tuberculosis prevalence (per million adults). Given the problems with administrative data on illnesses, only data from the latest NFHS survey of more than 600,000 households in 2015-16 has been used. Beyond the north-south divide, the analysis shows a sharp divide between the 50 worst districts (marked in red in the map) and the rest of the country. The IMR for the 50 worst districts is 64 compared with 37 for the rest of the country. The share of underweight (low-BMI) women is 34% in the worst-performing districts, 12 percentage points higher than in the rest of the country. And TB prevalence at 9,440 (per million adults) is more than double the rest of the country.

While 24 of these districts are part of the list of the so-called ‘aspirational districts’ of the NITI Aayog, 26 of them are not part of that list.

More than two-thirds of the 50 districts lie in just three states—Uttar Pradesh, Bihar, and Jharkhand.

Life in these districts is marked by low life expectancy, and high morbidity. And things are unlikely to improve soon given that these districts also tend to be under-served by health services.

Across India, districts with poorer health outcomes tend to have lower proportion of pregnant women who receive the recommended number (four) of antenatal care visits. These districts also have a higher proportion of people who are dissatisfied with the public health system.

While the less storied component of the Ayushman Bharat health insurance scheme is aimed at revamping India’s poorly performing public health system, the measly outlay of ₹1,200 crore for that programme—it amounts to less than 5% of the health budget—is unlikely to make much of a difference.

The major component of the Ayushman Bharat programme, focused on medical insurance, is likely to receive a far bigger outlay of ₹10,000 crore.

But while it may offer respite to the poorest when faced with health shocks, it won’t fix India’s basic health deficits.

As several health economists have noted, the biggest bang for buck in healthcare comes from investments in preventive public health—including waste-management, sanitation and disease surveillance systems.

It is investments in these systems that have helped most countries lower infant mortality and improve health outcomes since the second World War, the Nobel Prize winning economist Angus Deaton wrote in his 2013 book The Great Escape: Health, Wealth, and the Origins of Inequality.

Unfortunately, such lessons have been ignored by Indian policymakers for most of independent India’s history.

This is the concluding part of a four-part data journalism series on India’s healthcare challenge.

The first part examined the staggering costs of India’s failing health systems. The second part examined the problems with state-run insurance schemes. The third part examined the data challenges Ayushman Bharat faces.

Abhishek Jha is a recipient of the Mint-Hindustan Times-HowIndiaLives Data Fellowship 2018.

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