Daily Editorial – Reforming information system on health indicators

• Reforming Information System on health indicators

1. Developmental challenges facing India
2. Need for data
3. Data related challenges facing India
4. Recommendations

Click here to Download Daily Editorial PDF (7th Dec. 2016)

India has already accepted the SDGs as the guiding framework for country’s development trajectory.

28 countries including India recently met in Geneva to finalize the categorization of indicators across the 17 global Sustainable Development Goals (SDGs).

In India, the NITI Aayog and other government agencies are involved in a consultative process to prepare a 15-year vision, a seven-year strategy, and a three-year action plan defining the country’s development trajectory ahead.

Developmental challenges facing India

• India has not achieved much in the two areas: Health and Nutrition.
• A health SDG index released in September by The Lancet ranked India at 143 among 188 countries.
• In the Global Hunger Index published by the International Food Policy Research Institute in October, India is ranked 97th among a total of 118 countries.
• While on the other hand India is also facing the burden of overnutrition.
• Overweight and obesity contribute to the increasing burden of non-communicable diseases.
• India is also facing double burden of communicable (tuberculosis, malaria, AIDS, leprosy, dengue, diarrhoeal diseases, etc.) and non-communicable diseases (heart and lung diseases, stroke, cancer, diabetes, etc.).

Need for data

• The scale of the malnutrition and disease burden differs across States and districts.
• There is a need to customise policy and planning to match ground-level requirements. Requirement can only be predicted based on the available data.
• There is need for more reliable and frequent data to be collected and analysed to inform initiatives by the government.
• An efficient national health information system facilitates transparent and evidence-based decision-making, which in turn leads to improvements in health outcomes
• Higher investments in HMIS (Health Management Information System) offer various benefits, including:
• Helping decision-makers to detect and control emerging and endemic health problems,
• Monitor progress towards health goals,
• And promote equity

Data related challenges facing India

• India relies on sample registration and surveys to track mortality-related goals because of the inadequate coverage of its Civil Registration System (CRS).
• Only eight States/UTs have achieved the target of 90 percent in both birth and death registration.
• The proportion of female birth registration is 47 percent and death registration, just 42 percent.
• 48 million births were registered in 2013, the registered number of infant deaths was less than nine infant deaths per 1000 births, which is quite low given India’s IMR, which is 40 according to SRS 2013.
• HMIS (Health Management Information System) covers only 12.7 percent of the annual estimated infant deaths and 24.8 percent of the annual estimated maternal deaths (Annual Report 2014-15).
• There is no uniformity in the registration processes; registration is done by officials from different state departments—ranging from police to health, to revenue.
• The National Sample Survey (NSS) ‘central sample’ data, which is widely used by policy researchers still does not give reliable district-level estimates for many indicators.
• While several government departments and ministries collect data across institutions and other stakeholders, these are not often comparable, and there are instances of duplication.

Recommendations

•  There is a need to standardize actual registration processes to facilitate cross-coordination.
• Efforts to universalise birth and death registration, as well as integrate existing databases like the Census, NPR and CRS systems at the sub-district levels, can help track at-risk population in small areas.
• Surveys raising precise questions are required, and data will need to be collected based on these, avoiding duplication and redundancy.
• An interesting model is offered by the District Information System for Education (DISE), which provides annual, self-reported data by every school in India.
• An institutional mechanism to coordinate efforts at the national level, based loosely on the Forum on Child and Family Statistics of the US, should be considered.
• Pooling of Central and State samples will enhance the policy relevance of NSS data, as the data can then be used to arrive at district-level estimates.
• Setting up of a national forum on health and nutrition statistics in line with the Federal Interagency Forum on Child and Family Statistics of the U.S.
• Its mission should be to foster coordination and collaboration and to enhance consistency in the collection and reporting of health and nutrition data.