Child care? Gujarat No 1 in institutional deliveries, but one of the poorest in other health indicators: GoI report

By Rajiv Shah
In a curious disclosure, a top Government of India (GoI) study, “Healthy States, Progressive India Report on the Ranks of States and Union Territories”, has found that, while “model” Gujarat ranks No 1 in institutional delivery of babies, in sex ratio at birth it is one of the worst – 854 girls as against 1000 boys.
Prepared by the GoI’s powerful policy-making body headed by Prime Minister Narendra Modi, Niti Aayog, with the “technical” support of the World Bank, the report has found the “proportion of institutional deliveries” in Gujarat is a whopping 97.8%, much higher than Kerala (92.6%).
However, as for sex ratio, only two major Indian states perform worse than Gujarat: Uttarakhand (844/1000) and Haryana (831/1000).

The top policy-making body – which is headed by Amitabh Kant, a high-flying bureaucrat, who replaced well-known Columbia University economist Arvind Panagariya – does not say what the reason is for this odd paradox.
Yet, the data do suggest that in under-five mortality rate (U5MR) as many as 11 major states perform better than Gujarat, with a U5MR of 39 per 1000 live births, with the best performer being Kerala (U5MR 13/1000), followed by Tamil Nadu, Maharashtra, Punjab, Jammu & Kashmir, West Bengal, Karnataka, Himachal Pradesh, Telangana, Uttarakhand, and Andhra Pradesh.
Similarly, in the proportion of low birth weight among newborns, the states which perform better than Gujarat (10.5%), are seven (Telangana, Jammu & Kashmir, Andhra Pradesh, Punjab, Bihar, Uttarakhand, and Uttar Pradesh); in full immunization, nine states perform better than Gujarat (90.6%): Jammu & Kashmir, Punjab, Uttarakhand, Maharashtra, Karnataka, West Bengal, Himachal Pradesh, Kerala, and Andhra Pradesh.

Interestingly, while the report does not seek to explain the paradox of high institutional deliveries, which are in stark contrast to poor indices of early child care, another set of data of the top policy-making body reveals the poor state of Gujarat’s health care delivery system.
Thus, Gujarat has a 28.1% shortage of Auxiliary Nurse Midwives (ANMs), who are necessary during institutional deliveries at sub-centres, up from 17.1% in a year; just one state out of the 21 major ones analysed, Bihar, is found to have a still higher shortage of (59.3%) ANMs.
The situation is identical with regard to the the shortage of staff nurses at Primary and Community Health Centres (PHCs and CHCs). While Gujarat’s shortage is 36.5%, only five of 21 major states have a still higher proportion of vacancies – Chhattisgarh, Haryana, Rajasthan, Bihar and Jharkhand.

Then, Gujarat has a 32.2% vacancies of medical officers at PHCs, higher than 16 of 21 major states; and 55.5% vacancies of specialists in district hospitals, higher than all states but three (Uttarakhand, Bihar and Chhattisgarh).
Further, Gujarat has 43% “functioning” First Referral Units, worse than 14 other states; 31.5% “functional” PHCs, worse than 13 other states; and 48.5% cardiac care units, worse than seven other states.
One may find it amusing, yet, the fact is, despite these data, while measuring the “state of health”, the report has placed Gujarat fourth best among 21 major states. Only three states perform better than Gujarat in the “composite index score” – Kerala (76.5 on a scale of 100), followed by Punjab (65.21), and Tamil Nadu (63.38). Gujarat’s score is 61.99.

On its methodology, the report states: “The index was developed by Niti Aayog with technical assistance from the World Bank… in consultation with the Ministry of Health and Family Welfare (MoHFW), States and UTs, domestic and international sector experts and other development partners.”