Punjabis may not be as wealthy as they were thought to be at the time of green and white revolution in the State, but they sure are healthy. For, NITI Aayog has put robust Punjab in second place in the country in overall health index.
In a first of its kind health index, conducted over a period of 18 months, Punjab has come next to Kerala (76.55) with 65.21 points in terms of overall levels of performance evaluated at various indicators like Neonatal Mortality Rate (NMR), Under-five Mortality Rate (U5MR), full immunisation coverage, institutional deliveries, People Living with HIV (PLHIV) on Anti-Retroviral Therapy (ART), among others.
As per the ‘Healthy States, Progressive India’ Report, released by NITI Aayog on Friday, Punjab’s sex ratio has improved from 870 to 889, NMR stood at as low as 13, besides having 99.6 per cent immunisation cover, among other indicators.
The “Performance in Health Outcomes” Index, capturing the annual progress of States and Union Territories (UTs), was conducted by NITI Aayog in collaboration with the Union Ministry of
Health and Family Welfare, with technical assistance from the World Bank.
The report says that Punjab has made “moderate improvement” among 21 larger States on incremental performance and overall performance. Punjab is among only five States that has improved their position from base to reference year by improving its performance in the ranking by three positions.
The number of neonatal deaths or NMR (occurring in the first 28 days of life) per 1,000 live births during a specific year stood at 13 in Punjab reflecting the quality of prenatal, intra-partum, and neonatal care services.
“This is an important indicator as approximately 68 per cent of infant deaths in India occur during the neonatal period...With 13 NMR, Punjab has already attained the National Health Policy (NHP) 2017 NMR goal for 2025,” a senior Punjab Health Department official told The Pioneer while sharing the details of the report.
In Punjab, the Under-five Mortality Rate (U5MR) - reflecting probability of dying before attaining the age of 5 - has remained stagnant at 27.
U5MR, that is the number of deaths under the age of five per 1,000 live births during a specific year, reflects a combination of several factors, such as nutritional status of children, health knowledge of mothers, level of immunisation and oral rehydration therapy, access to maternal and child health services, income of the family, and availability of safe drinking water and basic sanitation services, read the report.
The proportion of low birth weight (LBW) among newborns, which is equal to or less than 2.5 kgs, is an important predictor of newborn health and survival, and Punjab has relegated its score from 6 to 6.9 per cent.
There are several risk factors related to the mother that may contribute to low birth weight, such as child bearing at a young age, multiple pregnancies, poor nutrition, heart disease or hypertension, untreated coeliac disease, and insufficient prenatal care, said the official.
The report, pointing that there has been little progress in reducing the proportion of LBW newborns showing an increase in several states, suggested that the states need to focus on strategies and interventions to address this issue and break the inter-generational cycle of malnutrition.
Even as Punjab has increased its sex ratio from 870 to 889, it is still among the bottom 10 states. The sex ratio at birth reflects the extent to which there is reduction in the number of girl children born by sex-selective abortions.
“There is a clear need for States to effectively implement the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994, and take appropriate measures to promote the value of the girl child,” recommended the report.
Punjab has achieved almost full immunization coverage, 99.6 percent - the 2025 target specified in the National Health Policy, 2017. Under this, infants between the ages of nine and 11 months, who have received one dose of BCG, three doses of DPT, three doses of OPV, and one dose of measles vaccine, are covered.
Punjab has registered a fall in institutional deliveries (public and private) from 83.2 per cent to 82.3 per cent with the report recommending to make substantial efforts to improve its coverage.
The State has 84.6 per cent of people living with HIV (PLHIV) on antiretroviral therapy (ART). However, significant improvements are needed to achieve 90 per cent coverage. The National Health Policy-2017 sets a specific goal corresponding to achieving the global target of 2020, namely to ensure that 90 percent of all people tested positive for HIV receive sustained ART.
Evaluating the vacant healthcare provider positions (regular and contractual) in public health facilities, the report listed 8.5 per cent vacancy of ANMs at sub-centres, 34 per cent of staff nurses at PHCs and CHCs, 7.8 per cent of medical officers (MOs) at PHCs - the third lowest among 21 larger states.
The reports says that Punjab has a high proportion of vacant specialist positions in district hospitals with 48 per cent, however, it has shown substantial increase of specialists, ranging between 11 to 26 percentage points.
As per the report, Punjab has achieved the numerical target of functional First Referral Units (FRUs) with 141.8 per cent functional FRUs as against required number of one FRU per 5 lakh population.
The functioning of 24x7 PHCs is important for providing a basic package of health services to the community and for reducing the workload at higher-level facilities, and it has witnessed a decline of nine percentage points in Punjab.
Punjab, among other States, has made satisfactory progress by establishing functional Cardiac Care Units (CCUs) in its 63.6 per cent districts. Besides, it is among 17 States or UTs that has achieved 100 percent registration of births.