Health equity through data and accountability
Evaluations of both public systems and the private sector have the potential to improve India’s health services
Better data is needed to enhance state intervention and harness the strengths of the private sector to achieve public health goals. To meet the global Sustainable Development Goals (SDGS) over the next 15 years, it is important to ensure course corrections when needed.
Availability and use of regular, good quality health data is thus increasingly becoming a policy imperative. The Delhi Commitment on SDGS for Health of May 2016 called for greater investments in health data collection, analysis and research. Multi-sectoral convergence and integrated solutions keeping in mind regional specificities in the health sector and a performance-based categorisation of districts will be immensely useful.
Huge unused bed strength in the private sector and long waiting lines in the public sector co-exist in India and a robust information infrastructure is a necessary condition for any solution that can improve access using government’s bargaining power.
Real-time data flow can also get rid of the thick wall of suspicion between private and public health sectors in India, given the inevitability of private sector engagement—it covers up to 70% of health services. Data flow in itself can be a confidence building measure. Right now, while administrative data on morbidity exist in hospitals, these are never compiled or analysed for macro policy purposes.
The quality as well as coverage of the national Health Management Information System (HMIS) have improved and some important information on improvements in equitable distribution of health infrastructure and coverage is available now.
Health policy debate in India typically happens post-facto: not during or before decisionmaking. There is a need for making the datasets behind policy decisions transparent for democratic decision-making. Digital architecture must be made universally adoptable so that even individually built components are consistent and uniform across the system.
The new health information infrastructure will also have to find ways of overcoming the inter-sectoral, inter-ministerial and inter-organisational incoherence. India has two different targets for the same year for MMR -while NITI Aayog seeks to reduce MMR to 120 per 1 lakh live births by 2020, the NHP seeks to decrease the MMR to 100 by 2020.
India is planning to undertake an ambitious step towards UHC through the National Health Protection Scheme (NHPS). To make that investment for the future meaningful, high quality data is inevitable. It is time for India to drop the much-discussed apprehension to programme evaluations and to liberate data to facilitate independent evaluations.