A composite child survival and health index to monitor performance of States, Union Territories in India

Vaccination is one of the 11 key indicators of child survival and health, according to the authors.
| Photo Credit: File Photo

A team of Indian researchers – an econometrist based out of Chennai and his two daughters, both medical professionals – have built a Child Survival and Health Index (CSHI) for Indian States and Union Territories using data from the National Family Health Survey.  

K.R. Shanmugam, former director of the Madras School of Economics, said the idea behind developing the composite CSHI was to provide a platform to evaluate the performance of India and its various States, both retrospectively, and in the future. “While India aims to achieve developed nation status by 2047, it compares poorly on various child survival and health indicators with notable regional disparity across the country. Although it has set targets to reduce neonatal and under-5 mortality rates, in line with the Sustainable Development Goals, no proper monitoring system is available to assess the overall and regional performance effectively,” the paper pointed out.  

“Developing such an index will not only help us to understand the approach and ability of the government in fulfilling its obligations to child health and survival, but also to identify regions/areas in which gaps exist,” Dr. Shanmugam explained. His daughters, Shakti Indra Shanmugam, an alumna of Omandurar Government Medical College, and Sri Karthika Shanumga, who is a post-doctoral medical fellow at Columbia University, U.S., provided the health inputs to the paper, published recently in Child Indicators Research, a peer-reviewed journal.  

Recently, the National Institution for Transforming India (NITI Aayog), along with the Ministry of Health and Family Welfare and the World Bank, have started publishing an annual Health Index, a composite index incorporating 24 indicators, for tracking the overall performance and incremental performance of all Indian States and Union Territories. “While it considers a few child health indicators, the focus is also not solely on child survival and health index, “ Dr. Shanmugam explained.  

The authors said they picked 11 major indicators as representing the child survival and health: 3 from population and household profile, 1 each from infant/child mortality rates, maternal care, delivery care, child vaccination and anaemia among children and 3 from child feeding practices and nutritional status of children. Equal weightage was assigned to each parameter to enable comparisons.  

Their evaluation showed India’s CSHI value increased from 0.49 to 0.52. in 4 years, pushing it into a better performer category. But if the current trend continues, India needs about 30 years to increase its CSHI value to 0.75 and reach the top slot. Out of 35 regions, 5 – Lakshadweep, Puducherry, Kerala and Andaman & Nicobar Islands – were classified as best-performing, 25 as good-performing, and 5 as low-performing.  

Dr. Shanmugam added that the CSHI can also monitor the effectiveness of interventions, track changes in child health over time, and enable policymakers to devise appropriate strategies to improve the health status of children.