The health of all people is not the same; nor is that of all nations. Countries across the world vary tremendously in terms of their burden of disease, and performance in terms of doing what is required. Shortfall in performance can be attributed to several factors that these columns have emphasized: policy, infrastructure, medical staff, and front-line workers. How we compare country-level performance, identify issues that cut across, and respond to them is the charter of what is called global health. Entering into the new millennium, there was a consensus that the world needed an agreed upon set of metrics that would translate into targets for countries and also enable cross-country comparisons. What are these metrics? How well has India done against them? What are we doing to improve our report card? This article touches on these issues.
The year 2000 saw the unprecedented coming together of 189 nation states along with multilateral agencies to reduce multi-dimensional poverty and ensure economic well-being and social development through global partnership. Therein was born the millennium development goals (MDGs) to run from 2000-2015. The MDGs were a set of eight broad metrics that ranged from eradicating extreme hunger (MDG 1) to ensuring environmental sustainability (MDG 7). The operative ones were reducing child mortality (MDG 4), improving maternal health (MDG 5) and combating HIV/AIDS and malaria (MDG 6). India’s performance on the MDGs, especially on health and nutrition, improved but stayed sub-optimal. The ministry of statistics and program implementation reports that India was only able to achieve the MDG target of halting and reversing the spread of HIV/AIDS and incidences of malaria by 2015. Among the states, only Kerala and Tamil Nadu achieved the MDG target of decline in infant death per thousand live births. Similarly, only Kerala and West Bengal managed to achieve the target of decline in maternal deaths per one lakh population.
By the end of the MDG era, there was a feeling that MDGs were too narrow in their scope as they did not touch upon the broader health and developmental issues confronting the world. This led to the dawn of the sustainable development goals (SDGs) to run from 2015 to 2030. The SDGs were signed in September 2015 by the leaders of 170 countries with the objective of finishing the unfinished business of the MDGs. The SDGs are wider in scope in that they covered social and environmental determinants of health such as gender, nutrition, sanitation, sustainable habitats and infrastructure. Crucially, the SDGs have a formal mechanism of voluntary review by individual countries, by submission to the High-level Political Forum on Sustainable Development of the United Nations. The SDGs also have a section on means of implementation, which spells out the resources required for its implementation. So, how is India faring on the SDGs? In the global SDG index that assesses the performance of countries in meeting the SDGs, in 2017, India ranked at 116 out of 157 countries. By way of comparison, Brazil ranks at 56, Bangladesh at 111, Sri Lanka at 89 and China at 54. Specific to health, India ranks at 143 out of 188 countries.
If India wants to succeed on SDGs, political will is the key, and the good news is that there is strong intent. Programs such as Transformation of Aspirational Districts are a welcome approach by the government of India to localize the SDGs with a focus on health, nutrition, infrastructure, education and agriculture. Similarly, programs like Ayushman Bharat, National Nutrition Mission, and the Swachh Bharat Mission can potentially play a pivotal role in meeting the targets under different SDGs. The NITI Aayog has been entrusted with the task of coordinating the SDGs for India, to ensure monitoring at the highest level. That institution is coming up with a much-needed index to assess the performance of Indian states on the SDGs with the objective of spurring competition among them. Given India’s size, clearly the world will only succeed if India meets the SDGs. We cannot afford to fail. – Livemint