India must focus on improving healthcare delivery to climb ladder of SDG achievement

By Aravindan Srinivasan, CEO, AVPN India Foundation & Director, Thematic Collaboration, AVPN and Dr. Neeraj Agarwal, Senior Director, CPHC System and Chief of Party, NISHTHA at Jhpiego

Good health and Sustainable development are twin born goals, each supplementing the other. The global 2030 SDG Agenda reflects this interconnectedness between the two. From India’s perspective, the national Apex Policy think-tank NITI Aayog has undertaken the task of mapping the performance for the states against each of the SDG goals. The index ranks the states as Achievers, Front-runners, Performers and Aspirants depending on the progress made by the state against each SDG. 

While most of the country ranks as front runners on Goal 3: Good health and Well Being, states of Uttar Pradesh, Madhya Pradesh, Chhattisgarh, and the North-eastern cluster involving Arunachal Pradesh, Assam, Nagaland, and Sikkim are still making progress in this regard. 
Need to focus on the NER

As shown by the pan India data, India’s success in meeting the SDG 3 is linked to our success in providing basic health services to the NER. Healthcare, especially given India’s young population and high out of pocket expenditure directly impacts equity and social justice. Further, in the Northeast it also forms a strategic consideration. 

However, due to lack of in-depth understanding about the region, the NER is often lumped into one group of the “seven sisters”. This however is not accurate from a policy planning perspective. NITI Aayog recently developed the North-eastern Region District SDG Index and Dashboard 2021–22 to understand the district level progress and challenges faced by NER. 

The data highlights the significant diversity among the states in the NE-R: 
Out of the 103 districts considered for ranking by NITI Aayog
64 districts belonged to the Front Runner category 
39 districts were in the Performer category in the composite score and ranking of districts. 
All districts in Sikkim and Tripura fall in the Front Runner category and there are no districts in the Aspirant or Achiever categories.

From a Multi-dimensional Poverty Index (MPI) 2020 perspective: 
Proportion of people who are MPI poor in Assam (36.21 per cent) is more than seven times that of Sikkim (4.87 per cent). 
Inequality amongst the MPI poor is high in Meghalaya (0.248) and Arunachal Pradesh (0.237) and surpasses the all-India level of inequality (0.234). 
The percentage of the population living in rural areas is highest in Assam (85.92) and lowest in Mizoram (48.49). 

The Infant Mortality Rate in Meghalaya (47) is close to five times as that of the rate for Manipur (10)
Connection between other SGDs and health SGD - and how health is impacting others
Health SDGs help reinforce the synergies between SDGs and act as force multipliers. Improvement on the health SDG also helps improve the scope of impact and reduce the trade-offs for policy makers. Take for instance better health means - better education for girls (goal 4.1), which would improve maternal health (goal 3.1); would be closely linked to tackling child malnourishment (goal 2.2) and ensuring access to safe water (6.1). It is similarly linked to goals of urban health, equal access to treatments, and non-communicable diseases, among others.  Thus, Universal health coverage will be integral not only to achieving SDG 3, but also ending poverty and reducing inequalities.

Universal health care - Quality and range of services - not all services will be available 
In September 2018, The Lancet Global Health Commission on High Quality Health Systems (HQSS Commission) detailed the state of health system quality in low-income and middle-income countries.1 The Commission found that nearly 9 million lives are lost each year from treatable conditions for lack of good quality care and that a startling 60% of the deaths were among people who obtained access to care. Universal healthcare is thesis not only about quantity - As outlined in the National Health Policy of 2017, but services must also include quality care, continuum of care and range of services available at the community level. Both quality of services, and ensuring all basic diagnostic needs are met at the PHC level itself critically impacts the health outcomes as well as Out of Pocket expenditure, both of which can have catastrophic impact on financial wellbeing if not addressed. 

Urgency and focus of health SDG: 

 It considers widening economic and social inequalities, rapid urbanisation, threats to the climate and the environment: 
Continuing burden of HIV and other infectious diseases, 
Emerging challenges such as non-communicable diseases. 
Renewed focus on mental health issues as well. 
Universal health coverage, including financial risk protection, access to quality essential health care services and access to safe, effective, quality, and affordable medicines are integral to this goal.

Need for localisation: 
This data thus reveals the need for SDG Localisation. Through localising subnational contexts are developed and issues are recognised and addressed at the community level. This includes contextualisation of event goals and targets along with the implementation tools and progress metrics. 
Localisation is thus critical - both for understanding how local and sub-national governments can support the achievement of the SDGs through bottom-up action as well as how the SDGs can provide a framework for local development policy.