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How the Aspirational Districts Programme is making India healthier

The Aspirational Districts Programme (ADP) was launched in January 2018 with the aim to accelerate the socio-economic outcomes of the most underdeveloped districts of the country.

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By CNBCTV18.com Contributor November 11, 2020, 5:29:40 PM IST (Published)

How the Aspirational Districts Programme is making India healthier
Authored by: Dr Amit Kapoor


If the year 2020 has taught the world anything, it is the necessity to invest and improve the health and nutrition of the people above all else. India has historically lacked on this front. It spends 1.28 percent of its GDP on public health at the central level—one of the lowest in the world. As a result, the better part of India’s healthcare system lies in its cities led by the private sector in the form of tertiary care. The primary healthcare system at the village-level has always been a point of concern where the gap of trained healthcare workers has been filled by informal providers. The recent efforts by NITI Aayog with the Aspirational Districts Programme have been directed towards addressing these gaps in the least developed part of the country.

The Aspirational Districts Programme (ADP) was launched in January 2018 with the aim to accelerate the socio-economic outcomes of the most underdeveloped districts of the country. Currently, the programme has been implemented in 112 of the country’s 739 districts. The idea is to track the performance of these districts on key parameters pertaining to several development outcomes, in which health is a key focus area.

The ADP dashboard captures the status of several health and nutrition indicators like sex ratio, ante-natal and post-natal care, child malnutrition, immunisation and so on. All of these are crucial parameters to ensure that basic health outcomes improve, especially in the areas that need it the most given the programme’s focus on districts that have been left behind. It will help reduce the disparities across Indian regions in terms of the quality of health service provisions.

Addressing these concerns are expected to have gains beyond mere health outcomes as well. A healthy population can make more effective contributions in the labour force as their capacity for skilling and working improves. This occurs through various channels such as improved learning among school children, increased productivity of adult workers, and lower absenteeism rates. It also allows for more productive uses of financial resources that would have otherwise used for health treatments.

Therefore, the focus on improving governance through the Aspirational Districts Programme across the most underdeveloped districts can maximise the gains through such channels. And over the last two years, the programme has made significant gains across these districts as well. As per a study conducted by the Institute for Competitiveness, among all the focus areas of the programme, the districts have achieved maximum gains in health and nutrition. Based on targets set by all districts for all health and nutrition indicators, the average distance away from the achievement of targets is around 10 percentage points, which is the lowest across all focus areas.

In fact, districts such as Dahod (Gujarat), Baramulla (Jammu and Kashmir), Gadchiroli (Maharashtra), Raichur (Karnataka), Bijapur (Karnataka), Bastar (Chhattisgarh), Yadgir (Karnataka) have been able to exceed targets that they had set. Bastar has been offering free health check-ups, free medicine, and free nutritious food and counselling of malnourished children under the ‘Suposhit Bastar Abhiyaan’. Meanwhile, in Bijapur, 15000 health and wellness centres have been launched to facilitate comprehensive healthcare. These initiatives based on data-driven policies help in bringing a significant change in the remote areas.

Further, issues of critical concern have shown significant progress under the programme. Severe Acute Malnutrition (SAM), for instance, is directly responsible for the deaths of about 35 percent of children below the age of 5 across the world and has a high prevalence in India, especially across the least developed states as per NFHS-4 data. At least five ADP districts have shown an improvement of over 10 percent in SAM incidence rates during the course of the programme compared to the baseline period. Araria, a district from Bihar, has shown an improvement of over 40 percent.

These improvements in health and nutrition have been led by efforts by district administrations based on their specific local requirements. To tackle SAM, for instance, Nandurbar in Maharashtra set up community kitchens to provide nutritious meals while Dholpur in Rajasthan organised a programme focussed on improving the nutrition levels of girl children called Beti Janmotsav. In further health interventions like infant mortality, West Sikkim has been providing manual Ambu bags that ensure constant oxygen supply for infants. Therefore, such district-specific efforts have proved immensely successful in improving the health and nutrition status of these regions.

However, while the Aspirational Districts Programme has gained notable successes in improving the performance of the districts on key indicators of health and nutrition, these efforts are not an end in themselves. The road to improve India’s healthcare system is a long one with multiple challenges. But the ADP has shown how improvements in governance mechanisms can ensure consequential changes on the ground.

Another key learning from ADP is the role of coordination among different stakeholders from the central government, NITI Aayog, officers at the district-level and civil society. At some level, the engagement from the state government in scaling up the programme to relevant districts will be necessary. Moreover, the states need to make commensurate investment towards health as it is eventually a state subject.

All districts across the country—irrespective of their engagement with ADP— can draw actionable learnings from the programme. After all, it is only when Indian districts develop into healthier regions, the country will make long-term gains.

—Dr. Amit Kapoor is the Honorary Chairman at Institute for Competitiveness, India. The views expressed are personal
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