Need for a Public Health Data Architecture for India

• IAS NEXT, Lucknow
• 25, Dec 2021

What is the issue?

In a country perennially thirsty for reliable health data, the National Family Health Survey (NFHS) is like an oasis, prompting for a few comprehensive national surveys than being over-dependent on the omnibus NFHS.

What is the range and scope of NFHS?

• The NFHS is a large survey conducted in a representative sample of households throughout India which started in 1992-93 and is repeated at an interval of about four to five years.
• It is the Indian version of the Demographic and Health Surveys (DHS), as it is known in other countries.
• The Ministry of Health and Family Welfare, Government of India, has designated International Institute for Population Sciences (IIPS) as the nodal agency for the NFHS.
• The fifth round covered 6,36,699 households costing upwards of Rs. 250 crore.
• The funding has been provided by the United States Agency for International Development (USAID), Department for International Development (DFID), Bill and Melinda Gates Foundation (BMGF), UNICEF, United Nations Population Fund (UNFPA), and Ministry of Health and Family Welfare.
• Scope- Currently, the survey provides district-level information on fertility, child mortality, contraceptive practices, reproductive and child health, nutrition, and utilisation and quality of selected health services.
• Its scope has been expanded to include HIV, non-communicable diseases, or NCDs (tobacco and alcohol use, hypertension, blood sugar, etc.), Vitamin D3.

What are the other surveys and goals?

• Health Ministry has conducted various surveys in the last five years, including the
  • National NCD Monitoring Survey (NNMS)
  • National Mental Health Survey (NMHS)
  • Global Adult Tobacco Survey (GATS)
  • Alcohol survey
  • Comprehensive National Nutrition Survey (CNNS), etc.,
• However, the requirements for the monitoring of NCD targets are not met by the NFHS, as it covers an age group different than that needed for the global set of indicators.

What is the difficulty in aligning these surveys?

• Previous attempts to align these surveys have failed as different advocates have different demands and push for inclusion of their set of questions.
• The Department of Planning, Statistics and Programme Monitoring lacks the technical capacity and ends up using a please all approach of accepting all requests.
• The household which is selected for the survey have no power of negotiation.
• NFHS is the only major survey that India has a record of doing regularly and one does not know if and when the other surveys will be repeated.
• Multiple surveys also raise the problem of differing estimates due to sampling differences in the surveys.
  • For instance, there is a wide divergence in sex ratio at birth reported by the NFHS and the Sample Registration System (SRS).

What is the road map for public health data architecture for India?

• National surveys– There is a need to identify a set of national-level indicators and surveys that will be done using national government funds at regular intervals.
• National surveys can be done every 3-5 years in a staggered manner such as
  • A concise NFHS focusing on Reproductive and Child Health (RCH) issues,
  • A Behavioral Surveillance Survey (focusing on HIV, NCD, water sanitation and hygiene (WASH)-related and other behaviours)
  • A nutrition-biological survey (entails collection of data on blood pressure, anthropometry, blood sugar, serology, etc.)
• State participation– A national-level sample for such surveys can be taken and States can be asked to invest in conducting focused State-level surveys.
• States have to become active partners including providing financial contributions to these surveys.
• Specific studies– Important public health questions can be answered by specific studies conducted by academic institutions on a research mode based on availability of funding.
• Transparency of data– It is very important to ensure that the data arising from these surveys are in the public domain.
• This enables different analyses and viewpoints to be presented on the same set of data enriching the discussion thus unlocking the full potential of the survey.