The Union Minister of Health and Family Welfare, Dr. Mansukh Mandaviya released the National Report of the Fifth Round of the National Family Health Survey (NFHS-5) in the presence of Shri Bhupendrabhai Patel, Chief Minister of Gujarat and Dr Bharati Pravin Pawar, Union Minister of State for Health and Family Welfare at the ‘Swasthya Chintan Shivir’ held in Vadodara, Gujarat today.
The report includes detailed information on key areas of population, family health and well-being and related areas such as population characteristics; fertility; family planning; infant and child mortality; maternal and child health; nutrition and anemia; morbidity and health care; empowerment of women, etc.
The main objective of successive cycles of the NFHS has been to provide reliable and comparable data relating to family health and well-being and other emerging areas in India. The NFHS-5 survey work was conducted in about 6.37 lakh sample households from 707 districts (as of March 2017) across the country in 28 states and 8 UTs, covering 7,24,115 women and 1,01,839 men for provide disaggregated information. estimates down to district level. The national report also provides data by socio-economic and other background characteristics; useful for policy formulation and effective program implementation.
The scope of NFHS-5 is expanded from the previous round of the survey (NFHS-4) by adding new dimensions such as death registration, preschool education, expanded areas of childhood immunization, components of micronutrients for children, hygiene, frequency of alcohol and tobacco consumption, additional components of non-communicable diseases (NCDs), expansion of the age range to measure hypertension and diabetes in all ages 15 and older, which will provide the inputs needed to monitor and strengthen existing programs and develop new strategies for policy intervention. Thus, NFHS-5 provides information on important indicators that are useful in tracking the progress of Sustainable Development Goals (SDGs) in the country. NFHS-4 (2015-16) estimates have been used as baseline values for a large number of SDG indicators and NFHS-5 will provide data for around 34 SDG indicators at different levels.
Key Findings from the NFHS-5 National Report – Progress from NFHS-4 (2015-16) to NFHS-5 (2019-21)
India has made significant progress in population control measures in recent times. Total Fertility Rates (TFR), an average number of children per woman, further declined from 2.2 to 2.0 nationally between NFHS-4 and 5. There are only five states in India, who are above the fertility replacement level of 2.1. These are Bihar (2.98), Meghalaya (2.91), Uttar Pradesh (2.35), Jharkhand (2.26) and Manipur (2.17).
The overall contraceptive prevalence rate (CPR) has increased significantly from 54% to 67% in the country. The use of modern methods of contraception has also increased in almost all states/UTs. Unmet need for family planning has dropped significantly from 13% to 9%. The unmet need for spacing, which has remained a major problem in India in the past, has fallen to less than 10%.
The proportion of pregnant women who had a prenatal visit during the first trimester increased from 59% to 70% between NFHS-4 and NFHS-5. In most states, with a maximum increase of 25 percentage points in Nagaland, followed by Madhya Pradesh and Haryana, it was noticed. In contrast, Goa, Sikkim, Punjab and Chhattisgarh showed marginal decrease in first trimester antenatal visits. Considerable progress is observed in CPN 4+ at the national level, going from 51% in 2015-16 to 58% in 2019-21.
Institutional births have increased dramatically, from 79% to 89% in India. Even in rural areas, about 87% of births take place in institutions and 94% in urban areas. Institutional births increased by a maximum of 27 percentage points in Arunachal Pradesh, followed by more than 10 percentage points in Assam, Bihar, Meghalaya, Chhattisgarh, Nagaland, Manipur, India. Uttar Pradesh and West Bengal. More than 91 percent of districts have more than 70 percent of births in the last 5 years that have taken place in health facilities.
In NFHS-5, more than three-quarters (77%) of children ages 12-23 months were fully immunized, compared to 62% in NFHS-4. Full immunization coverage among children ranges from 57 percent in Nagaland to 95 percent in DNH&DD. Odisha (91%), Tamil Nadu (89%) and West Bengal (88%) also showed relatively higher vaccination coverage.
The level of stunting in children under 5 has slightly decreased from 38% to 36% for India over the past four years. Stunting is higher among children in rural areas (37%) than in urban areas (30%) in 2019-21. The variation in stunting ranges from lowest in Pondicherry (20%) to highest in Meghalaya (47%). A notable decrease in stunting was observed in Haryana, Uttarakhand, Rajasthan, Uttar Pradesh and Sikkim (7 percentage points each), Jharkhand, Madhya Pradesh and Manipur (6 percentage each), as well as Chandigarh and Bihar (5 percentage points each). with NFHS-4, the prevalence of overweight or obesity increased in most NFHS-5 states/UTs. At the national level, it goes from 21% to 24% among women and from 19% to 23% among men. Over a third of women in Kerala, A&N Islands, Andhra Pradesh, Goa, Sikkim, Manipur, Delhi, Tamil Nadu, Puducherry, Punjab, Chandigarh and Lakshadweep (34- 46%) are overweight or obese.
NFHS-5 shows overall improvement in SDG indicators across all states/UTs. The extent to which married women typically participate in three household decisions (concerning health care for themselves; making major household purchases; visiting family or relatives) indicates that their participation in household decision is high, ranging from 80% in Ladakh to 99% in Nagaland and Mizoram. The rural (77%) and urban (81%) difference is marginal. The prevalence of women having a bank or savings account that they use has increased from 53% to 79% over the past 4 years.
Between NFHS-4 and NFHS-5, the use of clean cooking fuels (44% to 59%) and improved sanitation facilities (49% to 70%), including a facility to wash hands with water and soap (60% to 78%) have improved considerably. There has been a substantial increase in the proportion of households using improved sanitation facilities, which could be attributed to the Swatch Bharat Mission program.
New Dimensions in NFHS-6 (2023-24) – Learning from NFHS-5
The Government of India’s Ministry of Health and Family Welfare (MoHFW) has launched a number of flagship programs such as Ayushman Bharat, Poshan Abhiyan, etc. to improve the health of the general population and sections of India. vulnerable and disadvantaged population in particular. In addition, India is also moving towards the direct bank transfer of benefits to the beneficiaries of its various programs. Furthermore, India is committed to achieving the Sustainable Development Goals (SDGs). The MoHFW continuously monitors health targets related to the SDGs. Due to the ongoing COVID-19 pandemic, a number of new health system challenges have emerged in the country.
In this context, NFHS-6, which should be conducted in 2023-24, proposes to cover various new areas, including:
“Funding for COVID-19 Hospitalization and Distress, COVID-19 Vaccinations, Director’s Benefit Transfers (DBT) under various welfare schemes initiated by the Government of India, Migration, Utilization of Health Services – health and wellness center, health insurance/health financing, digital literacy, post-abortion family planning counseling and incentives for new family planning methods, family planning program quality, hygiene period, marital choice, community health worker visit for sensitization and health needs, supplementary nutrition from Anganwadi center/ICDS during lactation, blood transfusion (month and year), financial inclusion women, knowledge of anemia, hepatitis B and C, syphilis, etc.
Unlike previous cycles, NFHS-6 will adopt the Urban Frame Survey (UFS, 2012-17) from ONS, MoSPI as the sampling frame for the urban area. This strategy will minimize non-sampling errors to a large extent because the problems of identifying boundaries using the 2011 Census frame will be resolved. While for rural areas, the updated list of villages from the ONS will be used as the basis, which will be compared to the Census PCA for auxiliary information.
On the occasion of Chintan Shivir, the Ministry of Health and Family Welfare has also released the publication of rural health statistics for the year 2020-21 (as of March 31, 2021). It is an essential source of information on health infrastructure and human resources available in public health facilities in all states/UTs. It also facilitates the identification of additional resources for better management of the public health service delivery system. The data is widely used for decision making and policy intervention by policy planners, researchers, NGOs and other stakeholders.
According to the ERS 2020-21, there are 157,819 sub-centres (SC), 30,579 primary health centers (PHC) and 5,951 community health centers (CHC) functioning respectively in rural and urban areas of the country. In addition to this, a total of 1224 sub-division/sub-district hospitals and 764 district hospitals (DH) are operational across the country.
The publication also provides information on the needs, vacancies and lack of key infrastructure and human resources across the country based on specific standards that help fill gaps, if any.
Progress in publishing rural health statistics
The Ministry of Health and Family Welfare (MoHFW) has been publishing the Rural Health Statistics (RHS) publication since 1992, which contains important and crucial information on the human resources and health infrastructure available in the facilities. Public Health of India as of March 31 annually.
According to the new requirement, the formats of the publication have been changed from time to time. From the year 2018-2019, data related to the components of urban health have also been included in the publication.
For the planning of health programs and policies in the country, this publication is used by various stakeholders such as policy makers, researchers, NGOs and various institutions working in the field of public health. It also serves as important sources of information for various issues related to ITRs and Parliament.
(With GDP entries)