In a special initiative run by Union Ministry of Health and Family Welfare based on “result based funding", the penalised states will lose out on NHM funds for performance linked conditionalities from the Central government.
According to the scheme, while 80% of the resource envelope earmarked for the State would be assuredly available, 20% of the resource envelope would depend on State’s performance on agreed conditionalities.
According to the Health System Strengthening Conditionality Report of states 2018-19 released on Wednesday, Bihar, Uttarakhand, West Bengal, Madhya Pardesh and Mizoram remained the worst performers. On the contrary, Dadra and Nagar Haveli, Haryana, Assam, Kerala and Punjab were among top five states that performed well on various health system strengthening parameters of the NHM and will receive incentives.
The union health ministry assessed the states and UTs on the basis of parameters such as immunisation status, Health and Wellness Centres (HWCs), provisioning of mental health services in districts covered under the NHM programme, screening of 30 plus population non-communicable diseases and grading of primary health centres (both urban and rural), among others.
The incremental improvement as per the NITI Aayog ranking of states on "Performance on Health Outcomes" was one of the major conditionalities and was the highest weightage.
On NITI Aayog ranking of states on "Performance on Health Outcomes" indicator, 20 out of the 36 states and UTs have shown progress, whereas 16 states or UTs have shown a decline in their performance compared to previous year.
All the three hilly states -- Jammu and Kashmir, Himachal Pradesh and Uttarakhand -- have received penalty due to non-fulfilment of conditionality.
Among the eight North-Eastern states, four could not meet the eligibility criteria. Of the remaining Assam, Tripura and Manipur earned incentives, the report stated.
“Performance-based incentives are a proven way to encourage productivity, increase efficiency and boost growth in any system. Conditionalities under the NHM in India were introduced with a similar rationale," said Union Health Minister Harsh Vardhan.
"The aim is to instill a sense of healthy competition amongst the states and stimulate better health outcomes across the country. Keeping this aspect in mind, we have increased the NHM funds for performance linked conditionalities from 10 to 20 per cent of the resource envelope. The pools under NHM have been so designed that funds from high focus states do not go to better performing states and do not disturb the equity in fund distribution," Vardhan stated in the report.
Arunachal Pradesh, Meghalaya, Nagaland and Sikkim could not meet the minimum criteria of full immunisation of 75%, therefore the progress made by the states was not considered for assessment and all the four states were penalised.
Daman and Diu among the UTs and Punjab among the states, have achieved the highest percentage in terms of operationalisation of Health and Wellness Centres whole among the EAG states, Odisha has shown the highest achievement, according to the states.
West Bengal, Jammu and Kashmir, Andaman and Nicobar Islands, Bihar and Nagaland were penalised as they did not achieve the set benchmarks in the implementation of the Mental Health Programme and providing services as per programme guidelines.
Out of the rest 31 states, in 27 states at least 75% of the districts are providing mental health services. Whereas in two EAG states, Uttar Pradesh and Jharkhand, the percentage of districts providing mental health services is below 75%, the report stated.
Incentive for screening of 30-plus population for various non-communicable diseases was earned by 23 states. This includes 11 states that were able to screen more than 15% of the 30-plus population and earned full points. Seven states have neither earned any incentive nor penalty against the set indicator. The state of Tamil Nadu has reported an achievement of 100% screening of 30 plus population followed by Goa at 68% and Daman & Diu at 57%. Among the EAG states highest achievement was reported by Rajasthan at 33%; while the lowest was reported by Bihar and Madhya Pradesh. Nil achievement was reported by Delhi and Lakshadweep Islands, the report stated.
Among the eight Empowered Action Group (EAG) states, four states were incentivised, one state has earned no incentives or penalty and two states received penalty.