Needed, a public health architecture for India

News: India conducts numerous health surveys, most prominent of which is NFHS. Lately, there have been various additions into NFHS which have made it disoriented and lacking any specific policy purpose. 

There is need for selected comprehensive surveys that can broadly cover major public health themes for a complex country like ours.  

What is the National Family Health Survey (NFHS)?

Read about NFHS here. 

NFHS is used by many researchers, policymakers and is frequently used by NITI Aayog for its various rankings. 

It is conducted in a representative sample of households, where respondents are mostly women. 

Funding for different rounds of NFHS has been provided by some international organisations like United States Agency for International Development (USAID), etc and Ministry of Health and Family Welfare. 

Issues have been raised on the quality of the agencies conducting NFHS and their workers too.

What are other public health surveys in India, and the associated issues? 

Apart from NFHS, Health Ministry conducts the National NCD Monitoring Survey (NNMS), the National Mental Health Survey (NMHS), etc. 

Overinclusion, like inclusion of questions on HIV, non-communicable diseases, or NCDs in NFHS, has lead to extremely huge NFHS questionnaires. This affects the quality of data. Example: In NFHS-4,the women’s questionnaire was 93 pages long. 

Surveys done for research should not be confused with those done for programme monitoring and surveillance needs.   

– Irregularity and uncertainty of other surveys: NFHS is the only major survey that India has a record of doing regularly. One does not know if and when the other surveys will be repeated.  

Multiple surveys also raise the issue of differing estimates, as is likely, due to sampling differences in the surveys. For example: wide divergence in sex ratio at birth reported by the NFHS and the Sample Registration System (SRS). 

What should be the way forward?

Need to end overdependence on NFHS: 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. 

Need to ensure that the data is collected in an orderly and regular manner with appropriate budgetary allocation. 

There should be clarity of purpose behind conducting a survey and their need should be reanalysed. 

States should invest in conducting focused State-level surveys. 

For a detailed understanding of some issues, each round of survey can focus on a specific area of interest. Other important public health questions can be answered by specific studies (which may or may not need a national-level study), conducted by academic institutions on a research mode based on availability of funding.

It is also very essential to ensure that the data arising from these surveys are in the public domain. So that it can be analysed through different viewpoints. 

Source: This post is based on the article “Needed, a public health architecture for India” published in The Hindu on 24th Dec 2021. 

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