National Family Health Survey (NFHS-5) - Daily Current Affair Article

Why in news:

Union Health Ministry releases NFHS-5 Phase II Findings

About National Family Health Survey (NFHS):

  • The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
  • The NFHS is a collaborative project of the International Institute for Population Sciences(IIPS), Mumbai, India; ICF, Calverton, Maryland, USA and the East-West Center, Honolulu, Hawaii, USA.
  • The Ministry of Health and Family Welfare (MOHFW), Government of India, designated IIPS as the nodal agency, responsible for providing coordination and technical guidance for the NFHS.
  • NFHS was funded by the United States Agency for International Development (USAID) with supplementary support from United Nations Children's Fund (UNICEF). IIPS collaborated with a number of Field Organizations (FO) for survey implementation. Each FO was responsible for conducting survey activities in one or more states covered by the NFHS. Technical assistance for the NFHS was provided by ICF and the East-West Center.

The history of NFHS

The First National Family Health Survey (NFHS-1) was conducted in 1992-93. The survey collected extensive information on population, health, and nutrition, with an emphasis on women and young children.

The Second National Family Health Survey (NFHS-2) was conducted in 1998-99 in all 26 states of India with added features on the quality of health and family planning services, domestic violence, reproductive health, anemia, the nutrition of women, and the status of women. The results of the survey are currently being published.

The Third National Family Health Survey (NFHS-3) was carried out in 2005-2006. Eighteen Research Organizations including five Population Research Centres carried out the survey in 29 states of India.

The NFHS-4 (2015-16) surveyed 572,000 households in 640 districts of India (as per the 2011 Census). The survey collected information on the socio-economic characteristics of households, education, fertility, family planning, infant and child mortality, maternal and child health, reproductive health, sexual behaviour, marriage, domestic violence, attitudes to gender roles, HIV/AIDS status, nutrition, water, sanitation, and health services and insurance. The survey also provides vital estimates of the prevalence of malnutrition, anaemia, hypertension and high blood sugar.

The key results from the State/UT factsheets are as follows:

  • The Total Fertility Rates (TFR) has further declined since NFHS-4 in almost all the Phase-1 States and UTs. The replacement level of fertility (2.1) has been achieved in 19 out of the 22 States/UTs and only 3 states viz. Manipur (2.2), Meghalaya (2.9) and Bihar (3.0) have TFR above replacement levels now.
  • Overall Contraceptive Prevalence Rate (CPR) has increased substantially in most States/UTs and it is the highest in HP and WB (74%). Use of modern methods of contraception has also increased in almost all States/UTs.
  • Unmet needs of family planning have witnessed a declining trend in most of the Phase-1 States/UTs. The unmet need for spacing which remained a major issue in India in the past has come down to less than 10 per cent in all the States except Meghalaya and Mizoram.
  • Full immunization drive among children aged 12-23 months has recorded substantial improvement across States/UTs/districts. More than two-third of children are fully immunized in all the States and UTs except Nagaland, Meghalaya and Assam. In almost three-fourths of districts, 70% or more children aged 12-23 months are fully immunized against childhood diseases.

The NFHS 5 that started in 2019, however, was stalled amid the COVID-19 associated lockdown. Eventually, the NFHS-5 findings were released in December 2020. Based on these findings, the ministry has set up a technical expert group to improve indicators pertaining to Malnutrition, Stunting, Anaemia, and C-Section.

The recent NFHS 5 survey key points:

  • The Total Fertility Rates (TFR), an average number of children per woman has further declined from 2.2 to 2.0 at the national level and all 14 States/UT’s ranging from 1.4 in Chandigarh to 2.4 in Uttar Pradesh. All Phase-II States have achieved replacement level of fertility (2.1) except Madhya Pradesh, Rajasthan, Jharkhand and Uttar Pradesh.
  • Overall Contraceptive Prevalence Rate (CPR) has increased substantially from 54% to 67% at all-India level and in almost all Phase-II States/Uts with an exception of Punjab. Use of modern methods of contraceptives has also increased in almost all States/UTs.
  • Unmet needs of family Planning have witnessed a significant decline from13 percent to 9 per cent at all-India level and in most of the Phase-II States/UTs. The unmet need for spacing which remained a major issue in India in the past has come down to less than 10 per cent in all the States except Jharkhand (12%), Arunachal Pradesh (13%) and Uttar Pradesh(13%).
  • Full immunization drive among children aged 12-23 months has recorded substantial improvement from 62 per cent to 76 percent at all-India level.11out of 14 States/UTs has more than three-fourth of children aged 12-23 months with fully immunization and it is highest (90%) for Odisha.
  • On comparing NFHS-4 and NFHS-5 data, the increase in full immunization coverage is observed to be expeditious in many states and UTs; More than50 percent of Phase-II States/ UTs are sharing over 10 percentage points during the short span of 4 years. This can be attributed to the flagship initiative of Mission Indradhanush launched by the government since 2015.
  • There is an increase from 51 per cent to 58 percent of women receiving the recommended four or more ANC visits by health providers at all-India level.
  • Also, all the Phase-II States/UTs have shown improvement except Punjab between 2015-16 to 2019-20.
  • Institutional births have increased substantially from 79 per cent to 89 percent at all-India Level. Institutional delivery is 100 percent in Puducherry and Tamil Nadu and more than 90 percent in 7 States/UTs out of 12 Phase II States/UTs.
  • Along with an increase in institutional births, there has also been a substantial increase in C-section deliveries in many States/UTs especially in private health facilities.
  • Child Nutrition indicators show a slight improvement at all-India level as Stunting has declined from 38 per cent to 36 per cent, wasting from 21 per cent to 19 per cent and underweight from 36 per cent to 32 percent at all India level. In all phase-II States/UTs the situation has improved in respect of child nutrition but the change is not significant as drastic changes in respect of these indicators are unlikely in a short span period.
  • Anaemia among children and women continues to be a cause of concern. More than half of the children and women (including pregnant women) are anaemic in all the phase-II States/UTs and all-India level compared to NFHS4, in spite of substantial increase in the composition of iron folic acid (IFA) tablets by pregnant women for 180 days or more.
  • Exclusive breastfeeding to children under age 6 months has shown an improvement in all-India level from 55 percent in 2015-16 to 64 percent in 2019-21. All the phase-II States/UTs are also showing considerable progress.
  • Women's empowerment indicators portray considerable improvement at all India levels and across all the phase-II States/UTs. Significant progress has been recorded between NFHS-4 and NFHS-5 in regard to women operating bank accounts from 53 percent to 79 percent at all-India level. For instance, in the case of Madhya Pradesh the increase was to the tune of 37 percentage points from 37 per cent to 75 per cent. More than 70 percent of women in every state and UTs in the second phase have operational bank accounts

Major issues in Indian health sector:

1. Neglect of Rural Population:

A serious drawback of India’s health service is the neglect of rural masses. It is largely a service based on urban hospitals. Although, there are large no. of PHC’s and rural hospitals yet the urban bias is visible. According to health information 31.5% of hospitals and 16% hospital beds are situated in rural areas where 75% of total population resides.

Moreover, the doctors are unwilling to serve in rural areas. Instead of evolving a health system dependent on paramedics (like bare-footed doctors in China) to strengthen the periphery. India has evolved one dependent on doctors giving it a top-heavy character.

2. Emphasis on Culture Method:

The health system of India depends almost on imported western models. It has no roots in the culture and tradition of the people. It is mostly a service based on urban hospitals. This has been at the cost of providing comprehensive primary health care to all. Otherwise speaking, it has completely neglected preventive, pro-motive, rehabilitative and public health measures.

3. Inadequate Outlay for Health:

According to the National Health Policy 2002, the Govt. contribution to the health sector constitutes only 0.9 percent of the GDP. This is quite insufficient. In India, public expenditure on health is 17.3% of the total health expenditure while in China, the same is 24.9% and in Sri Lanka and USA, the same is 45.4 and 44.1 respectively. This is the main cause of low health standards in the country.

4. Social Inequality:

The growth of health facilities has been highly imbalanced in India. Rural, hilly and remote areas of the country are under served while in urban areas and cities, health facilities are well developed. The SC/ST and the poor people are far away from modern health service.

5. Shortage of Medical Personnel:

In India shortage of medical personnel like doctors, nurses etc. is a basic problem in the health sector. In 1999-2000, while there were only 5.5 doctors per 10,000 population in India, the same is 25 in the USA and 20 in China. Similarly, the number of hospitals and dispensaries is insufficient in comparison to our vast population.

6. Medical Research:

Medical research in the country needs to be focused on drugs and vaccines for tropical diseases which are normally neglected by international pharmaceutical companies on account of their limited profitability potential. The National Health Policy 2002 suggests allocating more funds to boost medical research in this direction.

7. Expensive Health Service:

In India, health services, especially allopathic, are quite expensive. It hits the common man hard. Prices of various essential drugs have gone up. Therefore, more emphasis should be given to the alternative systems of medicine. Ayurveda, Unani and Homeopathy systems are less costly and will serve the common man in a better way.

Way forward

  • Encouraging innovation and manufacturing (of medical devices) within the country.
  • Spending more on medical research.
  • Improving medical, nursing and technical education as well as upskilling of existing manpower.
  • International collaborations.

Source: PIB

General Studies Paper 2
  • Population and Associated Issues, Poverty and Developmental issues

Key phrases: NFHS, TFR