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Union Minister for Health and Family Welfare, Dr. Mansukh Mandaviya released the National Report of the fifth round of 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’ being held at Vadodara, Gujarat today.
The report comprises of detailed information on key domains of population, health and family welfare and associated domains like characteristics of the population; fertility; family planning; infant and child mortality; maternal and child health; nutrition and anaemia; morbidity and healthcare; women’s empowerment etc.
The main objective of successive rounds of the NFHS has been to provide reliable and comparable data relating to health and family welfare and other emerging areas in India. The NFHS-5 survey work has been conducted in around 6.37 lakh sample households from 707 districts (as on March, 2017) of the country from 28 States and 8 UTs, covering 7,24,115 women and 1,01,839 men to provide dis-aggregated estimates up to district level. The national report also provides data by socio-economic and other background characteristics; useful for policy formulation and effective programme implementation.
The scope of NFHS-5 is expanded in respect of earlier round of the survey (NFHS-4) by adding new dimensions such as death registration, pre-school education, expanded domains of child immunization, components of micro-nutrients to children, menstrual hygiene, frequency of alcohol and tobacco use, additional components of non-communicable diseases (NCDs), expanded age range for measuring hypertension and diabetes among all aged 15 years and above, which will give requisite inputs for monitoring and strengthening existing programmes and evolving new strategies for policy intervention. Thus, NFHS-5 provides information on important indicators which are helpful in tracking the progress of Sustainable Development Goals (SDGs) in the country. NFHS-4 (2015-16) estimates were used as baseline values for a large number of SDG indicators and NFHS- 5 will provide data for around 34 SDG indicators at various levels.
Key results from 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. The Total Fertility Rates (TFR), an average number of children per women, has further declined from 2.2 to 2.0 at the national level between NFHS-4 & 5. There are only five States in India, which are above replacement level of fertility of 2.1. They are Bihar (2.98), Meghalaya (2.91), Uttar Pradesh (2.35), Jharkhand (2.26) Manipur (2.17).
- Overall Contraceptive Prevalence Rate (CPR) has increased substantially from 54% to 67% in the country. 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 per cent to 9 per cent. The unmet need for spacing, which remained a major issue in India in the past has come down to less than 10 per cent.
- The proportion of pregnant women who had an ANC visit in the first trimester increased from 59 to 70 percent between NFHS-4 and NFHS-5. In most of the States, with the maximum increase of 25 percentage points in Nagaland, followed by Madhya Pradesh and Haryana was noticed. In contrast, Goa, Sikkim, Punjab and Chhattisgarh showed marginal decrease in first trimester ANC visits. A considerable progress is noticed in 4+ ANC at the national level from 51 percent in 2015-16 to 58 percent in 2019-21.
- Institutional Births have increased substantially from 79 percent to 89 percent in India. Even in rural areas around 87 percent births are delivered in Institutions and same is 94 percent in urban areas. Institutional births increased by a maximum of 27 percentage points in Arunachal Pradesh, followed by over 10 percentage points in Assam, Bihar, Meghalaya, Chhattisgarh, Nagaland, Manipur, Uttar Pradesh, and West Bengal. Over 91 percent of districts have more than 70 percent of births in the last 5 years that took place in health facilities.
- In NFHS-5, more than three-fourths (77%) children age 12-23 months were fully immunized, compared with 62 percent in NFHS-4. Full vaccination 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 have shown relatively higher immunization coverage.
- The level of stunting among children under 5 years has marginally declined from 38 to 36 percent for India since the last four years. Stunting is higher among children in rural areas (37%) than urban areas (30%) in 2019-21. Variation in stunting ranges from the lowest in Puducherry (20%) and 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 points each), and Chandigarh and Bihar (5 percentage points each).Compared with NFHS-4, the prevalence of overweight or obesity has increased in most States/UTs in NFHS-5. At national level, it increases from 21 percent to 24 percent among women and 19 percent to 23 percent among men. More than 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 an overall improvement in SDG indicators in all States/UTs. The extent to which married women usually participate in three household decisions (about health care for herself; making major household purchases; visit to her family or relatives) indicates that their participation in decision making is high, ranging from 80 percent in Ladakh to 99 percent in Nagaland and Mizoram. Rural (77%) and urban (81%) difference is found to be marginal. The prevalence of women having a bank or savings account that they use has increased from 53 to 79 percent in the last 4 years.
- Between NFHS-4 and NFHS-5, the use of clean cooking fuel (44% to 59%) and improved sanitation facilities (49% to 70%), including a hand-washing facility with soap and water (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 programme.
New dimensions in NFHS-6 (2023-24) – Learning from NFHS-5
The Ministry of Health and Family Welfare (MoHFW), Government of India has launched a number of flagship programmes, such as Ayushman Bharat, Poshan Abhiyan etc., to improve the health of the Indian population in general and the vulnerable and deprived sections of the population in particular. Moreover, India is also moving towards the direct bank transfer of benefits to the beneficiaries of its various programmes. In addition, India has committed to achieve Sustainable Development Goals (SDGs). The MoHFW is constantly monitoring the SDG related health goals. Due to the ongoing COVID-19 pandemic, a number of new challenges related to health system have been emerged in the country.
In this context, NFHS-6, which is scheduled to be conducted during 2023-24, propose to cover various new domain areas, which include:
“COVID-19 hospitalization and distress financing, COVID-19 vaccinations, Director Benefit Transfers (DBT) under various welfare schemes initiated by GoI, Migration, Utilization of health services –Health and wellness centre, health insurance/ health financing, digital literacy, counselling on family planning after abortion and incentives under new methods of family planning, quality of family planning programme, menstrual hygiene, marital choice, visit by community health workers for health awareness and needs, supplementary nutrition from the Anganwadi/ ICDS center while breastfeeding, blood transfusion (month and year), financial inclusion among women, knowledge of anaemia, Hepatitis B &C, Syphilis etc.”
Unlike in previous rounds, NFHS-6 will adopt Urban Frame Survey (UFS, 2012-17) of NSO, MoSPI as a sampling frame for urban area. This strategy will minimize the non-sampling errors to large extent as the boundary identification problems using 2011 census frame will be resolved. While for rural areas, updated list of villages from NSO will be used as a frame, which would be matched with the PCA from the Census to get auxiliary information.
On the occasion of Chintan Shivir, the Ministry of Health and Family Welfare has also released the Rural Health Statistics publication for the year 2020-21 (as on 31st March, 2021). It is a vital source of information on health infrastructure and human resources available in the public health institutions of all States/UTs. It also facilitates identification of additional resources for better management of public health delivery system. The data is extensively used for decision making and policy intervention by Policy Planners, researchers, NGOs and other stakeholders.
As per RHS 2020-21, there are 157819 Sub Centres (SC), 30579 Primary Health Centres (PHCs) and 5951 Community Health Centres (CHCs) respectively functioning in rural and urban areas of the country. Besides this, a total of 1224 Sub Divisional/Sub District Hospital and 764 District Hospitals (DHs) are operational throughout the country.
The publication also provides the information on requirement, vacancy and shortfall of key infrastructures and human resources across the country based on specific norms which helps in filling the gaps, if any.
Progress of Rural Health Statistics Publication
Ministry of Health & Family Welfare (MoHFW) has been publishing Rural Health Statistics (RHS) publication since the year 1992, which contains important and crucial information related to Human Resources and Health Infrastructure available in the Public Health facilities of India as on 31st March of every year.
Based on the new requirement, the formats of the publication have been changed from time to time. From the year 2018-19 onwards, the data with respect to the Urban Health components have also been included in the publication.
For planning of health programmes and policy in the country, this publication is used by various stakeholders like policy makers, researchers, NGOs and various institutions working in the field of Public Health. It also serves as important sources of information for various RTIs and Parliament related questions.
Some of the Key Parameters with respect to the year 2013-14 are as follows:
| Name of the Indicators | Year 2013-14 (as on 31st March 2014) | Year 2020-21 (as on 31st March 2021) | %age Growth of 2020-21 w.r.t 2013-14 |
| No. of SCs | 152326 | 157819 | 3.6 |
| No. of PHCs | 25020 | 30579 | 22.2 |
| No. of CHCs | 5363 | 5951 | 11.0 |
| No. of SDH | 1024 | 1224 | 19.5 |
| No. of DH | 755 | 764 | 1.2 |
| HW (F)/ANM at SCs & PHCs | 217780 | 235757 | 8.3 |
| Doctor at PHCs | 27335 | 38525 | 40.9 |
| Total Specialist at CHCs | 4091 | 5760 | 40.8 |
| Radiographer at CHCs | 2189 | 2746 | 25.4 |
| Pharmacist at PHCs & CHCs | 22689 | 33857 | 49.2 |
| Lab Tech at PHCs & CHCs | 16679 | 27733 | 66.3 |
| Nursing Staff at PHCs & CHCs | 63938 | 94007 | 47.0 |
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