National Family Health survey(NFHS)

Source: The Hindu

Manifest pedagogy: NFHS is an important statistics collecting organisation of India. Its sample surveys are used as a marker for key health statistics in India. It indicates the true side of Indian Inclusive and Sustainable Growth. This survey and its key findings act as great enrichers in Mains answers. The trends in these statistics also help in giving a comprehensive picture on health in India.

In news: National Family Health Survey celebrates 25 years

Placing it in syllabus: Health sector

Static dimensions: NFHS origin and evolution

Current dimensions:

NFHS-4 findings and achievements
WHO recommendations
NFHS-5

Content:

NFHS origin and its evolution:

The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
It is a collaborative project of the International Institute for Population Sciences(IIPS), Mumbai, India, ORC Macro, 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 the United Nations Children’s Fund (UNICEF).
IIPS collaborated with a number of Field Organizations (FO) where each FO was responsible for conducting survey activities in one or more states covered by the 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 NFHS-2 was conducted in 1998-99 in 26 states of India with added features on the quality of health and family planning services, domestic violence, reproductive health, anaemia, the nutrition of women and the status of women.
The NFHS-3 was carried out in 2005-2006 in 29 states of India.

NFHS-4:

The Fourth National Family Health Survey (NFHS-4) was carried out in 2014-2015.
NFHS-4 is the first of the NFHS series that collected data in each of India’s 29 States and 7 Union Territories.
It, for the first time, provided estimates of most indicators at the district level for all 640 districts of the country included in the 2011 Census.

Findings and achievements:

All States/UTs have Infant mortality rates (IMR) below 51 deaths per 1,000 live births.
The proportion of women (aged 15-49) who received antenatal care rose from 80 per cent in 2005-06 to 84 percent in 2015-16. Deliveries at health facilities has increased from 39 per cent to 79 per cent.
The total fertility rates range from 1.2 in Sikkim to 3.4 in Bihar. All states except Bihar, Madhya Pradesh and Meghalaya have either achieved or maintained replacement level of fertility.
Full immunisation coverage in India has increased to 62% in 2015-16 compared to 44% in 2005-06.
38 percent of children under the age of 5 were stunted for their age, 21 percent were thin for their height, 36 percent were underweight and 2 percent were overweight.
Though anaemia has declined, it still remains widespread. More than half of children and women are anaemic.
Over two-thirds of households in every State/UT have access to an improved source of drinking water.
More than 50% of households have access to improved sanitation facilities in all states/UTs except Bihar and Madhya Pradesh.
Tobacco use among men has fallen from 50 per cent in 2005-06 to 47 per cent in 2015. Similarly, alcohol consumption among men has fallen from 38 percent to 34 percent.
Of those interviewed for the survey, 86 percent of the men and 68 per cent women were literate.
75 percent of the men were employed as compared to 24 percent of women.
Less than 29 per cent of the households surveyed had at least one member covered by health insurance or under a health scheme.
69 percent of the population had an Aadhaar card.
The prevalence of HIV among women and men (aged 15-49) decreased from 0.28 percent to 0.24 percent and 0.36 per cent to 0.25 per cent between 2005-06 and 2015-16 respectively.
The prevalence of tuberculosis was higher among women (389 per 100,000) than among men (220 per 100,000).

Though NFHS-4 results demonstrate improvements over NFHS-3 in many key indicators, there are considerable rural, urban and inter State disparities. The lag in improvement of indicators is linked to low baselines, limited investment and inefficiencies in spending by States.

Hence the actions require significant multi-sectoral convergence. Under the National Health Mission (NHM), support is provided to the States/UTs to strengthen their health care system based on the requirements proposed by them under Programme Implementation Plans.

WHO recommendations for NFHS:

India should have a single major national health survey at five-year intervals. This could provide data on additional major causes of disease burden and their risk factors and include adult mortality rate estimation.
The sample sizes should aim to provide state-level estimates for all indicators and district-level estimates for crucial indicators to capture the key features of health status heterogeneity across the country.
Data collection on the key variables should be standardized to meet monitoring standards and to provide comparable data over time.
Effective partnerships with a larger range of relevant stakeholders, including the academic community, should be established.
Individual-level data from these surveys should be made publicly available as soon as possible so that it can be used in the urgent tasks of informing policy and developing a more effective health system.
Linking household survey data with health service use and administrative data, preferably using geospatial coding methods could be considered.

NFHS-5:

The process of collecting data for NFHS-5 has been started.
All household members will be considered for certain biomarkers such as determining haemoglobin levels (earlier members of 15 plus age was considered).
The survey covers a sample size of 0.7 million households.
In the first phase, 50% of the 36 States and UTs will be covered.
By mid 2020, the survey results for NFHS-5 are expected to be released.
Special arrangements have been made to avoid discrepancies while collecting data which includes 67 indicators.
The Indian Council of Medical Research (ICMR) in partnership with Population Council of India, has launched the National Data Quality Forum (NDQF) that aims to strengthen the data ecosystem in the country and generating reliable data to help in policy-making.