This article discusses the feasibility of conducting a single comprehensive survey for collecting health-related data in India.

Context

• In a country perennially thirsty for reliable health data, the National Family Health Survey (NFHS) is like an oasis.
• It has a large volume of data that is openly accessible.
• The report of the fifth round of the NFHS was recently released. Since then, we had many articles covering different aspects (malnutrition, fertility, and domestic violence to name a few).

What is NFHS?

• The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
• Three rounds of the survey have been conducted since the first survey in 1992-93.
• Currently, the survey provides district-level information on fertility, child mortality, contraceptive practices, reproductive and child health (RCH), nutrition, and utilization and quality of selected health services.
• The Ministry of Health has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey.

Issues with health surveys in India

• Multiple surveys: The NFHS is not the only survey. In the last five years, there has been the National NCD Monitoring Survey (NNMS), the National Mental Health Survey (NMHS) etc.
• Huge cost: Each survey funding for different rounds of NFHS costs upto ₹250 crore.
• Huge chunk of data: The size of the survey has obvious implications for data quality.
• Different estimates: Multiple surveys also raise the problem of differing estimates, as is likely, due to sampling differences in the surveys.
• Limited respondents: The respondents are largely women in the reproductive age group (15-49 years) with husbands included.
• Global obligations: Some of these surveys are done to meet the global commitments on targets (NCDs, tobacco, etc.).
• Undefined purpose The health surveys have confusing research with programme monitoring and surveillance needs. Ex. Questions on domestic violence in NFHS.

Need of the hour

• Alignment of purpose: There have been previous attempts to align these surveys but they have failed as different advocates have different “demands” and push for inclusion of their set of questions.
• Regularity of 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.

One-stop solution

• National health data architecture: With diverse aspects of health, there is a need to plan the public health data infrastructure for the country.
• Budgetary outlay: We also need to ensure that these data are collected in an orderly and regular manner with appropriate budgetary allocation.
• Purpose definition: This requires clarity of purpose and a hard-nosed approach to the issue that randomized activities.
• National-level indicators: We have to identify a set of national-level indicators and surveys that will be done using national government funds at regular intervals.

How should surveys be done?

• There should be three national surveys done every three to five years in a staggered manner:

1. NFHS focuses on Reproductive and Child Health (RCH) issues
2. Behavioral Surveillance Survey (focusing on HIV, NCD, water sanitation and hygiene (WASH)-related and other behaviors) and
3. Nutrition-Biological Survey (entails collection of data on blood pressure, anthropometry, blood sugar, serology, etc.)

We need to look at alternate models and choose what suits us best.

Way forward

• Important public health questions can be answered by specific studies conducted by academic institutions on a research mode based on availability of funding.
• States have to become active partners including providing financial contributions to these surveys.
• It is also very important to ensure that the data arising from these surveys are in the public domain.

Conclusion

• We are ready to establish public health data architecture for our complexity of needs.
• We have the technical capacity to do so.
• All it requires now is the political will.

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