Introduction
The National Family Health Survey (NFHS-6) reflects commendable national progress on key development parameters, yet reveals deep spatial fault lines in health and demographic indicators across India. A stark divergence persists between high-performing Peninsular states and lagging Empowered Action Group (EAG) states like Uttar Pradesh, Bihar, Madhya Pradesh, and Rajasthan, demanding localized structural remedies.
Spatial Patterns of Health and Demographic Indicators
Regional health trajectories in India exhibit a distinct north-central versus southern divergence. While southern states such as Kerala and Tamil Nadu have attained below-replacement Total Fertility Rates (TFR) alongside lower infant and maternal mortality, northern and central EAG states continue to report elevated fertility, higher child stunting, and sub-optimal nutritional outcomes.
Causes of Regional Disparities
- Socio-Economic Deprivation: Widespread multidimensional poverty and low levels of female literacy in EAG states directly suppress health awareness, institutional delivery rates, and preventive healthcare utilization.
- Healthcare Infrastructure Deficits: There are pronounced gaps in functional Primary Health Centres (PHCs), sub-centres, and specialist doctors in rural eastern and central India, leading to severe access bottlenecks.
- Fiscal and Resource Constraints: Public health expenditure remains constrained at approximately 1.9% of GDP, translating to exceptionally low per-capita public health outlays in populous, fiscally constrained states.
- Demographic Pressures: High fertility rates, early marriages, and rapid population momentum in states like Bihar place disproportionate burdens on existing primary health delivery systems.
A Decentralised Approach to Address Disparities
- Empowering Panchayati Raj Institutions (PRIs): Localize health planning by integrating village-specific health targets into Gram Panchayat Development Plans (GPDPs), financed through tied health grants under the 15th Finance Commission.
- Strengthening District Health Societies (DHS): Grant operational and financial autonomy to District Health Societies under the National Health Mission (NHM) to devise bottom-up, outcome-linked action plans tailored to district epidemiological profiles.
- Replicating Aspirational District Strategies: Expand the NITI Aayog Aspirational Districts framework to institutionalize real-time delta tracking of maternal and child health indicators at the sub-district block level.
- Mobilising Community-Level Health Networks: Reinvigorate Village Health, Sanitation and Nutrition Committees (VHSNCs) in synergy with ASHAs and ANMs to drive sustained behavioral change, immunization drives, and nutritional counseling.
Conclusion
Bridging regional health divides requires scaling public health investment to the National Health Policy target of 2.5% of GDP while adopting a tailored, decentralized operational model. Empowering local administrative and community institutions offers the most viable pathway toward equitable demographic transition and the realization of SDG-3.