Institute of Economic Growth

In 2018, the Government of India launched the Anemia Mukt Bharat (AMB) program to accelerate reductions in the prevalence of anemia among children aged 6-59 months, children aged 5-9 years, adolescents aged 10-19 years, pregnant women, and lactating mothers through 6 programmatic interventions and 6 institutional mechanisms. We describe the process of computing the AMB index, aimed at providing timely and systematic information on iron and folic acid (IFA) supplementation coverage across these groups to aid in evaluating the effectiveness of the program. This study presents data from fiscal year 2018-2019 to 2022-2023 on IFA supplementation coverage among these 5 groups. We calculated the AMB index that provides an average for IFA supplementation coverage for target groups. Data on the target groups were acquired from the AMB dashboard, and information on IFA supplementation coverage was sourced from the health management information system. The AMB index confirmed that between 2018-2019 and 2022-2023 IFA supplementation coverage increased overall in India by 22.1 percentage points, from 35.5% to 57.6%. During this period, IFA supplementation coverage increased for all target groups including pregnant women, children aged 6-59 months, children 5-9 years, adolescents aged 10-19 years, and lactating mothers. The supply chain management and reporting of the data on the portal were among the key factors that substantially impacted the IFA supplementation coverage. The IFA supplementation coverage will significantly increase if the IFA supply chain and reporting standards improve. We discuss the policy implications and suggestions to improve the overall IFA supplementation coverage across India.

PurposeIndia lacks a comprehensive, village-level assessment of primary healthcare accessibility needed to guide policies for improving access. This article provides a nationwide, village-level baseline measure of public primary healthcare accessibility in India using three distinct spatial metrics.Design/methodology/approachA geocoded census of public healthcare facilities from the National Health Resource Repository is merged with spatial and demographic data for rural census villages. A multi-dimensional framework is developed to assess healthcare accessibility using three metrics: (1) a regional availability metric that captures infrastructure shortfalls relative to Indian Public Health Standards (IPHS) norms; (2) a measure using Euclidean distance to the nearest facility and (3) a capacity-constrained, catchment-based propensity-of-access metric conceptually aligned with the two-step floating catchment area method. Descriptive and spatial analyses are conducted at national and sub-national levels to highlight geographic variation in accessibility.FindingsThe first metric shows that a rural Primary Health Centre (PHC) serves an average of 33,800 people, exceeding the Indian Public Health Standards norm of 30,000. The second indicates an average village-to-PHC distance of 5.49 kilometres. The third shows that, when population pressure and distance are considered jointly, residents in 20% of villages are effectively crowded out, even at the national average distance.Originality/valueThis nationwide, village-level assessment is the first to integrate availability, proximity and capacity-adjusted access across India. The analysis challenges single-metric planning approaches and suggests that upgrading or expanding infrastructure alone cannot resolve persistent spatial and capacity gaps in rural healthcare. The insights extend beyond India, where similar metrics often misstate healthcare accessibility.

This study assesses the impact of the services provided by the custom hiring centres (CHCs) on paddy yield, the cost of cultivation, and net returns using propensity score matching (PSM). The analysis is based on primary data collected from 464 farmers in Lucknow and Deoria districts of Uttar Pradesh on the socioeconomic characteristics of farm households, input use patterns, and marketing of farm produce. The study’s findings indicate that using services from government-supported CHCs rather than private agents significantly reduces the cost of cultivation and improves the net income of farmers in paddy cultivation. However, no significant impact on the paddy yield was observed. This highlights the need to provide advanced machineries for more efficient use of production resources and suggests that relying on services from CHCs makes use of farm machineries sustainable and more affordable in the long run.

Introduction Achieving universal health coverage (UHC) requires not only financial resources but also strong and capable states that can mobilise, allocate and effectively manage those resources. Although fiscal capacity is widely acknowledged as a key determinant of health systems financing, state capacity is a broader, multidimensional construct that encompasses the administrative, legal and coercive functions of the state.Methods This study investigates how multiple dimensions of state capacity-bureaucratic quality, corruption, rule of law, military involvement in politics, government effectiveness, property rights and state fragility-are associated with key measures of health financing. We analyse an unbalanced global panel of 141 countries, including 49 low- and middle-income countries, over the period 2000-2020. Using data from established cross-country institutional and health financing sources, we estimate fixed-effects and random-effects panel regression models to assess the relationship between state capacity and the two health financing metrics: government health expenditure per capita and out-of-pocket health spending as a share of current health expenditure, used here as a proxy for financial protection.Results Our findings indicate that stronger state capacity is consistently associated with higher public health investment and reduced out-of-pocket spending by households. A 1 SD increase in bureaucratic quality is associated with a 2.6 percentage-point lower share of OOP health expenditure in current health spending. Similarly, 1 SD improvements in government effectiveness and property rights are associated with 1.6 and 2.8 percentage-point lower OOP shares, respectively. A 1 SD increase in rule of law, government effectiveness or property rights is associated with a 13%-31% higher level of government health expenditure (GHE) per capita, whereas a 1 SD increase in state fragility is associated with a 32% lower GHE per capita. The aggregate state capacity index is positively associated with GHE per capita, with a 1 SD increase corresponding to a 17.5% higher level of public health spending.Conclusion The results underscore the critical role of state institutions in achieving sustainable and equitable health financing and highlight the importance of governance reforms in accelerating progress toward UHC across diverse national contexts.