A method for prioritizing a state for maternal, child health and nutrition intervention/investment, when multiple states are in race

In India, health is a state subject, requiring investments to occur at state-level (n=35). With limited resources, range and complexities of issues (nutrition, infrastructure, urbanisation, education, economy) priority setting in health is often a challenge to policy-makers/donors. Using USAID’s Results-Framework as theoretical base and Multi Criteria Decision Analysis (MCDA) as analytical approach – we have devised a methodology for identifying the state with ‘highest burden’ of health problems and with ‘potential for maximum impact’. We included eight poor performing states (Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Orissa, Rajasthan) of India as units of analysis for this exercise. Percent deviation of the state from the national average on four-domains (Impact/Outcome; Access/Availability; Quality/Demand/Supply; and Sustainability) of results-framework were estimated by including most-recent indicators and by giving equal weight to each of the 57 included indicators. States were ranked (‘8’-maximum, ‘1’-minimum) according to cumulative-variation of indicators on these four-domains. Further, impact/outcomes were clubbed to get ‘burden’; and access/availability, quality, demand, supply and sustainability - were clubbed to measure ‘potential for impact’. Using MCDA approach – Uttar Pradesh