Why Delhi’s prescription for newborn testing is flawed

India’s states are often criticised for chronically underinvesting in health.

- Chandrakant Lahariya

Yet, Delhi has long stood apart, consistently allocating one of the highest proportions of its budget to the health sector. In the latest state budget, one of the key announcements is the launch of the Advanced Newborn Monitoring for Optimal Lifecare (ANMOL) initiative—a programme that proposes to conduct as many as 56 blood tests on every newborn.At first glance, this appears to be a bold decision. The proposed panel includes conditions such as congenital hypothyroidism, phenylketonuria, congenital adrenal hyperplasia, G6PD deficiency, galactosemia, biotinidase deficiency, cystic fibrosis, and a range of metabolic and genetic disorders. Several of these tests are clinically justified in well-defined contexts; however, when applied universally and without prioritisation, they raise serious concerns about scientific validity and policy prudence.

The foundational principles of screening are clear and time-tested. A condition should be sufficiently prevalent to justify population-wide testing; its natural history must be well understood; the screening test should be reliable, affordable, and acceptable; and early detection should offer a clear advantage over later diagnosis. Screening in the absence of assured treatment is not prevention — and could be a source of distress.

Assessed against these criteria, the proposal to screen every newborn for 56 conditions appears excessive. Many of the disorders included are exceedingly rare, with incidence rates so low that the cost of identifying a single case becomes disproportionately high. More troubling is the uneven capacity of Delhi’s health system to provide comprehensive and lifelong care for many of these conditions. Diagnosing a rare metabolic disorder in anewborn may be scientifically impressive, butit offers little practical benefit if families cannot access specialised diets, long-term therapies, or genetic counselling.