Uttar Pradesh, Bihar and Odisha were among the worst-performing states on the index. (Representational)

Kerala has once again topped the latest health ranking report, released by NITI Aayog today, called "Healthy States, Progressive India". The report ranks states and Union Territories on their year-on-year incremental change as well as overall performance with respect to each other between 2016 and 2018.

The report takes a comprehensive look at health in terms of health outcomes in several health indicators, governance and impact of policy decisions. The first edition of the report had come out last February.

There are big surprises in the latest health rankings as states which previously held second and third positions have been replaced. Andhra Pradesh is now second after it knocked off Punjab to the fifth place. The new third ranker is Maharashtra, which has pushed down Tamil Nadu to the ninth place.

The changes in ranking come as Andhra Pradesh and Maharashtra have improved in indicators like low birth weight and full immunization coverage while Punjab and Tamil Nadu have deteriorated. Low birth weight is counted as the number of children who weigh less than 2.5 kg at birth every 1,000 births; full immunization coverage is defined as a child having received a BCG vaccination against tuberculosis; three doses of DPT vaccine to prevent diphtheria, pertusis, and tetanus (DPT); at least three doses of polio vaccine; and one dose of measles vaccine.

In the bottom three, while the states have remained the same their rankings have shuffled. Uttar Pradesh remains the worst in the health rankings at 21. Bihar has shifted from 19th to 20th and Odisha has dropped from 18th to 19th.

Uttar Pradesh and Bihar remain the worst performing as they have fared badly in indicators such as sex ratio, success rate of treatment of TB cases and time taken for transfer of funds under National Health Mission.

Vice Chairman of NITI Aayog Rajiv Kumar said, "I would suggest the health departments of every state to monitor everything. They should learn from other states that are progressing with a perfect success rate."

There are surprises in the performances of states when it comes to sex ratio. The sex ratio at birth is now the highest in Chhattisgarh at 963, which has overtaken Kerala. Kerala's sex ratio at birth has fallen from 967 to 959.Haryana has the worst sex ratio at 832 although this is a slight improvement from 831. UP has also improved a bit from 879 to 882.

However, Maharashtra, Gujarat and Rajasthan have worsened.

UP, Bihar, Odisha and Madhya Pradesh have the poorest rates among both neonatal as well as under-5 mortality rates and Kerala ranks best in both categories. The Neonatal mortality rate is the number of children under 28 days of age who die per 1,000 births in that year and the Under-5 mortality rate is the number of children under the age of 5 who die per 1,000 births.

Among the smaller states, Mizoram has ranked first in overall performance while among Union territories, Chandigarh has ranked first.