Kerala, followed by Andhra Pradesh and Maharashtra, were the top performers in health, while Bihar and Uttar Pradesh were the worst, according to the NITI Aayog’s Health Index, which was released on Tuesday.

The report, titled “Healthy States, Progressive India”, measured the health index through various indicators like child mortality rates, sex ratios at birth, immunisation rates, proportion of people living with HIV/AIDS, notification of tuberculosis and health care facilities. The reference years for most indicators is 2017 or 2018 and the base years to gauge improvement are between one and three years before the reference year. It was prepared in collaboration with the Ministry of Health and Family Welfare and the World Bank.

The report said India has made “significant improvements” in health in the last decade. But despite this remarkable progress, health remains a critical area that needs improvement, the report said, adding that India was lagging behind on some critical health indicators when compared to countries with similar levels of economic development.

“Moreover, there are huge disparities across states and Union Territories,” the report said. “The health outcomes of some states are comparable to that of some upper middle-income countries and high income countries (for example, Neonatal Mortality Rate in Kerala is similar to that of Brazil or Argentina), while some other states have health outcomes similar to that in the poorest countries in the world (for example, NMR in Odisha is close to that of Sierra Leone).”

The ranking was done in three categories – larger states, smaller states and Union territories. Among the larger states, Kerala, with a score of 74.01, Andhra Pradesh (65.13), Maharashtra (63.99), Gujarat (63.52) and Punjab (63.01) were the best in overall performance, while Uttarakhand (40.2), Madhya Pradesh (38.39), Odisha (35.97), Bihar (32.11) and Uttar Pradesh (28.61) were the worst.

In terms of incremental performance in index scores from the base year to reference year, however, the top three ranked states were Haryana (up 6.55 points), Rajasthan (up 6.3 points) and Jharkhand (up 5.99 points). Bihar (down 6.35 points) and Uttar Pradesh (down 5.08 points) registered the biggest decrease.

Credit: "Healthy States, Progressive India", NITI Aayog

Credit: "Healthy States, Progressive India", NITI Aayog

Among the smaller states, Mizoram with a score of 74.97 was the best performer, followed by Manipur (60.6) and Meghalaya (55.95). Nagaland, with a score of 38.51 was the worst performer. In terms of incremental performance in index scores from the base year to reference year, Tripura (up 2.87 points) and Manipur (up 2.82 points) ranked on top. Arunachal Pradesh (down 3.44 points), Sikkim (down 2.7 points) and Goa (down 1.23 points) registered the biggest declines.

Credit: "Healthy States, Progressive India", NITI Aayog

Among the Union Territories, Chandigarh, with a score of 63.62 points, ranked first in overall performance, while Dadra and Nagar Haveli (56.31) was second. With an increase of 21.67 points, Dadra and Nagar Haveli had also improved the most. Lakshadweep (53.34), which stood third in the overall score, had decreased the most (down 12.25 points) compared to the base years.

Credit: "Healthy States, Progressive India", NITI Aayog

“NITI Aayog is working closely with states to improve their overall performance,” Vice Chairman Rajiv Kumar said while releasing the report. “Focus is being given to aspirational districts of low ranking states on the Health Index, where data on health indicators is regularly being monitored and verified.”

Vinod Kumar Paul, a member of the think tank, said the Centre should spend 2.5% of gross domestic product on health, PTI reported. “And state governments should increase their spending on health from an average of 4.7% to 8% of their budget (net state domestic product) on health.”

The report attributed the decline in the overall Health Index score of Bihar, Uttar Pradesh, Uttarakhand, Madhya Pradesh, Odisha between the base year and the reference year to the deterioration of performances of several indicators. “For instance, in Bihar, the deterioration between the base year and the reference year was primarily due to the performance related to total fertility rate, low birth weight, sex ratio at birth, TB (tuberculosis) treatment success rate, quality accreditation of public health facilities, time taken for NHM (National Health Mission) fund transfer,” the report said.

The report added that there was room for improvement in all states, even among the best performing states, and added: “Among the large states, the overall Health Index score of the best-performing state is more than two-and-a-half times of the overall score of the least-performing state”. States such as Kerala and Tamil Nadu have made good progress towards achieving sustainable development goals, it added.