NEW DELHI: Kerala remains at the top of the heap among larger states in terms of various health parameters, followed by Andhra Pradesh and Maharashtra. Uttar Pradesh, Odisha and Bihar are the worst performers, according to Niti Aayog’s latest health index released on Tuesday. Haryana, Rajasthan and Jharkhand top the charts based on incremental performance.The health index – which took into account 23 health indicators during 2015-16 (base year) to 2017-18 (reference year) – depicts huge disparities across states and UTs. The report, prepared by Niti Aayog in collaboration with the health ministry and with technical assistance from World Bank, has three categories – larger states, smaller states and Union territories – to ensure comparison among similar entities.Among the smaller states, Mizoram ranked first in overall performance while Tripura and Manipur were the top two states in terms of incremental performance. Sikkim and Arunchal Pradesh registered the biggest decline in overall health index scores. Among the UTs, Chandigarh ranked first in overall performance, while Dadra and Nagar Haveli improved the most.Among the top ten performers, seven states have improved in overall performance scores (Andhra Pradesh, Maharashtra, Gujarat, Himachal Pradesh, Jammu & Kashmir, Karnataka and Telangana ). However, among the six least performing states (Uttar Pradesh, Bihar, Odisha, Madhya Pradesh, Uttarakhand, and Rajasthan), all saw decline in overall performance scores with the exception of Rajasthan, which improved by 6.3 points. Among the eight empowered action group (EAG) states, only three — Rajasthan, Jharkhand and Chhattisgarh — showed improvement in overall performance during the period.The decline in the overall health index score of five empowered action group states (states that lag behind in demographic indicators and have high infant mortality rates) — Bihar, Uttar Pradesh, Uttarakhand, Madhya Pradesh and Odisha — is attributed to the deterioration of performances in several indicators.“While it is important to identify the challenges faced by the EAG states that hinder improvement in performance, the impressive improvement in some EAG states provides learning opportunities for the rest to identify effective actions to improve their overall performance scores,” the report said. For instance in Bihar, the deterioration was primarily due to performance related to total fertility rate, low birth weight, sex ratio at birth, tuberculosis treatment success rate, quality accreditation of public health facilities and time taken for National Health Mission fund transfer.In Uttar Pradesh, the poor performance related to low birth weight, TB treatment success rate, average tenure of key positions at state and district level and level of birth registration. The report also pointed to a general positive correlation between the health index scores and economic development levels of states and union territories as measured by per-capita net state domestic product (NSDP). The first round of the Health Index was released in February 2018, which measured annual and incremental performances of states and union territories from 2014-15 (base year) to 2015-16 (reference year).