Being at the top of the game is not always rewarding. So it would seem, going by Kerala’s story.

In the first-ever Health Index initiative spearheaded by NITI Aayog, Kerala has emerged on top as far as overall performance is concerned. But in terms of incremental progress, it ranks 21 because the targets for many of the indicators by which the States are being measured were achieved by Kerala way back in the ’80s and ’90s itself.

And last mile reduction as far as these indicators are concerned is never easy and requires much more investment in terms of money, infrastructure and technology.

Health planners in the State are now worried that being the top performer could actually turn out to be a disadvantage for the State, if the “Performance in Health Outcomes” Index is being linked with incentives under National Health Mission Funding.

‘Yardsticks must differ’

“Kerala has always been a high-performing State in health and our gains have been due to long years of systematic investment in human resource and improvement in health system and service delivery,” a senior Health official said. “The yardsticks applied to other States in measuring health outcomes cannot be used to measure high performing States like Kerala.”

“The State’s incremental progress would be low because because there is little room for improvement at the top. The focus of the NITI Index is on those States that have shown most improvement. We should not be punished for our absolute successes,” he added.