• Kerala has again emerged as the top performer in terms of overall health performance among Larger States, while Uttar Pradesh is the worst, according to the fourth Health Index launched by NITI Aayog.

• However, Uttar Pradesh topped in terms of incremental performance by registering the highest incremental change from the base year (2018-19) to the reference year (2019-20).

• Tamil Nadu and Telangana are second and third best performers, respectively, on health parameters. Bihar and Madhya Pradesh are second and third worst performers, respectively.

• Among Smaller States, Mizoram emerged as the best performer in overall performance as well as incremental performance. 

• Among the UTs, Dadra & Nagar Haveli and Daman & Diu (DH&DD) was at the top of the Index.

• Among UTs, Delhi and Jammu & Kashmir ranked at the bottom in terms of overall performance. However, these two were leading performers in terms of incremental performance.

What is the purpose of Health Index?

In 2017, the National Institution for Transforming India (NITI Aayog) in collaboration with the ministry of health and family welfare (MoHFW) and the World Bank initiated an annual Health Index for tracking overall performance and incremental performance across all states and Union Territories (UTs).

The objective of the Annual Health Index is to track progress on health outcomes and health systems performance, develop healthy competition and encourage cross learning among states and UTs. 

Health Index Scores and rankings for states and UTs are generated to assess incremental performance (year-to-year progress) and overall performance (current performance). It is expected that the exercise will help drive efforts of states/UTs towards achievement of health-related Sustainable Development Goals (SDGs), including those related to Universal Health Coverage (UHC) and other health outcomes. 

The Health Index is conceptualised as a game-changer, as it helps to shift the focus of the states and UTs from inputs, outputs and budget spends to health outcomes. It leverages co-operative and competitive federalism and facilitates states/UTs in focusing attention on better targeting of interventions and improving the delivery of health services. 

States/UTs with similar characteristics that have demonstrated improvement, can learn from each other through sharing of experiences. States such as Andhra Pradesh, Assam, Chhattisgarh, Gujarat and Karnataka have also adapted this tool to monitor district level performance.

How was the Index prepared?

‘Healthy States, Progressive India: Health Index Round IV (2019-20)’ generates Health Index Scores and rankings for different categories of states and UTs based on both overall performance and incremental performance (year-to-year progress).

Health Index is a weighted composite score incorporating 24 indicators covering key aspects of health performance. 

Health Index comprises of select indicators in three domains: 

1) Health Outcomes

2) Governance and Information

3) Key Inputs and Processes. 

The indicators are selected on the basis of their importance and availability of reasonably reliable data at least annually from existing data sources such as the Sample Registration System (SRS), Civil Registration System (CRS) and Health Management Information Systems (HMIS).

A Composite Index is calculated as a weighted average of various indicators, focused on measuring the state of health in each state and UT for a Base Year (2018-19) and a Reference Year (2019-20).

Incremental performance tracking not only helps in nurturing optimism amongst states/UTs that have historically lagged in performance and are striving to make substantial improvements, but also reduces complacency among states/UTs that have historically done well.

Other key points of the Index:

• The gap in the overall performance between the best and the worst performing Larger States and UTs narrowed in the current round of the Health Index, while it increased for the Smaller States.

• Nearly half the states and UTs did not reach the halfway mark in the Composite Overall Index Score, and despite good performance, even the top ranking states and UTs could benefit from further improvements.

• Mizoram and Telangana were the only two states that demonstrated strong overall performance and showed most improvements in the incremental performance between the Base Year (2018-19) and Reference Year (2019-20).

• Among the Larger States, Telangana, Maharashtra, Kerala, Tamil Nadu and Andhra Pradesh showed strong overall performance and also registered improvements in incremental performance. 

• Assam and Uttar Pradesh, though among the bottom one-third performers in overall performance, did exceedingly well in incremental performance recording the highest progress from Base Year (2018-19) to the Reference Year (2019-20).

• Rajasthan was the weakest performer both in terms of overall performance and incremental performance.

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