Despite being among the fastest improving states, Uttar Pradesh ranked at the bottom among 21 large states on health indicators as per NITI Aayog's Health Index Rankings announced on Friday. Kerala emerged on top followed by Punjab and Tamil Nadu.

In terms of annual incremental performance, UP ranked third behind Jharkhand and Jammu and Kashmir. "Jharkhand, Jammu and Kashmir and UP showed the maximum gains in improvement of health outcomes from base (2014-15) to reference year (2015-16) in indicators such as neonatal mortality rate, under-five mortality rate, full immunization coverage, institutional deliveries, and People Living with HIV (PLHIV) on anti-retroviral therapy," the "Healthy States, Progressive India" report said.

However, it noted that while states that start at lower levels of development are generally at an advantage in notching up incremental progress over states with high health index scores, it is a challenge for states with high index scores to even maintain their performance levels.

In overall rankings among the larger states, Punjab jumped three places to knock off Tamil Nadu from the second place. Both Jammu & Kashmir and Jharkhand jumped four places to be placed at 7th and 14th places respectively. However, despite improving its overall score on the index, Uttar Pradesh could not improve its ranking and was placed at the bottom below Bihar and Rajasthan. Among the smaller states, Mizoram ranked first followed by Manipur on overall performance. In terms of annual incremental performance, Manipur came out on top followed by Goa.

Among the union territories, Lakshadweep showed both the best overall performance, as well as the highest annual incremental performance. The NITI Aayog said the index would be linked to incentives under the National Health Mission, which underlines the importance of such an exercise. While releasing the report, NITI Aayog CEO Amitabh Kant said it would serve as a tool to leverage co-operative and competitive federalism to accelerate the pace of achieving health outcomes.

It would also serve as an instrument for "nudging" states and union territories to put much greater focus on output and outcome-based measurement of annual performance, he said. Kant added that the next such report on the states' performance will be released in June. He added that NITI Aayog would also bring out a ranking of 730 district hospitals based on their performance. "The intention is to give incentives to good performers while shaming those who do not improve by naming them and putting out their details in public domain," he said.

The health ranking of states has been done in three categories namely larger states, smaller states and union territories to ensure comparison among similar entities. The NITI Aayog said it is a weighted composite index based on indicators in three domains: health outcomes (70 per cent weightage), governance and information (12 per cent), and key inputs and processes (18 per cent). According to the report, the incremental measurement reveals that about one-third of the states have registered a decline in their performance in 2016 as compared to 2015, stressing the need to pursue domain-specific, targeted interventions.