The three southern states of Kerala, Tamil Nadu and Telangana have emerged as the top performers among the ‘larger states’ in India in the NITI Aayog’s annual ‘health index’ for the Covid year (2020-21).

NITI Ayog is Government of India’s think tank on development. The Aayog brings out the index in collaboration with the Union Health Ministry and World Bank.

Launched in 2017, the health index measures the performance of states and UTs annually on a ‘weighted composite score incorporating 24 health performance indicators’. The report for 2020-21, described as the ‘Covid year’ is yet to be formally released.

The health index assesses states and UTs on two parameters – incremental performance (year-on-year progress) and overall performance. The states and UTs — categorised separately as ‘larger states’, ‘smaller states’ and UTs — are then ranked based on their scores.

The worst performers for the year are Bihar (19th), Uttar Pradesh (18th) and Madhya Pradesh (17th). In terms of incremental performance, Rajasthan, Uttarakhand and Odisha emerged as the top three performers in 2020-21, as compared to their performance in 2019-20.

Among the eight smaller states, Tripura has recorded the best overall performance, followed by Sikkim and Goa; Arunachal Pradesh (6th), Nagaland (7th) and Manipur (8th) are at the bottom.

And among the eight UTs, Lakshadweep has been ranked as the top performer in terms of overall performance, while Delhi ranked at the bottom.

In the last (fourth) health index report for 2019-20, released on December 27, 2021, Kerala and Tamil Nadu were ranked as top overall performers among the larger states. Telangana, Uttar Pradesh and Assam were the top three states in terms of annual incremental performance.

The ‘health outcomes’ include indicators like neonatal mortality rate, total fertility rate, sex ratio at birth, immunisation coverage, proportion of institutional deliveries, total case notification rate of tuberculosis, and proportion of people living with HIV on antiretroviral therapy.