Healthy States, Progressive India: Report on the Ranks of States and Union Territories


This report provides an overview of the Performance in Health Outcomes Index, undertaken by NITI Aayog, the Ministry of Health and Family Welfare, and the World Bank. The Index seeks to capture the annual progress of states and union territories (UTs) on a variety of health indicators and to provide a picture of their overall performance.

The Index is the first of its kind by the central government, the report says, and was constructed over 18 months. It will be calculated and disseminated annually.

The Index is based on 24 indicators in three domains: health outcomes, governance and information, and key inputs and processes such as health systems and service delivery. States are ranked on the basis of incremental change and overall performance, and the Index identifies specific areas for improvement.

The report categorises larger states, smaller states and UTs separately to enable comparison among similar entities. Among the larger states, Jharkhand, Jammu & Kashmir and Uttar Pradesh were the top three in terms of annual incremental performance, while Kerala, Punjab and Tamil Nadu ranked on top for overall performance.


  1. Between 1991 and 2015, India made major improvements in health – life expectancy increased by approximately 10 years; the infant mortality rate more than halved; the total fertility rate dropped to near-replacement levels (a steady population over time); and the maternal mortality rate declined by more than 60 per cent.

  2. The top five performing states in the reference year (2015-16) were Kerala, Punjab, Tamil Nadu, Gujarat and Himachal Pradesh, in descending order. Uttar Pradesh ranked the lowest and was preceded by Rajasthan, Bihar, Odisha, and Madhya Pradesh.

  3. Based on their scores for 2015-16, states were grouped into three categories: aspirants, achievers and front-runners. Aspirants were in the bottom third with a score below 48. Achievers were in the middle third with a score between 48 and 62. Front-runners, the top third, had a score above 62 and were the best performing states.

  4. The report concludes that the larger states needed to focus on certain indicators, including sex ratio at birth, establishing functional district cardiac care units, accrediting the quality of public health facilities, and institutionalising human resources management information systems.

  5. While Manipur, Meghalaya, Sikkim, Goa and Arunachal Pradesh were among the better performing smaller states, they only scored between 50 and 58 points. The reports says that there is substantial scope for improvement even for these relatively better performing states.

  6. Approximately 68 per cent of infant deaths in India occurred during the neonatal period or within the first 28 days of life.

  7. The sex ratio at birth (SRB) was substantially lower in almost all the larger states – 17 out of 21 had SRB of less than 950 females per 1,000 males. In most states, the SRB had declined between the base year (2012-14) and reference year (2013-15), except for Bihar, Punjab and Uttar Pradesh, where improvements in the SRB were notable, and Jammu & Kashmir, where it stagnated. 

  8. The report says that a stable tenure for key administrative positions in the health sector is critical to effectively implement programmes. The average occupancy of the positions of principal secretary, mission director (National Health Mission), and director (Health Services) in a period of three years (36 months) was the highest in West Bengal (28 months) among the larger states, Sikkim (24 months) among the smaller states, and Lakshadweep (27 months) among the UTs.

  9. Among the larger states, less than 25 per cent of the auxiliary-nurse-midwife (ANM) positions were vacant, except for Gujarat and Bihar, which reported 28 per cent and 59 per cent vacancies, respectively. Odisha, Uttar Pradesh, West Bengal and Kerala had less than 5 per cent vacancies.

  10. The number of vacant medical officer positions at primary health centres was the highest in Bihar (64 per cent), followed by Madhya Pradesh (58 per cent), Jharkhand (49 per cent), Chhattisgarh (45 per cent) and West Bengal (41 per cent). It was the lowest in Kerala (6 per cent), followed by Tamil Nadu (8 per cent) and Punjab (8 per cent).

    Focus and Factoids by Vedika Inamdar.

    PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.


National Institution for Transforming India (NITI Aayog)


National Institution for Transforming India (NITI Aayog)


09 Feb, 2018