Kerala performs best on health and Uttar Pradesh does the worst among Indian states, according to the NITI Aayog’s health index, a report from the government think tank showed on Friday. Uttar Pradesh, however, was among the three states that showed the best annual improvement, after Jharkhand and Jammu and Kashmir, the report said.

The report, titled “Healthy States, Progressive India”, measured the health index through various indicators like child mortality rates, sex ratios at birth, immunisation rates, proportion of people living with HIV/AIDS and notification of tuberculosis. The reference years for most indicators is 2015 or 2016 and the base years to gauge improvement are between one and three years before the reference year.

Punjab has the second best performance on health, while Tamil Nadu and Gujarat take the third and fourth spots among larger states. Odisha, Bihar and Rajasthan occupy the bottom three positions.

Among small states, Mizoram ranks first, followed by Manipur and Goa. Lakshadweep had the best overall performance as well as the best annual incremental performance among Union territories.

“The health index has been evolved through comprehensive study and inputs from World Bank and Ministry of Health and Family Welfare,” said NITI Aayog Chief Executive Officer Amitabh Kant. “The study of incremental performance of states will ensure we can better assess health outcomes.”

The think tank said such an index would “promote cross-learning between states” and boost cooperative and competitive federalism.

The indicators for the index included mortality rates, immunisation, sex ratios and health care facilities among others.