Kerala emerged as the best state in terms of overall health performance among large states while Uttar Pradesh ranked the lowest, according to the NITI Aayog’s Health Index released on Monday.

However, Uttar Pradesh ranked at the top among the states in terms of incremental performance by showing the most improvement from the previous year.

The health index pertains to the year 2019-’20 and uses 2018-’19 as the base year. The report was prepared in consultation with the Union health ministry, and with technical assistance from the World Bank.

This was the fourth time that the health index was prepared. In the report for 2018-’19, Kerala had emerged as the best performing large state, while Uttar Pradesh had ranked last.

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Mizoram emerged as the best performer on overall health performance among smaller states, and also showed the most incremental improvement. Among the Union Territories, Delhi showed the best incremental performance, followed by Jammu and Kashmir.

Daman and Diu and Dadra and Nagar Haveli showed the best overall performance among Union Territories, followed by Chandigarh.

The worst overall performers among Union Territories were the Andaman and Nicobar Islands and Jammu and Kashmir.

The report found that 14 out of 19 larger states, four out of eight smaller states, and five out of seven Union Territories showed an improvement in the health index score between 2019 and 2010 as compared to the base year.

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Kerala had the lowest neonatal mortality rate of five per 1,000 live births, while Madhya Pradesh had the highest rate at 35 per 1,000 live births. The state also had the lowest under-five mortality rate and the highest number of sex ratio at birth (measured as numbers of female children born per 1,000 male children).

Himachal Pradesh showed the most improvement in terms of neonatal mortality and under-five mortality. Punjab was ranked as the most improved state in terms of sex ratio at birth.