New Delhi: Kerala again emerged as the top ranking state in terms of health performance among large states followed by Andhra Pradesh and Maharashtra, whereas Uttar Pradesh and Bihar remained at the bottom, according to the Niti Aayog’s second round of health index, which was released on Tuesday.

The ranking was done under three categories — larger states, smaller states and Union territories (UTs) — to ensure comparison among similar entities.

Gujarat, Punjab and Himachal Pradesh stood at fourth, fifth and sixth spots, according to the report, titled “Healthy States, Progressive India: Report on Rank of States and UTs”.

Uttar Pradesh, Bihar and Odisha were among the worst-performing states on the index.

In terms of annual incremental performance among the larger states, Haryana, Rajasthan and Jharkhand are the top-three states.

The second round of the health index took into account the period 2015-16 (base year) to 2017-18 (reference year).

The Index is a composite score incorporating 23 indicators covering key aspects of health sector performance with major weightage to the outcomes.

Among the smaller states, Mizoram ranked first in overall performance, while Tripura and Manipur were the top two states in terms of incremental performance. Sikkim and Arunchal Pradesh had the biggest decrease in overall health index scores.

Among the UTs, Chandigarh ranked first in overall performance, while Dadra and Nagar Haveli improved the most.

Releasing the report, Niti Aayog vice-chairman Rajiv Kumar said the Aayog is committed to establishing the health index as an annual systematic tool to propel states towards undertaking multi-pronged interventions to bring better health outcomes.

Niti Aayog member Vinod Kumar Paul said the Union government should spend 2.5 per cent of gross domestic product on health.

“And state governments should increase their spending on health from an average of 4.7 per cent to 8 per cent of their budget (net state domestic product) on health,” Mr Paul said.