Kerala has topped among large states on overall health performance in NITI Aayog's Health Index, while Uttar Pradesh appears at the bottom though it has shown big improvement in the recent past.

Kerala was followed by Punjab, Tamil Nadu and Gujarat, according to the report -- 'Healthy States, Progressive India: Report on Rank of States and UTs'.

Rajasthan, Bihar and Odisha are among those which have performed poorly on the index.

In terms of annual incremental performance, Jharkhand, Jammu & Kashmir and Uttar Pradesh are the top three states.

These three states showed the maximum gains in indicators such as Neonatal Mortality Rate (NMR), Under-five Mortality Rate (U5MR), full immunisation coverage, institutional deliveries.

Among the smaller states, Mizoram ranked first followed by Manipur and Goa.

Among Union Territories or UTs, Lakshadweep showed both the best overall performance as well as the highest annual incremental performance.

Releasing the report, NITI Aayog CEO Amitabh Kant said the government think tank believes that the Health Index will act as a tool to leverage co-operative and competitive federalism, accelerating the pace of achieving health outcomes.

Kant further said: "By June this year, we would take out the ranking of 730 district hospitals based on their performance. We want to encourage the good performers and name and shame those who don't."

NITI Aayog member Vinod Kumar Paul said that absolute and incremental changes in health outcomes, as measured by the Health Index, promote cross-learning between states, capturing the very spirit of cooperative & competitive federalism.

Health and Family Welfare Secretary Preeti Sudan said her ministry will soon announce the linked incentives for states which have performed better on Health Index.

World Bank India Country Director Junaid Ahmad said that India is the only large country which has done this kind of exercise and the index developed by NITI Aayog and World Bank has global implication.

According to a NITI Aayog statement, the ranking was done under three categories -- larger states, smaller States and UTs to ensure comparison among similar entities.

The three indicators which were factored while ranking the states are Health Outcomes (70 per cent), Governance and Information (12 per cent) and Key Inputs and Processes (18 per cent), with each domain assigned a weight based on its importance.

The statement said that there was a large gap in overall performance between the best and the least performing states and UTs.

"In the reference year (2015-16) among the larger states, the index scope for overall performances ranged widely between 33.69 in Uttar Pradesh to 76.55 in Kerala," it said.

The Index is expected to nudge states towards further achieving a rapid transformation of their health systems and population health outcomes, it added.