New Delhi : (DHNS): In the latest report on health index released on Friday, Karnataka finds itself in the ninth position, below Kerala, Tamil Nadu and Andhra Pradesh.

In fact, Karnataka found a place among those six states that demonstrated a decline in their health performance in 2015-16 from the base year.

In 2014-15 (base year), Karnataka was at the seventh spot among 21 large states. But it slipped to the ninth spot in 2015-16.

The areas of concerns for many states, including Karnataka, is to have a functional district level cardiac care unit, quality accreditation of public health facilities and management of manpower through an institutional mechanism. Almost all the states need to improve the sex at birth ratio too.

Among the large states, Kerala, Punjab and Tamil Nadu occupy the top three spots.

Andhra Pradesh comes at the eighth spot, a marginal improvement from the previous ranking, while Maharashtra retained the sixth position.

In the smaller states category, Mizoram ranked first followed by Manipur.

The index was prepared by a team of professionals at the NITI Ayog, the Ministry of Health & Family Welfare and the World Bank on the basis of 25 parameters, including neonatal mortality rate, under-five mortality rate, full immunisation coverage, institutional deliveries, treatment for TB and HIV, and how health services are delivered at the grassroots level.

While states with poor public health parameters like Uttar Pradesh and Jharkhand have big scope for improvement, for better performing states of the south, it's a challenge to maintain their performance.

The index is now being used to allocate a part of the central funding on healthcare to the states.

"Currently 10% of the allocation given to the states under the National Health Mission is linked to the index. We would raise it to 20% shortly to incentivise the states that perform better," said Health Secretary Preeti Sudan.

Some of the areas where Karnataka doesn't fare well are treatment success rate of new TB cases and notification of total TB cases.

"The index is expected to nudge states towards further achieving a rapid transformation of their health systems and population health outcomes," said NITI Ayog chief executive officer Amitabh Kant.