Notwithstanding the malnutrition deaths in Mumbai's Palghar district last month, a survey from the prestigious Indian Institute of Management, Ahmedabad (IIM-A), states that Maharashtra has the best health index among the country's big states.

A statistical model worked out by IIM-A analyses that Maharashtra's health infrastructure as well as its health indicators are way ahead of the 20 other big states included in the study.

The study was conducted on the behalf of the Organisation of Pharmaceutical Producers of India (OPPI) and released on the occasion of OPPI's golden jubilee celebrations on Friday.

Maharashtra, as per the IIM paper called `Development of a Health Index of Indian States', is ahead of Tamil Nadu and Kerala which are the usual favourites.

The study considered mortality (infant mortality rate, under 5 mortality rate, neonatal mortality rate, maternal mortality rate, deaths due to HIV/TB and malaria) as "outcomes''. Infrastructure such as primary health clinics and hospitals as well as human resources were termed as "inputs''. A matrix weighing the outcomes against the inputs was prepared to arrive at the health index score, said IIM-A researchers at the OPPI function held on Friday.

While Maharashtra was third in ranking for input variables (Tamil Nadu was 2nd and Andhra Pradesh was 3rd) and second for outcome variables (with Kerala at 1st and Tamil Nadu at 3rd), it topped the outcome-income matrix. 

So, is Maharashtra really the tops in public healthcare? Maharashtra director of health services Dr Satish Pawar certainly believes so. ``The mortality indicators show that we are ahead of others in healthcare delivery,'' he said.

However, health economist Dr Ravi Duggal said that the survey had only considered mortality and not morbidity. "Health index cannot only be based on a few parameters,'' said Dr Duggal, whose study a decade back showed that Maharashtra's healthcare infrastructure was abysmal and on par with the poorest states of India. 

However, OPPI said the study was commissioned to get an idea of Indian healthcare needs in the near future. OPPI president Dr Shailesh Ayyangar, "Today, as a nation, we are at the edge of transformation. We have yet to fix healthcare financing issues, so that the disease burden doesn't impoverish our nation. More than ever, the need of the hour is for all stakeholders to come together to find solutions and keep our nation healthy."

The study divided states into three categories of high performers--middling performers and laggards for the purpose of policy directions. "This report is a first step. With the existing data, we are able to make limited comments on the drivers of changes - which can provide preliminary pointers on where action is required. At this stage, we are able to look at the changes in the underlying variables that may have caused the movement. Moving forward we will be able to provide more granular recommendations" said IIM-A professor Arvind Sahay, one of the authors of the study.