According to official data from the Ministry of Health & Family Welfare and the Sample Registration System (SRS) reports, India has made significant improvements in survival, maternal safety and financial protection over the last decade, even as the best-performing states retain their advantage and a new group of rapid improvers signals a broader national commitment to health governance.

If there is one place where governance stops being theory and becomes life or death, it is health. Roads can be built in a few years, industries can be attracted with incentives, and rankings can be marketed with ease. But health is harder. Health is slower. Health is deeply unforgiving. It asks the most fundamental questions of a state: Does a mother survive childbirth? Does a child live beyond infancy? Does illness push a family into poverty? And in India, perhaps the most important question of all is this: Does survival depend on geography?

Measured through globally accepted indices used by the WHO, the World Bank and the UN system, India’s health story over the last decade has been one of real progress, but also persistent gaps. Life expectancy at birth has risen to around 72 years, up from roughly 68 years in 2013, a gain that reflects better survival and expanding healthcare reach.

Yet Healthy Life Expectancy remains only about 58 years, reminding us that Indians are living longer, but often not living healthier, burdened increasingly by chronic disease and disability.

Infant Mortality Rate has fallen sharply to 26 deaths per 1,000 live births in 2022, down from 39 in 2014, while Maternal Mortality Ratio has dropped to 93 per 100,000 live births (2019–21) from around 167 a decade ago – one of India’s most important improvements in women’s survival.

Financial protection has also strengthened: out-of-pocket expenditure, once among the world’s highest, has declined to 39.4% of total health spending in 2021–22, easing the long-standing reality of medical bills becoming poverty traps.

Yet India’s deepest unfinished crisis remains nutrition and anaemia, with NFHS-5 showing stubbornly high stunting and widespread anaemia among women and children. In simple terms: India is saving more lives, but is still struggling to build full human well-being.

And this is where the model state debate truly begins – not in national averages, but in state trajectories.

The Best Performing Health States: Where Systems Have Outlived Schemes

India’s strongest health states are not those with the tallest hospitals. They are those that built the deepest systems – where primary care works, motherhood is protected, and survival is not left to chance.

Kerala remains the clearest benchmark of human development-led health, with an Infant Mortality Rate of just 5 per 1,000 live births, placing it closer to high-income outcomes than to India’s own national average. Kerala’s success is not a miracle; it is the outcome of decades of literacy, decentralised governance, women’s empowerment, and prevention-first public health.

Tamil Nadu, meanwhile, represents perhaps India’s most scalable model: near-universal institutional delivery (99.98%), under-five mortality as low as 13 per 1,000 live births, and a robust public health architecture that has been strengthened through institutional innovations and disciplined administration.

Karnataka stands out as one of the decade’s sharpest improvers, reducing Infant Mortality Rate by 55% over ten years, falling from 31 to 14, proving that rapid mortality decline is possible when neonatal care becomes a governance priority rather than an afterthought.

Himachal Pradesh similarly shows that geography is not destiny, matching steep improvements despite hill constraints through consistent outreach and primary health investment. Even Odisha, often starting from deeper structural disadvantage, underlines that progress is possible when institutional delivery expands and rural access is built steadily rather than outsourced entirely to private markets.

On composite measures like the SDG India Index, states such as Kerala, Tamil Nadu and Uttarakhand continue to remain among the top performers, reinforcing a simple truth: health progress is inseparable from governance capacity and equity.

Other States Doing Well: A Welcome Broadening of India’s Health Map

For far too long, India’s health success narrative has been limited to a few familiar names. But the last decade offers a more hopeful development: the map of progress is widening. Andhra Pradesh and Telangana have achieved some of the country’s lowest maternal mortality outcomes, reflecting stronger maternal care networks and institutional delivery systems.

Maharashtra, despite its private-sector dominance and urban inequality pressures, maintains relatively better mortality outcomes compared to many northern peers, though affordability and access remain its next frontier. West Bengal has shown steady gains in child survival and immunisation through strengthened district systems, while smaller states such as Goa and several northeastern states often perform strongly on immunisation, maternal care and life expectancy indicators.

Uttarakhand’s high SDG performance further reinforces that even geographically constrained states can improve meaningfully when service delivery is monitored seriously.

This broadening is not just statistical – it is a political and moral shift, suggesting that more state governments are finally treating health not as expenditure, but as the most foundational investment in human development.

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Conclusion: The Only True Model State is One Where Survival is Not a Pin Code Lottery

Ultimately, the question of a “model state” in health cannot be answered by a single name, because India’s health story is not about one champion – it is about what governance chooses to prioritise. The globally accepted criteria are clear: infant and maternal survival, nutrition, primary care strength, equitable access, financial protection, and institutional delivery.

And the states that have done best are not necessarily the loudest claimants, but the quiet system-builders. Kerala remains the benchmark of human development-led health, Tamil Nadu demonstrates scalable institutional public healthcare, Karnataka shows rapid improvement is possible, Himachal and Uttarakhand prove geography can be overcome, and transition states like Odisha remind us that disadvantage does not have to mean destiny.

What unites these models is not just infrastructure, but functioning primary care, protected motherhood, reduced out-of-pocket shocks, and governance that treats health as nation-building rather than welfare.

A true model state is ultimately one where survival does not depend on income, distance, or district – where healthcare is not luck, but guarantee. India’s future health model will not come from copying one state alone, but from learning across many, until the probability of life is no longer determined by geography. That is the real test of governance.

Editor’s Note: This article is part of The Logical Take, a commentary section of The Logical Indian. The views expressed are based on research, constitutional values, and the author’s analysis of publicly reported events. They are intended to encourage informed public discourse and do not seek to target or malign any community, institution, or individual.

Data sourced from: Three Models of Indian Primary Healthcare; National Family Health Survey (NFHS-5), 2019–21; NITI Aayog’s Healthy States, Progressive India