According to a Planning Commission report, UP has the highest birth rate among the 14 states; it also ranks 12th as far as death rate is concerned.

The people of the State suffer from the high burden of illness particularly in comparison with rest of the country. The incidence of blindness, tuberculosis leprosy and maternal morbidity is also high.

UP has the highest Disability Adjusted life years (DALYs) loss rate among all the Indian states.

Unfortunately, the overwhelming cause of premature death and disability are from communicable diseases, malnutrition and parental conditions, a disease pattern common among the poor.

Ironically many of diseases are preventable. The poor and women seem to be bearing the brunt of it.

The state has one of the highest incidence of infant and maternal mortality in the entire country. The infant mortality rate for the state is 72 as compared to the all India average of 58 and the figure of 11 in Kerala.

Deaths during neo-natal period (within 28 days of life) contribute to almost 64 per cent of infant mortality in the state. It is observed that nearly 25 per cent of IMR incidence in the country is accounted for by UP alone.

Maternal mortality rate (MMR) is also very high in UP as 38,000 women die every year in the state while delivering a child. There were estimated 517 maternal deaths per 1000 live births in UP. This was eight times higher than the MMR in Kerala.

A major reasons for MMR in the state is the poor quality of and low access of women to mental health facilities.

The proportion of unsafe delivery is also extremely high in the State with only 22 per birth being in intuitional deliveries. Trained personnel provide assistance to around one-fourth of the total deliveries in the state. Three-fourth of deliveries take place in unhygienic conditions at home.

The percentage of children getting immunisation is also very low. Nearly one third of children receive no vaccination at all. The vaccination level in the rural areas is even worse.

Nearly half of the children in the state suffer from mild to chronic malnutrition. In fact, UP accounts for 10-12 million of India's 72 million malnutrished children. According to a study, 47 per cent of children in the state were underweight, 46 per cent were stunted, while 14.5 were wasted. On an average 80 per cent of pregnant women are anaemic. Moreover maternal malnutrition is often a major contributing cause of low weight babies.

A major cause of poor health and illness is lack of sanitation. Out of 70 districts of the state only 30 have more then 33 per cent sanitation coverage. The problem in 40 districts is severe. The total Sanitation Campaign programme got going in 1999-20000 in four districts. By 2003 all the 70 districts were taken but the progress is very slow.

The poor health conditions also attributed to poor quality of public health delivery. The ratio of doctors per thousand population of UP is much below the national figure of one. Although the ratio of beds is almost the same as the all India figure of 0.7 their geographical distribution is highly skewed in favour of urban areas.

The problem of shortage is further compounded by the absenteeism of health personnel in the state. According to a World Bank report, 45 per cent of doctors were found to be absent from duty in UP. Interestingly 22 per cent of doctors were absent from post because they were on official duty.

As a result of all these deficiencies the reach of public health infrastructure existing in the state is very limited. Studies show that only 10 per cent of the people seek outpatient care from public facilities in rural UP as against the national figure of 22 per cent.

The Planning Commission report said that the task before the State Government in terms of meeting the challenge of high mortality and morbidity is daunting. The strategy of human development in UP has to put special focus on improving health services and their delivery in the state. Substantial increase in allocation to the health sector is urgently required to equip the public health system to meet the challenges before it. (IPA)