Punjab made little progress on key health indicators during the 1990s the state was not able to significantly reduce infant and under-five mortality rates. In 1998-99 institutional births accounted for only 37 percent of the total, while 37.4 percent of all deliveries were not attended by any health personnel, and 25 percent of children were malnourished. Finally, the tragedy of female feticide and infanticide continue to haunt the state, which has by far the lowest sex ratio in the country and there are strong indications that the situation is deteriorating rapidly. In terms of health system performance, Punjab compares well with the Indian average, but lags behind other states at comparable levels of socio-economic development. Key indicators point to a mixed picture with high contraceptive prevalence at 67 percent but a very low proportion of institutional deliveries, which at 38 percent is less than half that of Tamil Nadu or Kerala. Punjab shows the same acute inequalities as the rest of the country, in terms of distribution of service utilization by socio-economic groups. The health sector largely fails to reach the poor, mostly concentrated among rural populations and schedule castes. In conclusion, while coverage may still be an issue particularly in the peripheral rural areas, all the evidence shows that the key issue to address in Punjab is poor quality of services. In the public sector, the deterioration of services is extremely severe, particularly in primary care.