Kerala is a pioneer in implementing the universal health care program.[101] The sub-replacement fertility level and infant mortality rate are lower compared to those of other states, estimated from 12[84][2]: 49 to 14[102]: 5 deaths per 1,000 live births; as per the National Family Health Survey 2015–16, it has dropped to 6.[103] According to a study commissioned by Lien Foundation, a Singapore-based philanthropic organisation, Kerala is considered to be the best place to die in India based on the state's provision of palliative care for patients with serious illnesses.[104] However, Kerala's morbidity rate is higher than that of any other Indian state—118 (rural) and 88 (urban) per 1,000 people.