Health Sector Reform ORISSA

Dr Nihar Ranjan Ray

Bhubaneswar, India

OVERVIEW ORISSA

• Orissa formed on 1st April 1936• 4.87% of the total area of India having 3.28 %

population• Badly affected with natural calamities.• Rich with minerals • The root causes of poor health are poverty,

social deprivation, low levels of literacy and inefficient health systems and infrastructure

Demographic Profile

• Total Population 3.68 cr• No of Dist. 30• SC 16.53%• ST 22.13%• Rural 85%• Sex Ratio 972• BPL 47.14%• Life Expectancy 61.64 yrs

Health Infrastructure• Medical Colleges 06• District Hospitals 32• SD Hospitals 22• CHCs 231• PHCs 117• PHC new 1162• SCs 6688• MOs 762• Asst Surg. 2629• Specialist 824• Pharmacist 2039• Nurses 2244• HS M&F 3102• HW M&F

12032• LT 801• Radiographer 162

Basic Theme of Reform

• Project approach• Multilateral agencies• Focusing on high priority area of

investment & applying for loans.• Alternate sourse of Financing.• Human resourse development• Decentralisation • KBK Strategy

REFORMS

• Public Private Partnership-Handing over PHCs to NGOs

• Outsourcing of cleaning in hospitals• Initiatives in Decentralization• Formation of Zilla Swasthya Samitis• Centralized Drug Procurement & Distribution

System16-17-18-19• Establishment of a State Health and Family

Welfare Society

Zilla Swasthya Samiti• Formation of Zilla Swasthya Samitis in 1993• Amalgamation of Zilla Swasthya Samitis

ZSS

GB

EB

Dist. Magistrate

CDMO

• Collection & utilization users fee

• Maintenance of Infrastructures

• Ensuring community participation

•Implementation of program

Reforms related to Human Resources

• Increase in MBBS seats in Medical Colleges by 43 each

• Mandatory pre-PG rural service• Internship training program for better community

health orientation• Short-course training in anaesthesia

administration• Appointment of staff on a contractual basis &

enhancement of remenuration in KBK districts.

Reforms related to Human Resources

• Increase in incentive from 2000 to 8000 in difficult areas for doctors

• Increase in salary for Junior Doctors.12000-16000• Up gradation of posts at entry level for Doctors from

Class ll to class l • Increase in specialist allowance from 150 to 3000 pm.• Doubling of seats of LTs, RTs, ANMs.• Formation of district cadres for paramedics• Multi-skilling of health personnel• New courses: MSc & BSc Nursing

Drug Policy Reform

• Doubling of Budget

• Central procurement

• Adequate availability of ELDs (generic)

• Strict control of corruption.

Public-Private Partnership (PPP) Initiative in Health Sector in Orissa

1. Contracting out Primary Health Centre (N).2. Mother NGO (MNGO) – Service NGO (SNGO)

Programme.3. Urban Health Centres for slum population.4. PPP in Malaria Control.5. Janani Express.6. Accreditation of Private NGO Hospitals for Institutional

Delivery.7. Capacity Building of ASHA involving – MNGO / FNGO.8. Outsourcing cleaning and security services at Health

Institutions.

• National Rural Health Mission

• IMR Mission

• Navajyoti- The new light to address IMR & MMR• Reproductive Child Health (RCH-II) IMR 50

MMR 250TFR 2.1By 2010

•Janani Surakhya Yojana•Transport of sick children & Expectant Mothers•Chloroquin Prophylaxis• Performance linked incentive

Outcome of the Reform• Birth Rate 21.5• Death Rate 09.2• Contraceptive use 36-51• Antenatal care 64-87• Institutional Deliveries 14-39• Infant Mortality Rate 112-65• Maternal Mortality Ratio 375-330• Immunization 36-52• Total Fertility Rate 2.9- 2.4

Orissa: 2010 Goal

• MMR 250

• IMR 50

• TFR 2.1

• ANC 80%

• Inst. Delivery 80%

• Full Immunization 85%

• CPR 65%

Thank You