Health Sector Reform In Orissa

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 No of Dist. SC ST Rural Sex Ratio BPL Life Expectancy

3.68 cr 30 16.53% 22.13% 85% 972 47.14% 61.64 yrs

Health Infrastructure • • • • • • • • • • • • • • • •

Medical Colleges District Hospitals SD Hospitals CHCs PHCs PHC new SCs MOs Asst Surg. Specialist Pharmacist Nurses HS M&F HW M&F LT Radiographer

06 32 22 231 117 1162 6688 762 2629 824 2039 2244 3102 12032 801 162

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 GB

Dist. Magistrate

EB

CDMO

ZSS

• 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

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

• Navajyoti- The new light to address IMR & MMR IMR 50 • Reproductive Child Health (RCH-II) MMR 250 TFR 2.1 By 2010

Outcome of the Reform • • • • • • • • •

Birth Rate Death Rate Contraceptive use Antenatal care Institutional Deliveries Infant Mortality Rate Maternal Mortality Ratio Immunization Total Fertility Rate

21.5 09.2 36-51 64-87 14-39 112-65 375-330 36-52 2.9- 2.4

Orissa: 2010 Goal • • • • • • •

MMR IMR TFR ANC Inst. Delivery Full Immunization CPR

250 50 2.1 80% 80% 85% 65%

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