district : balasoresummary • the district of balasore has 89 public and 27 private health care...

1

Technical due diligenceDistrict : Balasore

DISCLAIMER1. The purpose of this document is to provide interested persons with information that may be useful to them in the preparation and

submission of their bids for the projects. The document includes statements which reflect various assumptions and assessments

arrived at by the Government of Odisha and IFC for the projects. Such assumptions, assessments and statements do not purport to

contain all the information that such persons may require. The information contained in the document may not be appropriate for

all persons and it is not possible for the Government of Odisha and IFC, its employees, its consultants or advisors to consider the

investment objectives, financial situation and particular needs of each party who reads the document. The assumptions,

assessments, statements and information contained in the document may not be complete, accurate, adequate or correct. Each

person should, therefore, conduct its own investigations and analysis and should check the accuracy, adequacy, correctness,

reliability and completeness of the assumptions, assessments, statements and information contained in the document and obtain

independent advice from appropriate sources. The Government of Odisha and IFC accept no responsibility for the accuracy or

otherwise for any interpretation expressed in the document.

2. The Government of Odisha and IFC, its consultants, employees and advisors make no representation or warranty and will have no

liability to any person under any law, statute, rules or regulations or tort, or otherwise for any loss, damage, cost or expense

which may arise from or be incurred or suffered on account of anything contained in the document or otherwise, including the

accuracy, adequacy, correctness, completeness or reliability of the document and any assessment, assumption, statement or

information contained in the document or deemed to form part of the document or arising from it in any way.

3. The Government of Odisha and IFC, its consultants, employees and advisors also accept no liability of any nature, whether

resulting from negligence or otherwise, howsoever caused arising from reliance of any person upon the content of this document.

4. The Government of Odisha and/or IFC may, in its absolute discretion, update, amend or supplement the information, assessment

or assumptions contained in this document.

5. The issue of this document does not imply that the Government of Odisha is bound to award the projects to any bidder.

2

SUMMARY

• The district of Balasore has 89 public and 27 private health care facilities with a total bed strength of 938

beds only.

• CHC’s in the district share the highest percentage of OP consultations and IP admissions, indicating a good

utilization of health care services at block level.

• OP to IP conversion has been higher than industry standards at all the public health facilities.

• BOR at all public health facilities is much above the optimum level of 80%, indicating an immediate need for

beds at secondary care level.

• Of the total surgeries for FY 2015-16 , 47.2% of the surgeries was conducted at DHH, of which 91% of these

surgeries were major surgeries.

▪ Data indicate over utilization of OT at DHH with more than 8 surgeries per OT per day. The IP to surgery

conversion at Pvt. Hosp. is highest.

▪ 15% of total deliveries in the district for FY 2015-16 is C-section which is a healthy trend.

▪ Data indicate majority of the diagnostic procedures are conducted at CHC (226 %).

▪ 60% of patient flow into DHH hail from the district headquarter town and fall under the BPL category.

▪ Considering the WHO norm of 3.5 beds per 1000 population, the district has a shortfall of 7785 beds (i.e. a

gap of 89% beds).

▪ Considering the WHO norm of 1 doctor per 1000 population, the district has a shortfall of 2495 doctors.

▪ Considering the WHO norm of 2 nurses per 1000 population, the district has a shortfall of 4990 nurses.

▪ The demand and supply gap of OP consultations and IP admissions indicate an OP gap of 73% and IP gap of

72%.

3

4

SECTION 1:

PROJECT

SNAPSHOT

PROJECT BACKGROUND

5

▪ As a part of a broader health sector enhancement program, the Government of Odisha

(GoO), wants to strengthen and enlarge the private health sector facilities and promote

the participation of quality private health providers across all the 30 districts in the

state to enhance the health infrastructure in the state by structuring and implementing

the rollout of low cost hospitals across the state in a PPP model which will offer decent

quality care at affordable prices.

▪ The project will look at the entire state as a whole and based on detailed financial,

fiscal, logistics and operational due diligence a network will be developed with

recommendations on the number, size, type and locations of the hospitals.

6

SECTION 2:

METHODOLOGY FOR TECHNICAL

AND MARKET DUE DILIGENCE

7

Demand & Supply Assessment Paying Capacity Assessment

• Assessment of district level demand for health services,

through primary research such as surveys, interviews of

patient/ doctor and review of available clinical data at

hospitals and MIS data from NHM

•Assessment of existing clinical services, infrastructure

and resources

• Capacity Utilisation Assessment of existing capacity

including OPD and IPD Numbers, bed occupancy, average

length of stay, OT utilisation, major and minor surgeries

and other clinical procedures

• Assessment of patient profile – APL

& BPL

• Prevailing market rates, CGHS and

various industry empanelled rates

• No. of patients referred outside

Odisha for secondary and high

secondary care

• Additional sources such as Centre &

State’s healthcare support schemes

– RSBY, BKKY, ESIS etc

Assessment of Gap in Health Facilities with respect to existing and future demand

TECHNICAL DUE DILIGENCE

8

METHODOLOGY

Step 1

•Secondary data survey: based on information available over public domain

•Primary data survey: Onsite healthcare facility assessment, data collection from government offices, interviews with hospital administrators, clinicians and general population

Step 2

•Preliminary assessment to cover the functional feasibility of developing a hospital along with the mapping of road and rail connectivity.

Step 3

•Correlation of primary and secondary data that is already collected from districts and state

•Data analysis the overall state and each of the 30 districts.

•Presentation on the findings of the market assessment to Government of Odisha.

9

SECTION 3:

DISTRICT PROFILE

10

DEMOGRAPHIC PROFILE

Particulars Odisha Balasore

Total Population 4,19,74,218 2,320,529

Urban

population16.6% 11%

Decadal

population

growth rate

14.05% 14.62%

Mean household

size4.35 4.35

BPL households* 44,08,070 185621

BPL Population* 1,91,75,105 808,139

BPL % 46% 35%

• Balasore is the 20th district in terms of

size and 4th in terms of population.

• Balasore is the 15th urbanized district in

state having only 10.92 percent of its

population living in urban areas.

• Balasore has 24th rank in terms of sex

ratio in the state.

Source :

Census of India – 2011, Odisha

* RSBY status 2015-16, Odisha

11

HEALTH INDICATORS

Source : Annual Health Survey Report 2011-12

* Maternal Mortality Ratio is of Central Division

222

3447 53

18.86.8

230

39

59

79

19.88.2

178

3144

55

22.27.1

Maternal MortalityRatio*

Neonatal Morality Rate Infant Mortality Rate Under 5 Mortality Rate Crude Birth Rate Crude Death Rate

Key Health Indicator

District Odisha India

Causes of deaths (Infants & Child)

12

Source : HMIS Data Analysis 2015-16, District Balasore

Balasore - Causes of Infant & Child Deaths -

Apr'15 to Mar'16

Measles 0

Diarrhoea 2

Fever 3

Pneumonia 25

Sepsis 26

Low Birth Weight (LBW) 154

Asphyxia 122

Others (for age upto 4 weeks of

birth) 212

Others (for 1 month to 5 years) 210

Total 754

Sepsis3.4%

Asphyxia16.2%

LBW20.4%

Pneumonia3.3%

Diarrhoea0.3%

Fever related0.4%

Others56.0%

Odisha - Baleshwar - Causes of Infant & Child Deaths against Total Reported Infant & Child

Deaths-Apr'15 to Mar'16

Causes of deaths (above 6 years of age)

13

Source : HMIS Data Analysis 2015-16, District Balasore

Causes of deaths (above 6 yrs of age) Apr'2015-March'16

Causes 6-14 yrs

15-55

yrs.

Above

55yrs Total

Malaria 1 - - 1

HIV/AIDS

Other fever Related 2 - - 2

Animal Bites & Stings - - - -

Tuberculosis - - - -

Respiratory Diseases(other than TB) - - - -

Known Acute Disease - - - -

Trauma/Accidents/ Burn Cases - - - -

Suicide - - - -

Diarrhoeal Diseases - - - -

Neurological Disease including strokes - - - -

Heart Disease/ Hypertension related - 1 1 2

Known Chronic Disease - 1 1 2

Causes not known 1 - 2 3

Total Deaths 4 2 4 10

Malaria 10.0% Other fever

Related20.0%

Heart Disease/

Hypertension related 20.0%

Known Chronic Disease 20.0%

Causes not known 30.0%

Odisha - Baleshwar - Cause of deaths 6 yrs & above against total reported deaths 6 yrs

& above - Apr'15 to Mar'16

14

SECTION 4:

SUPPLY ASSESSMENT

15

BEDS AVAILABILITY

Source: Primary data from DHH & Pvt. hospital & Secondary data from

NHM, DHS & DMET Odisha

Facility typeNumber of

facilitiesNumber of beds

District Headquarters Hospital 1 235

Sub-divisional hospitals 1 70

Community Health Centers 17 256

Primary Health Centers & IDH 69 16

Other hospitals / Area

Hospital 1 16

Private Hospitals 27 345

Total 116 938

Bed category at DHH Sanctioned beds Functional beds

Private beds 0 5

General ward beds 208 208

Day care beds 0 0

Emergency beds 0 0

ICU/MICU/SICU 0 0

NRC 10 10

SNCU 12 12

Extra/ Floor beds 0Provided when

needed

Total 235 235

Govt. Beds63%

Private Beds37%

Share of Beds at Govt. & Pvt. Hospitals in the district

16

ABOUT DISTRICT HEADQUARTERS HOSPITAL,BALASORE

Established in the year 1910, DHH Balasore is the most

renowned and preferred healthcare facility of the district.

Outpatient service for some tertiary care specialties like

Cardiology, Urology and Pulmonology is also available in the

hospital. DHH Balasore is the largest healthcare facility of

the headquarter town and district .

Total number of beds Sanctioned 235

Functional 235

Service specialties Internal medicine, General

surgery, Gynecology and

obstetrics, Neonatology,

Pediatrics, Ophthalmology,

ENT ,Dermatology,

Dentistry, Orthopedics,

Cardiology,

Urology,Pulmonology

Diagnostic facilities X-ray, ECG,EEG,

Audiometry,Laboratory

Operating rooms and

Labour tables

1major OT, 1 minor OT,

6 labour tables

Other clinical

facilities

Blood bank, Pharmacy,

Physiotherapy

Outsourced Support

facilities

Laundry, Dietary,

Biomedical waste

management, Security,

Housekeeping

17

Major Private Healthcare Facilities

Private Facilities Beds

Jyothi Hospital 60

Sriram Hospital 22

Maa Tarini Nursing Home 15

Kaushalya Memorial Hospital & Research Centre 15

Durga Nursing Home & Research Centre 25

Health point 20

Tarini Nursing Home 20

Aum Nursing Home 22

Bhabani Nursing Home 15

18

OPD Consultation & IPD Admission

Source: Primary data from DHH & Pvt hospital &

Secondary data from NHM Odisha

▪ OPD consultations have consistently increased over the years at all the healthcare facilities.

▪ During FY 2015-16, per day OP consultations at DHH was 891 and 304 at SDH, whereas on an average per day OPD per CHC was 123.

▪ OP consultations at Pvt. Hosp. for FYl2015-16 was 84.

▪ IP admissions have consistently increased over the years at the DHH and SDH, whereas decreased at CHC.

▪ For the FY 2015-16 per day IP admissions for DHH was 169 , 27 at SDH and an average of 13 IP admissions per CHC. Pvt. Hosp. had around 10 admissions per day.

▪ CHC’s in the district share the highest percentage of OP consultations and IP admissions, indicating a good utilization of health care services at block level.

DHH SDH CHCJyoti

Hospital

2013-14 200,728 73,315 498,114 0

2014-15 210,923 82428 584183 24,291

2015-16 267,442 91,348 629,210 25,912

0100,000200,000300,000400,000500,000600,000700,000

OPD Consultations

DHH SDH CHCJyoti

Hospital

2013-14 57,928 7,772 85,786 0

2014-15 61,870 8,955 82,814 3,059

2015-16 61,916 9,825 81,497 3,553

0

20,000

40,000

60,000

80,000

100,000

IPD Admissions

DHH26%

SDH9%CHC

62%

Pvt. Hosp.

3%

Facility wise share of OPDs (FY 2015-16)

DHH40%

SDH6%

CHC52%

Pvt. Hosp.

2%

Facility wise share of IPDs

Pvt.

Hosp.

Pvt.

Hosp.

BED UTILIZATION

19

Source: Primary data from DHH & Pvt. hospital & Secondary

data from NHM Odisha

▪ OP to IP conversion has been higher than industry

standards at all the public health facilities, however at

DHH it has been significantly higher compared to

other public health facilities.

▪ It is to be noted that although OP consultations at

Pvt. Hosp. has been low in comparison to CHC and

SDH,it still has a higher OP to IP conversion. As

opined by hospital manager of DHH , many of the

local practioners refer their patients for admission

/surgery to that hospital.

▪ BOR at all public health facilities is much above the

optimum level of 80%, however DHH has a startling

occupancy rate of 274.3%.

▪ The higher than optimum BOR at all public health

facilities indicate an immediate need for beds at

secondary care level in the district.

23%

11%13% 14%

DHH SDH CHC Jyoti Hospital

OPD to IPD Conversion (FY 2015-16)

Pvt. Hosp.

274.3%

123.1%

261.7%

48.7%


Bed Occupancy Rate (FY 2015-16)

Pvt. Hosp.

GENERAL SURGERIES

20



▪ Considering data for FY 2015-16 Surgeries

performed at the district are major surgeries.

▪ For FY 2015-16, only 9% surgeries of surgeries were

conducted at Jyothi, of which 47% surgeries were

major.

▪ Of the total surgeries for FY 2015-16 , 47.2% of the

surgeries was conducted at DHH, of which 91% of

these surgeries were major surgeries.

Surgeries for FY 2015-16

Facility Name Major Minor TOTAL

DHH 5,895 575 6,470

SDH 267 309 576

CHC 1,010 4,411 5,421

Pvt. Hosp. 583 650 1,233

TOTAL 7,755 5,945 13,700

Major57%

Minor43%

Proportion of Major & Minor Surgeries (FY 2015-16)

OT UTILIZATION

21

Source: Primary data from DHH & Pvt. hospital &

Secondary data from NHM Odisha

Name of

Facility

Number of

surgeon

Total number

of procedures

Procedures per

day

Procedure per

surgeon per

day

Number of OT

in the facility

Surgeries per

OT per day

DHH 16 10,484 34.9 2.2 4 8.7

SDH 6 693 2.3 0.4 1 2.3

CHCs 57 6,236 20.8 0.4 17 1.2

Pvt. Hosp. 7 1,646 5.5 0.8 2 2.7

▪ Data indicate over utilization of OT at DHH with

more than 8 surgeries per OT per day.

▪ The IP to surgery conversion at Pvt. Hosp. is highest,

indicating patient flow to the hospital is mostly for

surgical cases.

.

17%

7% 8%

46%


IPD to Surgery Conversion (FY 2015-16)

Pvt. Hosp.

INSTITUTIONAL DELIVERIES

22


data from NHM and DHS Odisha

▪ Institutional deliveries in the district showed a slight decrease (0.5%) in the year 2014-15.

▪ In 2015–16, DHH performed 39 deliveries per day (@28normal and 11 C-section).

▪ 74 % of the total C-sections during FY 2015-16 has been carried out at DHH.

▪ 15% of total deliveries in the district for FY 2015-16 is C-section which is a healthy trend.

Name of

Facility

2013-14 2014-15 2015-16

Normal

Delivery

C -

Section

Normal

Delivery

C -

Section

Normal

Delivery

C -

Section

DHH 9,741 3,324 9,608 3,696 10,224 4,014

SDH 1,266 0 1,352 84 1,434 117

CHC 21,326 766 19497 632 18,799 815

Pvt. Hosp. 0 0 948 404 1,013 413

Sub Total 32,333 4,090 31,405 4,816 31,470 5,359

Normal Delivery

85%

C -Section

15%

Category of Institutional Deliveries (FY 2015-16)

72%

92%

96%

71%

28%

8%

4%

29%

DHH

SDH

CHC

Jyoti Hospital

Facility wise proportion of Institutional deliveries (FY 2015-16)

Normal Delivery C - Section

Pvt. Hosp.

DIAGNOSTICS PROCEDURES

23



▪ Overall Lab tests accounts for more than the total

diagnostic tests in the district.

▪ X-ray and USG constitute of 18.3 % and 15.3 % of the

total diagnostic procedures conducted at the district

which is good enough when compared with industry

standards.

▪ Data indicate majority of the diagnostic procedures are

conducted at CHC (226 %).

▪ CT Scan facility is not available in the district.

Diagnostic

TestX Ray USG ECG CT ScanLab Tests

DHH 7,197 9,895 NA 0 136,720

SDH NA NA NA 0 6,630

CHC NA NA NA 0 193,811

Pvt. Hosp. 8,465 3,248 3,606 0 70,291

153,812

6,630

193,811

85,610


Facility wise total diagnostics

NA: Data not available

Pvt. Hosp.

24

ECONOMIC SEGMENT & MODE OF PAYMENT

Note: estimations given above are based on

discussion with ADMO Medical and Hospital Manager

Mode of Payment by Patients to the Hospital

Economic Segment of Patients

60%20%

15%

5%

DHH

BPL (Belowpoverty line)APL - LowIncomeAPL - MiddleincomeAPL - Highincome

20

2050

10

Pvt. Hosp.

BPL (Belowpoverty line)APL - LowIncomeAPL - MiddleincomeAPL - Highincome

Free17%

Cash74%

RSBY9%

DHH

Cash85%

RSBY10%

BKKY5%

Pvt. Hosp.

25

SECTION 5:

CATCHMENT AREA & REFERRALS

26

CATCHMENT OF DHH

Catchment

Type

Name of the

blockPopulation

Distance

from district

HQ

Primary Balasore 246047 -

Secondary

Khaira 179884 3 km

Oupada 143944 4 km

Remuna 180044 10 km

Nilgiri 190387 20 km

Bahanga 183369 28 km

Basta 188768 35 km

Soro 140607 35 km

Baliapal 197259 54 km

Simlia 182544 54 km

Jalaswar 204090 57 km

Bhograi 283586 75 km

District Headquarters Hospital

Block Headquarters

27

SOURCE OF PATIENT INFLOW

Source: estimations given above are based on

discussion with Management of concerned hospitals

Source of Patient Inflow

60%

40%

DHH

From within thedistrict town

From the districtother than thedistrict town

80%

15%5%

Pvt. Hospital

From within thedistrict town

From the districtother than thedistrict town

Other districts

28

POINTS OF REFERRAL

SCB, AHRCC & Sishu-bhawan at Cuttack

Various private empanelled hospitals

in Bhubaneswar

173km

3hrs

197km

3h40m

29

Top specialties of referral from DHH to other district

▪ Top 5 specialties of referrals accounts close to 81% of total referrals.

▪ Patients also prefer visiting SCB Medical college Cuttack and other

private hospitals in Cuttack and Bhubaneswar for tertiary health care

services.

Source: Interviews from ADMO (Med.), Specialist Physicians and General Physicians.

46%

11% 11% 8% 6% 5% 5% 4% 4% 1%

Genera

l/In

tern

al

medic

ine

Card

iolo

gy

EN

T

Neuro

logy

Pulm

onolo

gy/Chest

medic

ine

Uro

logy/N

ephro

logy

Gast

roente

rolo

gy/su

rgery

Gynaecolo

gy a

nd

obst

etr

ics

Paedia

tric

s

Cancer

TOP 5 SPECIALTIES OTHER SPECIALTIES

Top 5 specialties for which patients are referred out of district (Monthly)

Specialty

No. of

patients

reffered

TOP 5

SPECIALTIES

General/Internal

medicine150

Cardiology 35

ENT 35

Neurology 26

Pulmonology/Chest

medicine20

OTHER

SPECIALTIES

Urology/Nephrology 18

Gastro

enterology/surgery15

Gynaecology and

obstetrics14

Paediatrics 13

Cancer 2

Total referral per month 328

30

▪ Nearest railway station : Balasore

railway station is an important station on

the Howrah-Chennai main line of

the South Eastern Railway. The distance

to Kolkata is approximately 232 km,

while the distance to Bhubaneswar is

about 206 km. Balasore is connected to

all parts of India through trains.

▪ Road ways: National Highway 5 and

National Highway 60 pass through the

city. A part of the Golden

Quadrilateral project, this highway runs

from Chennai to Kolkata. The bus

terminus is at Sahadev Khunta and

thousands of private buses ply to

hundreds of destinations everyday.

▪ Airport : The nearest airport is

Bhubaneswar. Kolkata is approximately

three and a half hours by train and

approximately 4 to 5 hours by bus.

▪ Nearest government referral centre:

SCB Medical College Cuttack

(173.2km).

CONNECTIVITY & TRANSPORT

31

SECTION 6:

DEMAND-SUPPLY-GAP ASSESSMENT

32

DEMAND - OPD and IPD

▪ Out Patients: As per NSSO 60th round data, the estimates of spells of ailment in Odisha

population and percentage of the spells of aliment seeking non-institutional treatment i.e.,

ambulatory care, applied to the catchment population gives estimates of OP demand in the

population. The PAP (proportion of ailing person) per 1000 population in 15 days is 77 for

Odisha and spells of ailments treated during 15 days is 76%.

▪ Percentage of specialty mix for OPD is derived from morbidity rate of NSSO data 2004-05, 60th

Round, increased by a factor of 1.5 to develop a conservative estimate of patient need.

▪ Further the OP estimates has been extrapolated to include the load of estimated pregnant

women in a population, to cover ANC visits as OPD in health facilities.

▪ In patient: For the FY 2015-16, OP to IP conversion rate for 30 DHHs in Odisha has been 15%.

Hence for the calculation purpose OP to IP conversion rate is taken on an average to be at

15%.

▪ Diagnostics: Diagnostics demand is extrapolated as per industry standards.

▪ Population: Projected population for 2016 has been considered for estimation of OPD and IPD

demand

▪ * Other specialties include: Skin & VD, Psychiatry and Dental

33

Demand – Supply – Gap of OPD consultations

Source :

-NSSO 60th Round data

-Journal: the cost of universal healthcare in India –

A model based estimate, 2012

Department/

Specialties

Estimated %

of OPD

Estimated

demand

Actual

Supply

Estimated

Gap

Gen Med 22 815,472 223,061 592,411

OBG 14 518,936 141,948 376,989

Pediatrics 12 444,803 121,669 323,133

Gen. Surgery 11 407,736 111,530 296,205

Orthopedic 9 333,602 91,252 242,350

ENT 7 259,468 70,974 188,494

Ophthalmology 7 259,468 70,974 188,494

Others

specialties18 667,204 182,504 484,700

TOTAL 100% 3,706,689 1,013,912 2,692,777

Total OPD Gap 73%

Gen Med

OBG

Paediatrics

Gen. Surgery

Orthopaedic

ENT

Opthalmology

Others specialties

Gap assessment of OPD specialty mix

Estimated Demand Actual Suppy

34

Demand – Supply – Gap of IPD admissions

Source :

-NSSO 60th Round data

-Journal: the cost of universal healthcare in India –

A model based estimate, 2012

Department/

Specialties

Estimated IPD

demand (@

15% OP-IP

conversion)

Actual

Supply

Estimated

Gap

Gen Med 122,321 34,494 87,827

OBG 77,840 21,951 55,890

Pediatrics 66,720 18,815 47,905

Gen. Surgery 61,160 17,247 43,913

Orthopedic 50,040 14,111 35,929

ENT 38,920 10,975 27,945

Ophthalmology 38,920 10,975 27,945

Others

specialties100,081 28,222 71,858

TOTAL 556,003 156,791 399,212

Total IPD Gap 72%

Gen Med

OBG

Paediatrics

Gen. Surgery

Orthopaedic

ENT

Opthalmology

Others specialties

Gap assessment of IPD specialty mix

Estimated Demand Actual Supply

35

Demand – Supply – Gap of Diagnostics (OPD+IPD)

Key

diagnostics

services

Demand OPD Demand IPD Total

Estimated

Demand

Actual Supply

Total Estimated

GapTotal % of

OPD

Estimated

Demand

Total % of

IPD

Estimated

Demand

X Ray 15% 556,003 50% 278,002 584,763 15,662 818,343

USG 20% 741,338 35% 194,601 656,234 13,143 922,796

ECG 10% 370,669 60% 333,602 493,800 3,606 700,665

CT Scan 2% 74,134 5% 27,800 71,471 0 101,934

Lab Tests

(number of

patients)

60% 2,224,013* 100% 556,003 1,949,209** 407,452 2,372,565

* Considering industry standards 60% of OPD patients undergo at least 2 tests per patient. Hence,

demand number of OPD lab tests would be 4,448,027 tests.

** Considering industry standards 100% of IPD patients undergo at least 5 lab tests per patient.

Hence, demand number of IPD lab test would be 2,780,017

36

GAP - HOSPITAL BEDS

Hospital beds available in the district

Primary

health

centers &

IDH

Community

health centers

Sub district

Hospital

District

hospital

Other

Hospital

Private

Hospital

Total Bed

strength

6916 beds

17256 beds

170 beds

01235 beds

116 beds

27345 beds 938

The district of Balasore has 89 public and 27

private health care facilities with a total bed

strength of 938 beds only.

Considering the WHO norm of 3.5 beds per 1000

population, the district with a population of

24,95,192 has a shortfall of 7785 beds (i.e. a

gap of 89% beds).

* Source : Bed Strength, DHS Odisha and Clinical

Establishment, DMET Odisha

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Beds available Beds required as perWHO norm

948

8733

Gap in bed availibility

37

GAP – DOCTORS AND NURSES

▪ There are 211 sanctioned positions for doctors, of

which 64 positions are vacant.

▪ Considering the WHO norm of 1 doctor per 1000

population, the district has a shortfall of 2,348 doctors

* Source : District wise Incumbency list , DHS Odisha

▪ As per primary and secondary data collected There are

only 32 nurses posted in the district. (4 nursing sister

and 26 staff nurse, 1 Asst Matron, 1 Matron).

▪ Considering the WHO norm of 2 nurses per 1000

population, the district has a shortfall of 4,958

nurses.

* Source : Staff position list received from DHH Balasore and

nursing staff list from directorate of nursing, Odisha.

0

500

1000

1500

2000

2500

Doctors available Doctors required asper WHO norm

147

2495

Gap in doctors availibility

0

1000

2000

3000

4000

5000

Nurses available Nurses required

32

4990

Gap in nurses availibility

38

SERVICE AVAILIBILITY AND GAPS

Diagnostic Facility

Name of facility IPHS Requirement Available

500 M.A X-ray machine 1 0

300 M.A. X-ray machine 1 1

100 M.A. X-ray machine 1 0

60 M.A. X-ray machine (Mobile) 1 1

Dental X-ray machine 1 0

USG with colour doppler 3 1

ECG computerized 1 1

ECG ordinary 2 1

TMT 1 1

A Scan 1 1

B Scan 1 0

Audiometry 1 1

PFT 1 0

Bronchoscope 1 0

Haematology lab 1 1

Biochemistry lab 1 1

Microbiology lab 1 0

Histopathology lab 1 0

Immunology and Serology lab 1 0

Clinical Facility

Name of facility IPHS

Requirement

Available

General OPD 1 1

Speciality OPD 8-10 3

Major OT 2 1

Emergency OT 1 0

Ophthalmology/ ENT OT 1 0

Minor OT 1 1

Gyneaecology OT 1 0

Labour Table 11 4

Pharmacy 1 1

Blood Bank 1 1

Ambulance (BLS) 1 4

When compared with IPHS for district

hospitals, major gaps are in the areas of

Diagnostics and Specialty OPDs

Source : IPHS for District Hospital, Equipment norms 201 – 300

bedded

SECTION 7:

FINDINGS OF GENERAL POPULATION

SURVEY

39

40

5% 5%

15%

30%

15%20%

5% 5%

Occupation of the respondents

75%

20%

0%5%

0%

From savings Loan fromfamily/friends

Sold assets Healthinsurance

Others

Source of health related costs

5%

15%

40%

10%

25%

5%

Annual family income of the respondents

▪ Majority of the respondents were Business

owners followed by students & service

personnel with an annual income not more than

100,000.

▪ Only 5% of the patients surveyed had health

insurance as a primary source of health related

costs, which indicates lack of awareness in

insurance coverage.

INCOME AND OCCUPATION

41

HEALTH SEEKING BEHAVIOUR

Yes always50%

Not always50%

Do you visit a doctor / health facility whenever someone is sick in your family?

20% 20%

60%

The doctor/hospital isfar from my residence

Visiting adoctor/hospital is

expensive

The clinical condition isalways not that serious

Why, Not always?

The survey response indicates that people visit health care

facility only for a serious ailment.

0%

100%

Yes No

Have you consulted /visited any other doctor /hospital before coming to this hospital,in this

instance and for this ailment?

42

HEALTH SEEKING BEHAVIOUR

▪ While personal preference & proximity to the facility are the main reason for choosing hospital.

0%

50%

17% 17% 17%

50%

0% 0%

50%

0%

My Preferred doctor practicesthere

I have been visiting thefacility for a long time

The facility is large and mostservices offered under one

roof

The facility is proximate to myresidence

Low pricing of services andfree medicines

Reason for Choosing Hospital

Govt. hospital Pvt. Physician clinic

43

VISITING EXTERNAL FACILITIES

20%

80%

Yes No

Did you have to visit any other hospital/diagnostic center for any diagnostic test?

70%

30%

Yes No

Did you have to buy any medicine from an external pharmacy?

50% 50%

Blood test & Urine test Ferritin

Tests that has been performed from other hospital/diagnostic centres ▪ Only 20% of the respondents at DHH, had visited

external diagnostic center for Blood test, urine

tests & ferritin..

▪ 70% of respondents had to purchase medicines

from external pharmacy due to unavailability of the

required medications.

44

40%

60%

Yes No

Does any member of your family take regular medications?

30%

3%7%

17%

7%3% 3%

13%10%

7%

Gen

era

l M

ed

icin

e

Gen

era

l S

urg

ery

Ort

hop

edic

s/join

tre

pla

cem

ent

Gastr

oen

tero

logy/s

urg

ery

Ca

rdio

log

y/c

ard

iac

surg

ery

Dia

be

tes

Gynae

co

log

y a

nd

ob

ste

tric

s

Paed

iatr

ics a

nd

ne

ona

tao

log

y

Opth

alm

olo

gy

EN

T

Common specialities of consultation

20% 20% 20% 20% 20%

Gynaecology Orthopedics Gastricailment

Diabetes Hypertension

Conditions for which patients take regular medications

REGULAR MEDICATION BEHAVIOUR

▪ The findings indicate a high prevalence of chronic

diseases requiring continued treatment, with diabetes

and hypertensions & gastric problem being 60 % of

the total condition for which people take regular

medications.

▪ Majority of the respondents replied they have

consulted health care facilities majorly for general

medicine ailments.

45

IP ADMISSIONS

40%

60%

0%

10%

20%

30%

40%

50%

60%

70%

Yes No

There was atleast one hospital admission in the family in the last one year

75%

25%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Government hospital Private hospital

Place of admission

50% 50%

0%

10%

20%

30%

40%

50%

60%

<6 visits/year 7-12 visits/year

Frequency of hospital visit before admission

The survey response indicates that there has been atleast of the 40% of respondents who got admitted atleast once in last one year

chose a government hospital majorly for various kind ailment.

25% 25% 25% 25%

General Medicine Gastroenterology/surgery

Opthalmology ENT

Specialty of admission at hospital

46

SECTION 8:

FINDINGS OF OUTPATIENT AND INPATIENT

SURVEY

47

60%

20% 20%

General Medicine General Surgery Gynaecology andobstetrics

Specialty of the ailment of admission

2 0

158

200

0

44

Registration Consultation Diagnostictests

Medicines Any minorporcedure

Travel tohealthfacility

Amount spent on visit to the hospital

Average (Rs)

60%

20% 20%

General Medicine Gynaecology andobstetrics

ENT

Specialty of OP consultation

▪ Majority of inpatient respondents at DHH were admitted for general medicine followed by general surgery and OBG. Majority of OP respondents had consulted for

general medicine.

▪ Patients tend to spend mostly on diagnostic tests, medicines and travel to healthcare facility. This indicates that people are ready to purchase healthcare if services

are available.

▪ The amount spent during this admission is less than 10,000. The average amount spent during an inpatient admission was found Rs 2250/-

100% 100%

<10,000

Amount spent during admission

Government(%) Private(%)

48

SECTION 9:

FINDINGS OF PHYSICIAN SURVEY

49

COMMON SPECIALITIES OF CONSULTATION BY GENERAL

PHYSICIAN

21%

14%

7%

21% 21%

7% 7%

General/InternalMedicine

General Surgery Orthopedics/jointreplacement

Gastroenterology/surgery

Pulmonology/Chestmedicine

Diabetes and otherendocrinal disorders

Urology/Nephrology

50

ECONOMIC AND GEOGRAPHIC STRATIFICATION OF PATIENTS

27%

50%

23%

Upper economic class Middle economic class Low economic class

Economic class of patients

62%

35%

3%

From within thetown/city

From the district otherthan the town/city

From adjacentdistricts

Geographic classification of patients

19%

45%

36%

Upper economicclass

Middle economicclass

Low economic class

Economic class of patients

67%

22%

11%

From within thetown/city

From the districtother than the

town/city

From adjacentdistricts

Geographic classification of patients

GENERAL PHYSICIAN RESPONSE SPECILAIST PHYSICIAN RESPONSE

51

REASON FOR REFERRAL

0% 0%

33%

22%

33%

11%

0%

7% 7%

13%

20%

33%

0%

20%

Your professionalaffiliation with the

hospital/referral feefrom the hospital

Hospital that updatesyou on the

progonosis of yourpatient

Low pricing ofservices/price

discounts to yourpatients

Availability ofknown/reputed

physicians in thehospital

Availability ofcomprehensive

treatment facilitiesand capability to

handle complications

Good infrastructureand high end

facilities

Good clinical sericequality

Reasons to refer a patient to a particular hospital

General Physician Specialist Physician

52

SPECIALITIES OF CARE FOR WHICH PATEINT TRAVEL TO OTHER

CITIES

20%

18%

15%

13%

10%

8% 8%

5%

3% 3%

The above are averages of the responses from both general and specialist physicians. All the surveyed physicians indicated

that patients from the district go to other districts / cities for availing tertiary level healthcare, of which majority ailments

pertain to cardiology and neurology followed by pediatrics and urology.

53

SPECIALTIES THAT A NEW HOSPITAL SHOULD FOCUS

29%

0%

29% 29%

14%

0%

25%

17%

33%

8% 8% 8%

Cardiology / cardiacsurgery

Pulmonology / ThoracicSurgery

Neurology / NeuroSurgery

Gastro enterology /surgery

Cancer ENT

General Physician Specialist Physician

A mix of higher secondary and tertiary care facilities is what doctors voted for an upcoming hospital to

focus on.

FACILITIES RECOMMENDED BY THE PHYSICIANS

54

The physicians opined that any hospital proposed should focus on the above

facilities for the corresponding specialties.

Specialties

General

physician

Specialist

physician

Cardiology / cardiac surgery ECHO, TMT, ICU ECHO, TMT, ICU

Pulmonology / Thoracic Surgery - PFT, Bronchoscopy

Neurology / Neuro Surgery CT- Scan, MRI

CT- Scan, MRI,

Specialist

Gastro enterology / surgery

Endoscopy,

colonoscopy

Endoscopy,

colonoscopy

Cancer Chemotherapy Chemotherapy

ENT - Audiometry/BERA

THANK YOU

55

district : balasoresummary • the district of balasore has 89 public and 27 private health care...

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