district : ganjam - health.odisha.gov.inhealth.odisha.gov.in/oahp/district_profile/ganjam.pdf ·...
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1
Technical due diligenceDistrict : Ganjam
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 Ganjam has 124 government health care facilities and 17 private hospitals with a
bed strength of 3058 beds only.
• Among the other public health facilities CHC’s share the highest percentage of OP consultations
(44%) and IP admissions (44%).
• For FY 2015-16 MKCG, Berhampur had a BOR of 81.4% whereas Pvt. Hosp.1ital has a higher than
optimum BOR which is 97.7%. The High BOR in two most premier healthcare facility in the district
indicates the need for additional bed strength to meet the rising demand of healthcare services.
• Among the studied facilities OP to IP conversion for FY 2015-16 has been highest at Pvt. Hosp.1ital
(20%). Availibility of quality services and affordable rates is the prime reason for the population’s
preference for Pvt. Hosp.1ital.
• Considering data for FY 2015-16, surgeries performed at the district are mostly minor surgeries
(72%).
• For FY 2015-16 data indicate OT utilization highest at MKCG, with more than 7 surgeries per OT per
day.
• C-sections in the district for FY 2015-16 account for only 8% of total institutional deliveries, which is a
healthy trend.
▪ For 2015-16 overall Lab tests accounts for majority (94%) of total diagnostics at the studied facilities,
whereas CT-Scan facility is available only at MKCG, Berhampur and account for only 1% of the total
diagnostic procedure in the district.
▪ It can be inferred that at secondary care level only 31% of the existing demand is being met for OPD
and 25% for IPD.
3
SUMMARY
▪ Considering the WHO norm of 3.5 beds per 1000 population, the district has a shortfall of 10031
beds (i.e. a gap of 77% beds).
▪ Considering the WHO norm of 1 doctor per 1000 population, the district has a shortfall of 3408
doctors.
▪ Considering the WHO norm of 2 nurses per 1000 population, the district has a shortfall of 7009
nurses.
▪ For gaps under service facilities, when compared with IPHS for district hospitals, major gaps are in
the areas of Diagnostics and Specialty OPDs.
▪ As per population survey response, majority of the respondents choose govt hospital over private
for health care services.
▪ The survey responses indicate that a huge percentage of patients from City hospital Berhampur
(56%) had to visit external diagnostic centre for tests whereas (89%) had to purchase medicine from
external pharmacy.
▪ Survey response indicate that Diagnostic tests and medicines hold the major percentage of the
patient expenditure. The average amount spent during an inpatient admission was found Rs 3260/-
▪ All the surveyed physicians indicated that patients from the district travel to other districts /
cities for availing tertiary level healthcare, of which majority ailments pertain to cardiology and
neurology followed by Joint replacement surgeries, Oncology and urology.
4
5
SECTION 1:
PROJECT
SNAPSHOT
PROJECT BACKGROUND
6
▪ 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.
7
SECTION 2:
METHODOLOGY FOR TECHNICAL
AND MARKET DUE DILIGENCE
8
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
9
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.
10
SECTION 3:
DISTRICT
PROFILE
District HQ Town (Chhatarpur)
City Hospital / DHH in Berhampur
11
Particulars Odisha Ganjam
Total Population 4,19,74,218 3,529,031
Urban
population16.6% 21.76%
Decadal
population
growth rate
14.05% 11.66%
Mean household
size4.35 4.65
BPL households* 44,08,070 299,406
BPL Population* 1,91,75,105 13922
BPL % 46% 39%
• Ganjam is the 5th district in terms of size
and 1st in terms of population.
• Ganjam is the 6th urbanized district in
state having only 21.76 percent of its
population living in urban areas.
• Ganjam has 14h rank in terms of sex ratio
in the state. Source :
Census of India – 2011, Odisha
* RSBY status 2015-16, Odisha
District HQ Town (Chhatarpur)
City Hospital / DHH in Berhampur
DEMOGRAPHIC PROFILE
12
HEALTH INDICATORS
Source : Annual Health Survey Report 2011-12
* Maternal Mortality Ratio is of Central Division
297
3759
90
198.5
230
3959
79
19.88.2
178
3144
55
22.27.1
Maternal MortalityRatio*
Neonatal MoralityRate
Infant Mortality Rate Under 5 MortalityRate
Crude Birth Rate Crude Death Rate
Key Health Indicators
District Odisha India
Causes of deaths (Infants & Child)
13
Source : HMIS Data Analysis 2015-16, District Ganjam
Ganjam - Causes of Infant & Child Deaths -Apr'15 to Mar'16
Measles 0
Diarrhoea 0
Sepsis 2
Pneumonia 4
Fever 5
Asphyxia 8
Low Birth Weight (LBW) 30
Others (for age upto 4 weeks of birth)
90
Others (for 1 month to 5 years) 134
Total 273
Sepsis0.7%
Asphyxia2.9%
LBW11.0% Pneumonia
1.5%
Fever related1.8%
Others82.1%
Odisha - Ganjam - Causes of Infant & Child Deaths against Total Reported Infant & Child Deaths-Apr'15
to Mar'16
Causes of deaths (above 6 years of age)
14
Source : HMIS Data Analysis 2015-16, District Ganjam
Causes of deaths (above 6 yrs of age) Apr'2015-March'16
Causes 6-14 yrs 15-55 yrs. Above 55yrs Total
Malaria - 1 4 5
Animal Bites & Stings 2 4 11 17
Other fever Related 1 13 7 21Trauma/Accidents/ Burn Cases 2 13 7 22Respiratory Diseases(other than TB) 1 10 17 28
HIV/AIDS 2 22 11 35Neurological Disease including strokes 3 16 41 60
Suicide 1 5 69 75
Diarrhoeal Diseases 1 16 60 77
Tuberculosis - 63 24 87
Known Acute Disease 4 38 53 95
Known Chronic Disease 7 116 105 228Heart Disease/ Hypertension related 5 213 143 361
Causes not known 34 457 3,114 3,605Total Deaths 63 987 3666 4716
Diarrhoeal Diseases
1.6%
Tuberculosis1.8%
Respiratory Diseases
(Other than TB)
0.6%
Malaria 0.1%
Other fever Related
0.4%
HIV/AIDS0.7%
Heart Disease/
Hypertension related
7.7%
Neurological Disease
including strokes
1.3%
Trauma/Accidents/ Burn
Cases0.5%
Suicide 1.6%
Animal Bites & Stings
0.4%
Known Acute Disease
2.0%Known Chronic Disease
4.8%Causes not
known 76.4%
Odisha - Ganjam - Cause of deaths 6 yrs & above against total reported deaths 6 yrs & above - Apr'15
to Mar'16
15
SECTION 4:
SUPPLY ASSESSMENT
16
BEDS AVAILABILITY
Source: Primary data from DHH & Pvt. hospital & Secondary data from
NHM, DHS & DMET Odisha
Facility typeNumber of
facilitiesNumber of beds
Medical College Hospital 1 1062
District Headquarters
Hospital 1 137
Sub-divisional hospitals 2 156
Community Health Centers 30 582
Primary Health Centers &
IDH 90 52
Other hospitals / Area
Hospital 1 6
Private Hospitals 17 1,063
Total 142 3,058
Govt. Beds65%
Pvt. Beds35%
Share of Beds at Govt. & Pvt. Hospitals in the district
17
ABOUT MKCG MEDICAL COLLEGE AND HOSPITAL
Total number of
beds1062
Service specialties Internal medicine, General
surgery, Gynecology and
obstetrics, Neonatology,
Pediatrics, Orthopedics,
Ophthalmology, ENT Dentistry, TB
& Chest, Emergency , Psychiatry,
Cardiology, Cardiac
surgery,Pulmonology,Neurology,
Urology, Nephrology, Oncology,
Plastic surgery, Vascular surgery,
Geriatrics, Diabetology
Diagnostic facilities X-ray, USG, Mammography,ECG,
Echo, TMT,PFT, Colonoscopy,
Bronchoscopy, A scan, B scan,
Audiometry, Laboratory
Operating rooms and
Labour tables
8 major OT, 4 minor OT, 7 labour
tables
Other clinical
facilities
Blood bank, Pharmacy,
Physiotherapy, Dialysis, Speech
therapy
Outsourced Support
facilities
Laundry, Dietary, Biomedical
waste management, Security,
Housekeeping
18
ABOUT DISTRICT HEADQUARTER HOSPITAL (CITY HOSPITAL)
Total number of
beds137
Service specialties Internal medicine, General
surgery, Gynecology and
obstetrics, Neonatology,
Pediatrics, Orthopedics,
Ophthalmology, ENT, Dentistry,
Emergency
Diagnostic facilities X-ray, USG, ECG, Laboratory
Operating rooms and
Labour tables
1 major OT, 1 minor OT, 1 eye OT
3 labour tables
Other clinical
facilities
Blood bank, Pharmacy,
Physiotherapy
Outsourced Support
facilities
Dietary, Biomedical waste
management, Housekeeping
19
Major Private Healthcare Facilities
Private Facilities Beds
Amit Hospital 30
Satya Sai Nursing Home 12
Sakuntala Nursing Home 10
Pradhan Nursing Home 10
Banadevi Maternity & Child Health Centre 10
Arjun Memorial Hospital 10
Baidyanath Nursinghome 10
20
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 City Hospital and SDH’s
▪ During FY 2015-16, per day OP consultations at City hospital was 903, 1449 at MKCG, and 649 at SDH, whereas on an average per day OPD per CHC was 86 and 162 per day per SDH.
▪ OP consultations at Pvt. Hosp.1ital and Pvt. Hosp.2 for FY 2015-16 was 185 and 119 respectively.
▪ IP admissions have consistently increased over the years at MKCG, FY 2015-16 MKCG had 176 admissions per day , City hospital had 28 whereas Pvt. Hosp.1ital and Pvt. Hosp.2 had 31 and 11 admissions per day respectively.
▪ CHC’s in the district share the highest percentage of OP consultations (44%)and IP admissions (44%).
MKCGMCH
CityHosp
Christian Hosp
AmitHosp
SDHs CHCs
2013-14 454,498 233,179 56,348 34,680 93523 806,042
2014-15 428,575 267,145 52,755 34,780 125,813 806,604
2015-16 434,756 270,948 55,466 35,647 194,750 776,765
0100,000200,000300,000400,000500,000600,000700,000800,000900,000
OPD Consultations
MKCGMCH
CityHosp
Christian Hosp
AmitHosp
SDHs CHCs
2013-14 61,045 9,969 11,593 3,865 23,722 79,884
2014-15 62,058 9,579 10,579 3,770 27,127 92,250
2015-16 64,411 10,243 11,259 4,012 25,939 91,044
010,00020,00030,00040,00050,00060,00070,00080,00090,000
100,000
IPD Consultations
MKCG MCH25% City
Hosp15%
Pvt. Hosp.1
3%
Pvt. Hosp.2
2%
SDHs11%
CHCs44%
Facility wise share of OPDs (FY 2015-16)
MKCG MCH31%
City Hosp5%
Pvt. Hosp.1
5%Pvt.
Hosp.22%
SDHs13%
CHCs44%
Facility wise share of IPDs (FY 2015-16)
Pvt.
Hosp.-1Pvt.
Hosp.-2
Pvt.
Hosp.-1Pvt.
Hosp.-2
BED UTILIZATION
21Source: Primary data from DHH & Pvt. hospital & Secondary
data from NHM Odisha
▪ OP to IP conversion has been highest at SDH
and Pvt. Hosp.1ital, population prefer going to
the Christian hospital, the reason being timely
availability of services at affordability price and
good attitude of staff.
▪ OP to IP conversion rate at SDH’s is higher too
the reason being higher referrals from PHC and
CHC’s
▪ BOR of all the studied healthcare facilities
reflects a optimal inpatient flow, however BOR
of Pvt. Hosp.1ital being close to almost hundred
percent indicates a need for additional beds in
the district at private health care level.
13%
4%
21%
11%
25%
10%1
4%
4%
20%
11%
22%
11%15%
4%
20%
11% 13%
12%
MKCG MCH City Hosp ChristianHosp
Amit Hosp SDHs CHCs
OPD to IPD Conversion
2013-14 2014-15 2015-16
81.4%73.7%
97.7%
56.3%
MKCG MCH City Hosp Christian Hosp Amit Hosp
Bed Occupancy Rate (FY 2015-16)
Pvt.
Hosp.-1Pvt.
Hosp.-2
Pvt. Hosp.-1 Pvt. Hosp.-2
GENERAL SURGERIES
22Source: Primary data from DHH & Pvt. hospital &
Secondary data from NHM Odisha
▪ Considering data for FY 2015-16 Surgeries
performed at the district are majorly minor surgeries
(72%).
▪ For the FY 2015-16, of all the surgeries performed
at MKCG, only 48% comprise of major surgeries,
whereas city hospital conducted only 24 % of major
surgeries .
▪ Of the total surgeries for FY 2015-16,only 5% of the
surgeries was conducted at Pvt. Hosp.1ital of which
63% of these surgeries were major surgeries.
Facility Name Major Minor TOTAL
MKCG MCH 10,900 11,680 22,580
City Hosp 982 3,133 4,115
Pvt. Hosp.1 2,302 1,376 3,678
Pvt. Hosp.2 386 1,246 1,632
SDHs 1,113 13,159 14,272
CHCs 7,619 29,694 37,313
TOTAL 23,302 60,288 83,590
48%
24%
63%
24%
8%
20%
52%
76%
37%
76%
92%
80%
MKCG MCH
City Hosp
Christian Hosp
Amit Hosp
SDHs
CHCs
Facility wise proportion of Major & Minor Surgeries (FY 2015-16)
Major Minor
Major28%
Minor72%
Proportion of Major & Minor Surgeries (FY 2015-16)
Pvt. Hosp.-1
Pvt. Hosp.-2
OT UTILIZATION
23Source: 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
MKCG MCH 26 27,106 90.4 3.5 12 7.5
City Hosp 11 4,552 15.2 1.4 4 3.8
Pvt. Hosp.1 6 5,889 19.6 3.3 4 4.9
Pvt. Hosp.2 3 1,855 6.2 2.1 2 3.1
SDHs 9 14,703 49.0 5.4 4 12.3
CHCs 82 37,313 124.4 1.5 30 4.1
▪ Data indicate utilization of OT at MKCG at highest
with 7.5 surgeries per OT per day. However 52% of
these are minor surgeries.
▪ The IP to surgery conversion at SDH is highest
indicating referrals from CHC’s being a considerable
reason for the same.
42% 44%52%
46%
57%
41%
MKCGMCH
City Hosp ChristianHosp
AmitHosp
SDHs CHCs
IPD to Surgery Conversion (FY-2015-16)
Pvt.
Hosp.-1Pvt.
Hosp.-2
INSTITUTIONAL DELIVERIES
24Source: Primary data from DHH & Pvt. hospital &
Secondary data from NHM and DHS Odisha
▪ C-sections at the district constitute only 8 % of the total deliveries in the district FY 2015-16, which is a healthy trend.
▪ In 2015–16, City hospital performed 12 deliveries per day (@11normal and 1 C-section). MKCG performed 37 deliveries per day (@ 24 normal and 12 C- section).
▪ C-sections conducted at CHC’s have gradually dropped over the years, with no C-sections conducted in the year 2015-16.
▪ 67 % of the total C-sections during FY 2015-16 has been carried out at Pvt. Hosp.1ital.
Name of
Facility
2013-14 2014-15 2015-16
Normal
Delivery
C -
Section
Normal
Delivery
C -
Section
Normal
Delivery
C -
Section
MKCG MCH - - 9793 4123 8889 4526
City Hosp 4,163 233 3,859 415 3,922 437
Pvt. Hosp.1 2,371 2,208 2,502 2,188 2,444 2,221
Pvt. Hosp.2 317 201 296 174 342 223
SDHs 5,247 426 5,193 446 5,147 431
CHCs 29,717 7 29,122 1 27,774 0
Sub Total 41,815 3,075 40,972 3,224 39,629 3,312
66%
90%
52%
61%
92%
100%
34%
10%
48%
39%
8%
0%
MKCG MCH
City Hosp
Christian Hosp
Amit Hosp
SDHs
CHCs
Facility wise proportion of Institutional deliveries (FY 2015-16)
Normal Delivery C - Section
Normal Delivery
92%
C -Section
8%
Category of Institutional Deliveries (FY 2015-16)
Pvt. Hosp.-1
Pvt. Hosp.-2
DIAGNOSTICS PROCEDURES
25
Source: Primary data from DHH & Pvt. hospital & Secondary
data from NHM Odisha
▪ Overall Lab tests accounts for majority (94%) of total
diagnostics.
▪ X-ray and USG constitute of only 2% and 1% of the
total diagnostic procedures conducted at the district
which is far below industry standards.
▪ Data indicate majority of the diagnostic procedures are
conducted at MKCG medical college hospital (65%).
▪ Pvt. Hosp.1ital conducted 10% of the total diagnostics
for the FY 2015-16 , whereas City hospital conducted
only 5.4 % of the diagnostics.
▪ CT Scan facility in the district is available only at the
medical college and account for only1% of the total
diagnostic procedure.
NA: Data not available
Diagnostic Test X Ray USG ECG CT Scan Lab Tests
MKCG MCH 35,368 8,444 32,450 14,318 1,265,455
City Hosp 8,082 2,020 3,600 0 100,200
Pvt. Hosp.1 755 12,529 144 0 197,895
Pvt. Hosp.2 5,725 4,395 890 0 59,488
SDHs NA NA NA 0 36,547
CHCs NA NA NA 0 294,704
1,356,035
113,902211,323
70,498 36,547
294,704
MKCGMCH
City Hosp ChristianHosp
Amit Hosp SDHs CHCs
Facility wise total diagnostics (FY-2015-16)
Pvt.
Hosp.-1
Pvt.
Hosp.-2
26
ECONOMIC SEGMENT OF PATIENT
Note: estimations given above are based on
discussion with ADMO Medical and Hospital
Manager
70%
15%
10%
5%
MKCG MCH
BPL (Below povertyline)
APL - Low Income
APL - Middleincome
APL - High income
40%
40%
15%
5%
City Hosp
BPL (Below povertyline)
APL - Low Income
APL - Middleincome
APL - High income
77%
16%
5% 2%
Pvt.Hosp.1
BPL (Below povertyline)
APL - Low Income
APL - Middleincome
APL - High income
50%
20%
25%
5%
Pvt.Hosp.2
BPL (Below povertyline)
APL - Low Income
APL - Middleincome
APL - High income
27
MODE OF PAYMENT TOWARDS HOSPITAL SERVICES
Note: estimations given above are based on
discussion with ADMO Medical and Hospital Manager
Free10%
Cash60%
RSBY20%
BKKY10%
MKCG MCH
Free15%
Cash70%
RSBY10%
BKKY5%
City Hosp
Free5%
Cash85%
RSBY8%
BKKY2%
Pvt.Hosp.1
Cash90%
RSBY8%
BKKY2%
Pvt.Hosp.2
28
SECTION 5:
CATCHMENT AREA & REFERRALS
29
CATCHMENT OF MKKCG AND CITY HOSPITAL
MKCG & City Hospital in
Berhampur
Block Headquarters/ CT
Catchme
nt Type
Name of the
block
Populati
on
Distance
from
district
HQ
Primary Berhampur 689,170 -
Secondar
y
Hinjilicut 209,877 20 km
Purussottam
pur243,156 35 km
Asika 144,132 41 km
Seragad 242,510 44 km
Dharakote 207,946 50 km
Kavisurjyana
gar214,354 50 km
Polasara 233,386 55 km
Khalikote 169,171 60 km
Buguda 214,272 70 km
Beguniapada234,093 74 km
Bhanjanagar 138,774 80 km
Surada 243,428 85 km
Jagannathpr
asad131,326 88 km
Bellaguntha 213,436 88 km
30
SOURCE OF PATIENT INFLOW
Source: estimations given above are based on
discussion with Management of concerned hospitals
20%
30%
50%
MKCG MCH
From within thedistrict town
From the districtother than thedistrict town
Other districts
30%
50%
20%
City Hosp
From within thedistrict town
From the districtother than thedistrict town
Other districts
30%
50%
20%
Pvt.Hosp.1
From within thedistrict town
From the districtother than thedistrict town
Other districts
40%
40%
20%
Pvt.Hosp.2
From within thedistrict town
From the districtother than thedistrict town
Other districts
31
POINTS OF REFERRAL
SCB, AHRCC & Sishu-bhawan at Cuttack
Various private empanelled hospitals
in Bhubaneswar
195km
3h25m
165km
2h50m
• As opined by MS, MKCG, referrals to MKCG comes from all level of
healthcare facilities within the district and in case of required
service is/are not available at MKCG, patients are sent to SCB
Cuttack and various empanelled private hospitals in Bhubaneswar.
• Referrals from City Hospital is made mostly to MKCG and
sometimes even to empanelled private hospitals within Berhampur.
32
Top specialties of referral from DHH to other district
▪ Top 5 specialties of referrals accounts close to 66% of total referrals.
Source: Interviews from ADMO (Med.), MS-MKCG,
Specialist Physicians and General Physicians.
Specialty
No. of
patients
reffered
TOP 5
SPECIALTIES
General Surgery 102
General/Internal
medicine100
Gynaecology and
obstetrics98
Urology/Nephrology 56
Gastro
enterology/surgery53
OTHER
SPECIALTIES
Cardiology 50
Paediatrics 36
Orthopedics 31
Cancer 30
Neurology 25
Others 43
Total referral per month 624
16% 16% 16%
9% 8% 8%6% 5% 5% 4%
7%
Genera
l Surg
ery
Genera
l/In
tern
al
medic
ine
Gynaecolo
gy a
nd
obst
etr
ics
Uro
logy/N
ephro
logy
Gast
roente
rolo
gy/su
rgery
Card
iolo
gy
Paedia
tric
s
Ort
hopedic
s
Cancer
Neuro
logy
Oth
ers
TOP 5 SPECIALTIES OTHER SPECIALTIES
Top 5 specialties for which patients are referred out of district (Monthly)
33
▪ Nearest railway station : Brahmapur
railway station is situated on the East
coast railway line, a major route
connecting the two
metros Kolkata and Chennai of India. It
is directly connected to New Delhi,
Bangalore, Bhubaneswar, Chennai, C
uttack, Hyderabad, Kolkata, Mumbai,
Nagpur, Pune, Puri, Raipur, Sambalpur
, Vishakhapatnam, and many more
cities of India.
▪ Road ways: Brahmapur city is
connected with National Highways NH-
5 (Chennai–Kolkata), NH-
59 (Gopalpur–Nauparha) and NH-
217 (Gopalpur - Raipur) and other
cities and towns of Odisha.
▪ Airport : The nearest airports are Biju
Patnaik Airport, Bhubaneswar (169
km)
▪ Nearest government referral
centre: SCB Medical college 195 km
CONNECTIVITY & TRANSPORT
District HQ Town (Chhatarpur)
34
SECTION 6:
DEMAND-SUPPLY-GAP ASSESSMENT
35
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
36
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 1,238,486 393,449 845,038
OBG 14 788,128 244,497 543,631
Pediatrics 12 675,538 193,332 482,206
Gen. Surgery 11 619,243 210,157 409,086
Orthopedic 9 506,654 156,981 349,673
ENT 7 394,064 121,288 272,776
Ophthalmology 7 394,064 121,288 272,776
Others
specialties18 1,013,307 327,340 685,967
TOTAL 100% 5,629,484 1,768,332 3,861,152
Total OPD Gap 69%
Gen Med
OBG
Paediatrics
Gen. Surgery
Orthopaedic
ENT
Opthalmology
Others specialties
Gap assessment of OPD specialty mix
Estimated Demand Actual Suppy
37
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 185,773 45,841 139,932
OBG 118,219 29,088 89,131
Pediatrics 101,331 22,973 78,358
Gen. Surgery 92,886 25,311 67,576
Orthopedic 75,998 18,261 57,737
ENT 59,110 14,203 44,907
Ophthalmology 59,110 14,203 44,907
Others
specialties151,996 37,029 114,967
TOTAL 844,423 206,908 637,515
Total IPD Gap 75%
Gen Med
OBG
Paediatrics
Gen. Surgery
Orthopaedic
ENT
Opthalmology
Others specialties
Gap assessment of IPD specialty mix
Estimated Demand Actual Supply
38
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% 844,423 50% 422,211 1,266,634 49,930 1,216,704
USG 20% 1,125,897 35% 295,548 1,421,445 27,388 1,394,057
ECG 10% 562,948 60% 506,654 1,069,602 37,084 1,032,518
CT Scan 2% 112,590 5% 42,221 154,811 14,318 140,493
Lab Tests
(number of
patients)
60% 3,377,690* 100% 844,423** 4,222,113 1,954,289 2,267,824
* Considering industry standards 60% of OPD patients undergo at least 2 tests per patient. Hence,
demand number of OPD lab tests would be 6,755,381.
** Considering industry standards 100% of IPD patients undergo at least 5 lab tests per patient.
Hence, demand number of IPD lab test would be 1,688,845.
39
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
9052 beds
30582 beds
2156 beds
01137 beds
16 beds
171063 beds 3058
The district of Ganjam has 124 public and 17
private health care facilities with a total bed
strength of 3058 beds only.
Considering the WHO norm of 3.5 beds per 1000
population, the district with a population of
37,39,629 has a shortfall of 10031 beds (i.e. a
gap of 77% beds).
* Source : Bed Strength, DHS Odisha and Clinical
Establishment, DMET Odisha
0
2000
4000
6000
8000
10000
12000
14000
Beds available Beds required asper WHO norm
3058
13089
Gap in bed availibility
40
GAP – DOCTORS AND NURSES
▪ Considering the WHO norm of 1 doctor per 1000
population, the district has a shortfall of 3408 doctors
* Source : District wise Incumbency list , DHS Odisha
▪ As per primary and secondary data collected There are
only 38 nurses posted in the district. (33 nursing
sister and 435 staff nurse).
▪ Considering the WHO norm of 2 nurses per 1000
population, the district has a shortfall of 7009 nurses.
* Source : Staff position list received from City Hospital
Berhampur, MKCG Berhampur and nursing staff list from
directorate of nursing, Odisha.
0
500
1000
1500
2000
2500
3000
3500
4000
Doctors available Doctors required asper WHO norm
332
3740
Gap in doctors availibility
0
1000
2000
3000
4000
5000
6000
7000
8000
Nurses available Nurses required
470
7479
Gap in nurses availibility
41
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 101 – 200
bedded
42
SECTION 7:
FINDINGS OF GENERAL POPULATION
SURVEY
43
INCOME AND OCCUPATION
▪ Majority of the respondents were from
service (government/private) followed by
housewives with an annual income ranging
between 1,00,001-2,00,001.
▪ 63% of the population surveyed had savings
as there primary source of health related
costs and which is followed by the selling of
the assets and loan form family/friends.
5%11%
58%
0%
16%
5% 5%0%
Occupation of the respondents
63%
16%21%
0%
From savings Loan fromfamily/friends
Sold assets Health insurance
Source of health related costs
16%
58%
21%
5%
17,156-1,00,000 1,00,001-2,00,000 2,00,001-5,00,000 >5,00,001
Annual family income of the respondents
44
HEALTH SEEKING BEHAVIOUR
The survey response indicates that people visit health care facility only for a serious ailment and chose
private and government healthcare facility equally for treatment.
Yes always79%
Not always
21%
Do you visit a doctor / health facility whenever someone is sick in your family?
25%
75%
0%
The doctor/hospital isfar from my residence
Visiting adoctor/hospital is
expensive
The clinical conditionis always not that
serious
Why, Not always?
Yes22%
No78%
Have you consulted /visited any other doctor /hospital before coming to this hospital,in this
instance and for this ailment?
0% 0%
100%
0%
A privatepractitioner
A privatehospital
A local govt.hospital
District hospital
What is the type of healthcare facility that you had visited before coming to this hospital?
45
HEALTH SEEKING BEHAVIOUR
▪ Besides all possible reasons of visiting a government hospital the only reasons considered for
visiting a private physician clinic and a private hospital is the preferences of the doctor and
the respondents choice of visiting the facility for a long time, respectively.
14%
43%
29%
14%
0%
100%
0% 0%
100%
0% 0% 0%
My Preferred doctor practicesthere
I have been visiting the facility fora long time
The facility is large and mostservices offered under one roof
The facility is proximate to myresidence
Reason for choosing a hospital
Govt. hospital Pvt. Hospital Pvt. Physician clinic
46
VISITING EXTERNAL FACILITIES
▪ The survey indicates that a huge percentage
of patients are referred for diagnostic test out
of DHH. Mainly patients are going other
hospital for blood test , CT Scan & USG. Non
availability of CT Scan , waiting time in
USG are the main reasons for diagnostic
referrals.
▪ 89% of respondents had to purchase
medicines from external pharmacy due to
unavailability of the required medications.
56%
44%
Yes No
Did you have to visit any other hospital/diagnostic center for any diagnostic test?
89%
11%
Yes No
Did you have to buy any medicine from an external pharmacy?
20% 20%
40%
20%
HBsAg,Hep b Bloodtest(Dengue)
CT Scan USG
Tests that has been performed from other hospital/diagnostic centres
47
REGULAR MEDICATION BEHAVIOUR
▪ The findings indicate a high prevalence of chronic
diseases requiring continued treatment, with gastric
ailment and hypertensions being 76% 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.
90%
10%
Yes No
Does any member of your family take regular medications?
33%
7% 7%3% 3%
10%13%
17%
7%
Common specialities of consultation
38% 38%
6% 6%
13%
Conditions for which patients take regular medications
48
IP ADMISSIONS
The survey response indicates that there has been atleast of the 60% of respondents who got admitted atleast once in last one year
and chose both private hospital and government hospital equally mostly for gynecology and obstetrics. 33% of the respondents had
undergone atleast two OP consultations before getting admitted in the hospital.
60%
40%
Yes No
There was atleast one hospital admission in the family in the last one year
17% 17% 17% 17%
33%
Genera
l S
urg
ery
Ort
hopedic
s/join
tre
pla
cem
ent
Gastr
oente
rolo
gy/s
urg
ery
Neuro
log
y/N
euro
su
rgey
Gynaecolo
gy a
nd
obste
tric
s
Specialty of admission at hospital
50% 50%
Government hospital Private hospital
Place of admission
44%
33%
22%
0%
This is the first 2-6 visits 7-12 visits >12 visits
Frequency of hospital visit before this admission
49
SECTION 8:
FINDINGS OF OUTPATIENT AND INPATIENT
SURVEY
50
▪ Majority of inpatient respondents at DHH were admitted for general medicine followed by general surgery and Orthopedics/joint replacement. Majority of OP
respondents had consulted for OBG.
▪ 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 for government hospitals and it goes upto a limit of 30,000 for private hospitals. The average amount
spent during an inpatient admission was found Rs 3260/-.
40% 40%
20%
General Medicine General Surgery Orthopedics/jointreplacement
Specialty of the ailment of admission
13 0
608
313
043
Registration Consultation Diagnostictests
Medicines Any minorporcedure
Travel tohealth facility
Amount spent on outpatient visit to the hospital
Average (Rs)
25% 25%
50%
General Medicine Orthopedics/jointreplacement
Gynaecology andobstetrics
Specialty of OP consultation
100%
0% 0% 0% 0% 0%
33%
67%
0% 0% 0% 0%
Amount spent during admission
Government(%) Private(%)
51
SECTION 9:
FINDINGS OF PHYSICIAN SURVEY
52
COMMON SPECIALITIES OF CONSULTATION BY GENERAL
PHYSICIAN
19% 19%
0%
5%
10% 10%
0% 0%
10%
5% 5%
14%
0%
5%
0%
5%
10%
15%
20%
53
ECONOMIC AND GEOGRAPHIC STRATIFICATION OF PATIENTS
GENERAL PHYSICIAN RESPONSE SPECILAIST PHYSICIAN RESPONSE
18%
35%
48%
Upper economic class Middle economic class Low economic class
Economic class of patients
45% 45%
10%
From within the town/city From the district otherthan the town/city
From adjacent districts
Geographic classification of patients
14%
43% 43%
Upper economic class Middle economic class Low economic class
Economic class of patients
33%
47%
20%
From within the town/city From the district otherthan the town/city
From adjacent districts
Geographic classification of patients
54
REASON FOR REFERRAL
25%
8%
0%
17%
25% 25%
0% 0%
13% 13% 13%
7% 7%
20% 20%
7%
0%
5%
10%
15%
20%
25%
30%
Your professionalaffiliation with
thehospital/referral
fee from thehospital
Proximity to yourpatient'sresidence
Hospital thatupdates you on
the progonosis ofyour patient
Low pricing ofservices/price
discounts to yourpatients
Availability ofknown/reputedphysicians in the
hospital
Availability ofcomprehensive
treatmentfacilities andcapability to
handlecomplications
Goodinfrastructure andhigh end facilities
Good clinicalserice quality
Reasons to refer a patient to a particular hospital
General Physician Specialist Physician
55
SPECIALITIES OF CARE FOR WHICH PATEINT TRAVEL TO OTHER
CITIES
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.
19% 19%
15% 15%
13%
4% 4%
2% 2% 2% 2% 2%
56
SPECIALTIES THAT A NEW HOSPITAL SHOULD FOCUS
A mix of higher secondary and tertiary care facilities is what doctors voted for an upcoming hospital to
focus on.
20%
5%
20%
10%
5% 5% 5%
10% 10% 10%
20%
0%
20%
8%
20%
4%
8%
20%
0% 0%0%
5%
10%
15%
20%
25%
General Physician Specialist Physician
FACILITIES RECOMMENDED BY THE PHYSICIANS
57
Specialities General Physician Specialist Physician
Cardiology / cardiac surgery ECHO, Holter, Cath Lab, TMT ECHO, Holter, Cath Lab, TMT, CCU
Pulmonology / Thoracic Surgery PFT / Spirometry, Broncoscopy
Neurology / Neuro SurgeryEEG, EMG, specialised NeuroOT EEG, EMG, specialised Neuro OT
Gastro enterology / surgeryEndoscopy, Colonoscopy, USG, ERCP
Endoscopy, Colonoscopy, USG, ERCP
Cancer
Chemotherapy, radiotherapy, mammography, Onco Surgeries
Chemotherapy, radiotherapy, mammography, Onco Surgeries
NephrologyDialysis, Kidney TransplantationDialysis, Kidney transplant OT
UrologyUroflowmetry, Lithotripsy, TURP
Lithotripsy, TURP
Orthopaedics
BMD, Trauma, Joint Replacement, Specialized OT
BMD, Joint replacement OT, CT Scan, MRI
ENTAudiometry/BERA, ENT Surgeries
Pediatrics and neonatalogy Neonataology and surgeries
THANK YOU
58