district : kendujhar · summary •the district of keonjhar has 46 government health care...

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Technical due diligenceDistrict : Kendujhar

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

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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.

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

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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.

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SUMMARY

• The district of Keonjhar has 46 government health care facilities and 26 private hospitals with a

bed strength of 779 beds only.

▪ CHC’s comprise of 41.3% of the total OP consultations at government facilities, indicating a good

health seeking behavior of the people at the district.

• 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.

• Surgeries performed at government facilities are mostly minor in nature, for FY 2015-16,81% of the

total surgeries performed at government facilities were minor in nature.

• Less than 2 surgeries per surgeon per day at DHH and SDH and less than 1 surgery per surgeon per

day at CHCs indicate under utilization of surgeons.

• Institutional deliveries at the studied facilities have increased by 15% since 2013-14.

• Proportion of C-Sections to normal deliveries at secondary care public health facilities is 7.5%,

which is a healthy trend.

• Overall Lab tests accounts for majority (97%) of total diagnostics at the studied facilities, whereas

CT-Scan facility is not available at any of the healthcare facilities 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 6144

beds (i.e. a gap of 90% beds).

▪ Considering the WHO norm of 1 doctor per 1000 population, the district has a shortfall of 1726

doctors.

▪ Considering the WHO norm of 2 nurses per 1000 population, the district has a shortfall of 3850

nurses.

▪ For gaps under service facilities, when compared with IPHS for district hospitals, major gaps are in

the areas of Diagnostics and Specialty OPDs.

▪ Low pricing of services stands the most voted reason for choosing a government hospital, whereas

availability of preferred doctor and proximity to residence is the reason for interviewees choosing

a private facility.

▪ While Majority of the respondents depend on savings for their healthcare spending only 33% of the

patients surveyed had health insurance as a primary source of health related costs, which indicates

a need for awareness in insurance coverage.

▪ 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 gastroenterology and endocrinology.

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 pPvt.Hosp.3cipation 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.

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SECTION 3:

DISTRICT PROFILE

Keonjhar district headquarter hospital and

district HQT

11

DEMOGRAPHIC PROFILE

PPvt.Hosp.3cul

arsOdisha Kendujhar

Total Population 4,19,74,218 1,801,733

Urban population 16.6%14.05%

Decadal

population growth

rate

14.05%15.35%

Mean household

size4.35

4.45

BPL households* 44,08,070 211,132

BPL Population* 1,91,75,105 938,637

BPL % 46%52%

Source :

Census of India – 2011, Odisha

* RSBY status 2015-16, Odisha

District HQT Town

• Keonjhar is the 4th district in terms of size and 8th

in terms of population.

• Keonjhar is the 11th urbanized district in state

having only 14.05 percent of its population live in

urban areas as against 16.69 percent of state’s

population living in urban areas.

• Keonjhar is 18th densely populated district in the

state.

• Keonjhar has 12th rank in terms of sex ratio in the

state.

12

HEALTH INDICATORS

Source : Annual Health Survey Report 2011-12

212

4357

81

20.39.3

230

39

59

79

19.88.2

178

3144

55

22.27.1

MaternalMortality Ratio*

Neonatal MoralityRate

Infant MortalityRate

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 kendujhar

Keonjhar - Causes of Infant & Child Deaths -Apr'15 to Mar'16

Measles 0

Diarrhoea 4

Fever 25

Pneumonia 41

Sepsis 49

Asphyxia 102

Others (for age upto 4 weeks of birth) 142

Low Birth Weight (LBW) 155

Others (for 1 month to 5 years) 210

Total 728

Sepsis6.7% Asphyxia

14.0%

LBW21.3%

Pneumonia5.6%

Diarrhoea0.5%

Fever related3.4%

Others48.4%

Odisha - Keonjhar - 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 Kendujhar

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

Causes 6-14 yrs 15-55 yrs.

Above 55yrs Total

HIV/AIDS - - - -

Malaria - - - -

Tuberculosis - 6 4 10

Diarrhoeal Diseases - 1 10 11

Animal Bites & Stings 1 2 - 3

Other fever Related 1 3 - 4Respiratory Diseases(other than TB) - 8 4 12

Suicide - 3 6 9Trauma/Accidents/ Burn Cases - 12 1 13Neurological Disease including strokes - - 2 2

Known Acute Disease - 8 1 9

Known Chronic Disease 2 32 174 208Heart Disease/ Hypertension related - 14 11 25

Causes not known - - - -

Total Deaths 4 89 213 306

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

facilities

Number of

beds

District Headquarters

Hospital 1 160

Sub-divisional hospitals 2 118

Community Health

Centers17 230

Primary Health Centers

& IDH 0 0

Other hospitals / Area

Hospital 6 0

Private Hospitals 12 153

Total 38 661

Govt. Beds77%

Pvt. Beds23%

Share of Govt. Vs. Pvt. beds in district

Functional Beds at DHH Kendhujhar: 209

17

ABOUT DISTRICT HEADQUARTERS HOSPITAL,KENDHUJHAR

Total number of

beds

Sanctioned 160

Functional 209

Service specialties Internal medicine, General

surgery, Gynecology and

obstetrics, Pediatrics,

Orthopedics, Ophthalmology,

ENT, Ortho, Psychiatry, Dentistry,

TB & Chest, Emergency & Trauma

Diagnostic facilities X-ray, USG, ECG, A-scan,

Audiometry, Hematology lab,

Biochemistry lab, Microbiology

Operating rooms and

Labour tables

2 major OT 1 Minor OT, 4 labour

tables

Other clinical

facilities

Blood bank, OP & IP Pharmacy

Outsourced Support

facilities

Laundry, Dietary, Biomedical

waste management, Security,

Housekeeping

18

Major Private Healthcare Facilities

Private Facilities Beds

Aarti Hospital, Barbil 30

Mohata Hospital, Joda 17

Kasinath Healthcare, Sailang, Keonjhar town 19

Dipali Nursing Home, Keonjhar town 12

J.M. Hospital Diagnostics & Research Centre, Barbil 12

Keonjhar Hospital, keonjhar town 14

19

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 studied facilities except at SDH.

▪ During FY 2015-16, per day OP consultations at DHH was 549 and whereas on an average per day OPD per SDH and per CHC was 167 & 88 respectively.

▪ OP consultations during 2015-16 at Pvt.Hosp.1, Pvt.Hosp.2 and Pvt.Hosp.3 were 23, 30, 10 per day respectively.

▪ IP admissions per day at DHH were maximum (98) followed with 47 per SDH, 8 per CHC.

▪ Govt hospitals accounted for almost 97% of OPDs and 99% of IP admissions among the studied facilities during FY 2015-16.

DHH SDH CHCSwasthiHealthCare

JMJ Arti

2013-14 141,544 82,043 363,996 5,500 6,500 0

2014-15 148,004 117,965 396,153 6,000 7,500 0

2015-16 164,703 100,280 448,404 7,000 9,000 3,000

050,000

100,000150,000200,000250,000300,000350,000400,000450,000500,000

OPD Consultations

DHH SDH CHCSwasthiHealthCare

JMJ Arti

2013-14 31,669 27,105 47,553 100 90 0

2014-15 33,524 34,246 52,419 170 70 0

2015-16 35,809 34,031 51,252 210 100 250

010,00020,00030,00040,00050,00060,000

IPD Admissions

DHH23%

SDH14%CHC

61%

Pvt.Hosp.11%

Pvt.Hosp.2 1%

Pvt.Hosp.30%

Facility wise share of OPDs

DHH30%

SDH28%

CHC42%

Pvt.Hosp.10%

Pvt.Hosp.2 0%

Pvt.Hosp.30%

Facility wise share of IPDs

Pvt.Ho

sp.1Pvt.Ho

sp.2Pvt.Ho

sp.3

Pvt.H

osp.1

Pvt.H

osp.2Pvt.H

osp.3

BED UTILIZATION

20

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 SDH it has

been significantly higher compared to

other public health facilities because most

of the referrals from PHCs are directly sent

to SDH.

▪ The BOR of DHH is calculated against the

sanctioned beds (160 beds) considering

ALOS of 1.71 as per the HMIS data

provided by the facility. However, such a

short of 1.71 at DHH level is one among

the lowest in the state.

22%

34%

11%

3% 1%

8%

DHH SDH CHC SwasthiHealth Care

JMJ Arti

OPD to IPD Conversion (FY 2015-16)

104.9%

23.0%16.0%

4.8%

DHH Swasthi HealthCare

JMJ Arti

Bed Occupancy Rate (FY 2015-16

Note :-As per functional beds (209) BOR is 80.3%

Pvt.Hosp.

1

Pvt.Hos

p.2

Pvt.Hos

p.3

Pvt.Hosp.1 Pvt.Hosp.2 Pvt.Hosp.3

GENERAL SURGERIES

21

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

from NHM Odisha

▪ DHH accounts for 48% of the total surgeries among

the studied facilities.

▪ Among all the studied facilities, 66% of the major

surgeries and 41% of the minor surgeries happened

at DHH.

▪ On an average, 6 major surgeries and 8 minor

surgeries have been conducted at DHH.

▪ Private hospital accounts for only 3close to 3% of

total surgeries among the studied facilities.

Facility Name Major Minor TOTAL

DHH 1,640 2,454 4,094

SDH 704 362 1,066

CHC 83 3,026 3,109

Pvt.Hosp.1 20 50 70

Pvt.Hosp.2 10 70 80

Pvt.Hosp.3 20 80 100

TOTAL 2,477 6,042 8,519

40%

66%

3%

29%

13%

20%

60%

34%

97%

71%

88%

80%

DHH

SDH

CHC

Swasthi Health Care

JMJ

Arti

Facility wise proportion of Major & Minor Surgeries (FY 2015-16)

Major Minor

Major29%

Minor71%

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

Pvt.Hosp.1

Pvt.Hosp.2

Pvt.Hosp.3

OT UTILIZATION

22

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 9 5,547 18.5 2.1 3 6.2SDH 10 1,724 5.7 0.6 2 2.9CHC 56 3,109 10.4 0.2 17 0.6

Pvt.Hosp.1 1 70 0.2 0.2 1 0.2

Pvt.Hosp.2 1 80 0.3 0.3 1 0.3Pvt.Hosp.3 1 100 0.3 0.3 2 0.2

▪ Data indicate a healthy utilization of OT at DHH with 6

procedures per day per OT but surgeon utlization is a

bit of concern considering most of the procedures

(60%) are minor in nature.

▪ IPD to surgery conversion at public health facility is a

concern especially at SDH and CHC level considering

industry standards of more than 11% at secondary

care hospital.

▪ Higher IPD to Surgery conversion at private facilities is

indicate most of the admissions happen for surgical

interventions.

.

15%

5% 6%

33%

80%

40%

DHH SDH CHC SwasthiHealth Care

JMJ Arti

IPD to Surgery Conversion (FY 2015-16)

Pvt.Hosp

.1

Pvt.Hos

p.2Pvt.Hos

p.3

INSTITUTIONAL DELIVERIES

23


data from NHM and DHS Odisha

▪ Institutional deliveries among the studied facilities indicate flat tend with an average 24183 deliveries per year.

▪ Of total, DHH conducted 21% of total institutional deliveries.

▪ In 2015–16, DHH performed 14 deliveries per day (@10normal and 4 C-section per day).

▪ 69% of the total C-sections during FY 2015-16 has been carried out at DHH.

Name of

Facility

2013-14 2014-15 2014-15

Normal

Delivery

C -

Section

Normal

Delivery

C -

Section

Normal

Delivery

C -

Section

DHH 3,253 1,143 3,259 1,066 3,612 1,453

SDH 6,821 668 6,539 876 6,323 658

CHC 12,433 0 12,318 0 12,128 0

Sub Total 22,507 1,811 22,116 1,942 22,063 2,111

71%

91%

100%

29%

9%

0%

DHH

SDH

CHC

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

Normal C-Section

Normal Delivery

91%

C - Section9%

Category of Institutional Deliveries (FY 2015-16)

DIAGNOSTICS PROCEDURES

24


data from NHM Odisha

▪ Overall Lab tests accounts for majority (97%) of total

diagnostics.

▪ X-ray and ECG constitute of only 2% and 1% of the total

diagnostic procedures conducted at the district which

is far below industry standards. USG services are not

available among the studied facilities.

▪ Among the studied facilities, govt. hospitals accounts for

95% of the total diagnostics

▪ 29% of the diagnostics procedures among the studied

facilities are conducted at DHH.

▪ 83% of all X-Rays and 22% of all Lab Tests are

conducted at DHH among the studied facilities.

▪ CT Scan facility is not available in the entire district.

Diagnostic Test X Ray USG ECG CT Scan Lab Tests

DHH 4,754 0 1,371 0 62,121

SDH 0 0 0 0 20,214

CHC 0 0 0 0 137,401

Pvt.Hosp.1 490 0 295 0 820

Pvt.Hosp.2 150 0 75 0 6,000

Pvt.Hosp.3 300 0 50 0 2,500

NA: Data not available

68,246

20,214

137,401

1,605 6,225 2,850

DHH SDH CHC SwasthiHealthCare

JMJ Arti

Facility wise total diagnostics

Pvt.Hos

p.1

Pvt.Hos

p.2Pvt.Hos

p.3

25

ECONOMIC SEGMENT & MODE OF PAYMENT

Note: estimations given above are based on

discussion with ADMO Medical and Hospital Manager

Economic Segment of Patients

30%

40%

20%

10%

DHHBPL (Belowpoverty line)

APL - LowIncome

APL - Middleincome

APL - Highincome

5%

60%

35%

Pvt.Hosp.1

APL - LowIncome

APL - Middleincome

APL - Highincome

10%

70%

20%

Pvt.Hosp.2

APL - LowIncome

APL - Middleincome

APL - Highincome

90%

10%

Pvt.Hosp.3

BPL (Belowpoverty line)

APL - LowIncome

26

ECONOMIC SEGMENT & MODE OF PAYMENTMode of Payment by Patients to the Hospital

22%

70%

6%

2%DHH

Free

Cash

RSBY

BKKY

100%

Pvt.Hosp.1

Cash

100%

Pvt.Hosp.2

Cash

10%

80%

10%

Pvt.Hosp.3

Cash

RSBY

BKKY

27

SECTION 5:

CATCHMENT AREA & REFERRALS

28

CATCHMENT OF DHH

Catchmen

t Type

Name of

the blockPopulation

Distance

from

district HQ

Primary Keonjhar 161931 -

Secondary

Joda 125728 70

Champua 115321 60

Jhumpura 113149 25

Banspal 102527 50

Telkoi 167705 45

Harichandanpur

142150 40

Ghatgaon 118307 55

Patna 101518 20

Saharapada 159429 60

Anandpur 180784 90

Ghasipura 148555 85

Hatadih 164629 100

District Headquarters Hospital

Block Headquarters

29

SOURCE OF PATIENT INFLOW

Source: estimations given above are based on discussion with Management of concerned hospitals

Source of Patient Inflow

50%45%

5%

DHH

From within thedistrict town

From the districtother than thedistrict town

Other districts

30%

65%

5%

Pvt.Hosp.1



Other districts

65%

30%

5%

Pvt.Hosp.2



Other districts

85%

10% 5%

Pvt.Hosp.3



Other districts

30

POINTS OF REFERRAL

SCB, AHRCC & Sishu-bhawan at Cuttack

Various private empanelled hospitals

in Bhubaneswar

176km

3h34m

210km

4h

31

Top specialties of referral from DHH to other district

▪ Top 5 specialties of referrals accounts close to 79% of total referrals.

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

Specialty

No. of

patients

reffered

TOP 5

SPECIALTIES

Cardiology 165

Gynaecology and

obstetrics80

Urology/Nephrology 68

General/Internal

medicine60

Neurology 47

OTHER

SPECIALTIES

Neurosurgery 33

Pulmonology/Chest

medicine26

Gastro-

enterology/surgery23

Orthopedics 8

General Surgery 7

Others 15

Total referral per month 532

31%

15%13% 11%

9%6% 5% 4%

2% 1% 3%

Card

iolo

gy

Gynaecolo

gy a

nd

obst

etr

ics

Uro

logy/N

ephro

logy

Genera

l/In

tern

al

medic

ine

Neuro

logy

Neuro

surg

ery

Pulm

onolo

gy/Chest

medic

ine

Gast

roente

rolo

gy/su

rgery

Ort

hopedic

s

Genera

l Surg

ery

Oth

ers

TOP 5 SPECIALTIES OTHER SPECIALTIES

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

32

▪ Nearest railway station : Kendujhar

railway station is on the Padapahar-

Jakhapura branch line of Tatanagar–

Bilaspur section of Howrah-Nagpur-

Mumbai line. It is connected by broad

gauge line to Jakhpura, Barabil,

Japura, Bhadrak, Bhubaneswar by

daily trains.

▪ Road ways: Kendujhar is situated

the National Highway No 49 (formerly

it was 6) and 215. It well connected

with Bhadrak by SH 11, Sambalpur by

NH 6.

▪ Airport : The nearest airport is in in

Bhubaneswar which is approx 220 km

away.

▪ Nearest government referral

centre: SCB Cuttack (176 km)

CONNECTIVITY & TRANSPORT

33

SECTION 6:

DEMAND-SUPPLY-GAP ASSESSMENT

34

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

35

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 22 646,005 163,465 482,540

OBG 14 411,094 101,374 309,720

Pediatrics 12 352,367 88,286 264,080

Gen. Surgery 11 323,003 82,333 240,670

Orthopedic 9 264,275 64,205 200,070

ENT 7 205,547 49,937 155,610

Ophthalmology 7 205,547 49,937 155,610

Others

specialties18 528,550 132,850 395,700

TOTAL 100% 2,936,388 732,387 2,204,001

Total OPD Gap 75%

Gen Med

OBG

Paediatrics

Gen. Surgery

Orthopaedic

ENT

Opthalmology

Others specialties

Gap assessment of OPD specialty mix

Estimated Demand Actual Suppy

36

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 96,901 26,840 70,061

OBG 61,664 16,953 44,711

Pediatrics 52,855 14,551 38,304

Gen. Surgery 48,450 13,660 34,790

Orthopedic 39,641 10,898 28,743

ENT 30,832 8,476 22,356

Ophthalmology 30,832 8,476 22,356

Others

specialties79,282 21,797 57,486

TOTAL 440,458 121,652 318,806

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

37

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% 440,458 50% 220,229 660,687 5,694 654,993

USG 20% 587,278 35% 154,160 741,438 0 741,438

ECG 10% 293,639 60% 264,275 557,914 1,791 556,123

CT Scan 2% 58,728 5% 22,023 80,751 0 80,751

Lab Tests

(number of

patients)

60% 1,761,833* 100% 440,458** 2,202,291 229,056 1,973,235

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

demand number of OPD lab tests would be 3,523,665 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 2,202,291

38

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

450 beds

16230beds

1118 beds

01160 beds

00 beds

12153 beds 661

The district of Keonjhar has 63 public and 12

private health care facilities with a total bed

strength of 661 beds only.

Considering the WHO norm of 3.5 beds per 1000

population, the district with a population of

15,76,869 has a huge shortfall of 6144 beds

(i.e. a gap of 90% beds).

* Source : Bed Strength, DHS Odisha and Clinical

Establishment, DMET Odisha

0

1000

2000

3000

4000

5000

6000

7000

Beds available Beds required as perWHO norm

661

6805

Gap in bed availibility

39

GAP – DOCTORS AND NURSES

▪ There are 218 sanctioned positions for doctors, of

which 78 positions are vacant.

▪ Considering the WHO norm of 1 doctor per 1000

population, the district has a shortfall of 1726 doctors

* Source : District wise Incumbency list , DHS Odisha

▪ As per primary and secondary data collected There

are only 38 nurses posted in the district. (5 nursing

sister and 33staff nurse, 1 Asst Matron).

▪ Considering the WHO norm of 2 nurses per 1000

population, the district has a shortfall of 3850 nurses.

* Source : Staff position list received from DHH and nursing staff

list from directorate of nursing, Odisha.

0

500

1000

1500

2000

Doctors available Doctors required asper WHO norm

218

1944

Gap in doctors availibility

0

500

1000

1500

2000

2500

3000

3500

4000

Nurses available Nurses required

39

3889

Gap in nurses availibility

40

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

41

SECTION 7:

FINDINGS OF GENERAL POPULATION

SURVEY

42

INCOME AND OCCUPATION

▪ Majority of the respondents has agriculture

as there source of income followed by daily

wager with an annual income not more than

1,00,000.

▪ 23% of the patients surveyed had health

insurance as a primary source of health

related costs, which indicates there is a

moderate awareness among the population

of Keonjhar district.

23%20%

7%

13% 13%

7%

17%

Agriculture

La

ndle

ss

La

bou

r/D

aily

wa

ger

Serv

ice(g

ovt/p

vt)

Busin

ess

Ho

usew

ife

Stu

de

nt

Oth

ers

Occupation of the respondents

0% 0%

80%

17%3% 0%

Annual family income of the respondents

77%

0% 0%

23%

From savings Loan fromfamily/friends

Sold assets Healthinsurance

Source of health related costs

43

HEALTH SEEKING BEHAVIOUR

The survey response indicates that 97% of the population surveyed is quite aware bout health issues and they always visit

a facility whenever someone is sick in their family and there is an equal trend of visiting the government and private facility

which point s toward that good health seeking behavior among people.

97%

3%

Yes always Not always

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

0%

100%

0%

Thedoctor/hospital is

far from myresidence

Visiting adoctor/hospital is

expensive

The clinicalcondition is

always not thatserious

Why, Not always?

50% 50%

Yes No

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

this instance and for this ailment?

30%

0%

70%

0%

A privatepractitioner

A privatehospital

A local govt.hospital

Districthospital

What is the type of healthcare facility that you had visited before

coming to this hospital?

44

HEALTH SEEKING BEHAVIOUR

▪ The reason for choosing a health care is divided in to multiple factors. Service availability, large

infrastructure ,proximity to residence these were the factors for choosing Govt. healthcare facility. But the

proximity of the facility to the residence is the root cause for choosing a private facility

11% 11%

78%

0%

100%

0%

The facility is large and mostservices offered under one roof

The facility is proximate to myresidence

Low pricing of services and freemedicines

Reason for choosing a hospital

Govt. hospital Pvt. Hospital

45

VISITING EXTERNAL FACILITIES

▪ 25% of the respondents at DHH, had

visited external diagnostic centre for

Blood test ,USG and X-ray.

▪ 55% of respondents had to purchase

medicines from external pharmacy due

to unavailability of the required

medications.

25%

75%

Yes No

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

diagnostic test?

33% 33% 33%

USG X-ray Blood test

Tests that has been performed from other hospital/diagnostic centres

55%

45%

Yes No

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

46

REGULAR MEDICATION BEHAVIOUR

▪ The findings indicate a prevalence of chronic diseases

requiring continued treatment, with diabetes and

hypertensions being the entire condition for which people

take regular medications.

▪ Majority of the respondents replied they have consulted

health care facilities majorly for general medicine

ailments followed by pediatrics consultation.

50% 50%

Yes No

Does any member of your family take regular medications?

67%

33%

Diabetes Hyper tension

Conditions for which patients take regular medications

33%

10%7%

13%

7%

23%

7%

Ge

ne

ral

Med

icin

e

Ort

ho

pe

dic

s/jo

int

rep

lac

em

en

t

Ca

rdio

log

y/c

ard

iac

su

rge

ry

Dia

bete

s

Gy

na

ec

olo

gy

an

do

bste

tric

s

Pa

ed

iatr

ics a

nd

ne

on

ata

olo

gy

Op

tha

lmo

log

y

Common specialities of consultation

47

IP ADMISSIONS

The survey response indicates that there has been at least 20% of respondents who got admitted atleast once in last one

year mostly chose a government hospital for general medicine ailment followed by cardiac problem. The respondents had

undergone atleast two OP consultations before getting admitted in the hospital. So it proves that people in Keonjhar

district is quite aware with their health related issues.

20%

80%

Yes No

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

year

100%

0%

Government hospital Private hospital

Place of admission

25%

40%35%

0%

This is the first 2-6 visits 7-12 visits >12 visits

Frequency of hospital visit before this admission

50% 50%

General Medicine Cardiology/cardiac surgery

Specialty of admission at hospital

48

SECTION 8:

FINDINGS OF OUTPATIENT AND INPATIENT SURVEY

49

▪ Majority of inpatient respondents at DHH were admitted for General Medicine ,followed by general surgery, orthopedics and

diabetes.

▪ 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 30,000. The average amount spent during an inpatient admission was found

Rs 2530/-.

50%

30%

10% 10%

GeneralMedicine

General Surgery Orthopedics/jointreplacement

Diabetes

Specialty of the ailment of admission

30% 30%

10%

30%

General Medicine General Surgery Orthopedics/jointreplacement

Paediatrics andneonataology

Specialty of consultation

2 048

217

0

141

Amount spent on visit to the hospital

Average (Rs)

0%

100%

0% 0% 0% 0%

Amount spent during admission

50

SECTION 9:

FINDINGS OF PHYSICIAN SURVEY

51

COMMON SPECIALITIES OF CONSULTATION BY GENERAL PHYSICIAN

20% 20%

10%

5%

0%

5%

0% 0%

5%

0%

15%

20%

0% 0%

COMMON SPECIALITIES OF CONSULTATION BY GENERAL PHYSICIAN

52

ECONOMIC AND GEOGRAPHIC STRATIFICATION OF PATIENTS

GENERAL PHYSICIAN RESPONSE SPECIALIST PHYSICIAN RESPONSE

15%23%

63%

Upper economicclass

Middle economicclass

Low economicclass

Economic class of patients

68%

25%

8%

From within thetown/city

From the districtother than the

town/city

From adjacentdistricts

Geographic classification of patients

18%

31%

51%

Upper economicclass

Middle economicclass

Low economicclass

Economic class of patients

40%

48%

12%

From within thetown/city

From the districtother than the

town/city

From adjacentdistricts

Geographic classification of patients

53

REASON FOR REFERRAL

8%

33%

25% 25%

8%

13%

20%

27%

20% 20%

Low pricing ofservices/price discounts

to your patients

Availability ofknown/reputedphysicians in the

hospital

Availability ofcomprehensive

treatment facilities andcapability to handle

complications

Good infrastructure andhigh end facilities

Good clinical sericequality

Reasons to refer a patient to a pPvt.Hosp.3cular hospital

Genearl Physician Specialist Physician

54

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.

20%

16%13% 13%

11%9%

7%4% 4%

2%

SPECIALITIES OF CARE FOR WHICH PATEINT TRAVEL TO OTHER CITIES

55

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%

5%

10% 10%

20%

5%

0%

5%

21%

0%

21%

8%

17%

0%

17%

8% 8%

0%

Cardiology /cardiacsurgery

Pulmonology/ Thoracic

Surgery

Neurology /Neuro

Surgery

Gastroenterology /

surgery

Cancer Urology Nephrology Orthopaedics Gynaecology& Obstetrics

ENT

SPECIALTIES THAT A NEW HOSPITAL SHOULD FOCUS

General Physician Specialist Physician

FACILITIES RECOMMENDED BY THE PHYSICIANS

56

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

facilities for the corresponding specialties.

Specialities General Physician Specialist Physician

Cardiology / cardiac surgery

ECHO, TMT, Cath Lab,

Hotler

ECHO, TMT, Cath Lab,

Hotler,ECG

Pulmonology / Thoracic

Surgery

Spirometry,

Broncoscopy

Neurology / Neuro Surgery EEG, EMG EEG, EMG

Gastro enterology / surgery Endoscopy, Colnoscopy

Endoscopy, Colnoscopy,

ERCP

Cancer Chemotherapy Chemotherapy

Urology Lithotripsy

Nephrology Dialysis Dialysis

Orthopaedics

C-arm, Joint

replacement OT Joint Replacement, C-arm

Gynaecology & Obstetrics USG

THANK YOU

57

district : kendujhar · summary •the district of keonjhar has 46 government health care...

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