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Odisha Marching Ahead In Achieving Universal Health Coverage


17 November 2019

Debashish Maharana


Bhubaneswar: Odisha's journey towards Universal Health Coverage through BSKY (Biju Swasthya Kalyan Yojana) was highly appreciated in the 6th National Summit on Good & Replicable Practices and Innovations in Public Healthcare System in India held at Gandhinagar from 16th to 18th November 2019. Mission Director, NHM Salini Pandit gave a detailed presentation on BSKY and patient satisfaction monitoring through Mo Sarkar.

In lines with SDG, the National Health Policy 2017 envisaged that every State should strive to achieve Universal Health Coverage. The state of Odisha was faced with several challenges towards achieving this goal primarily a shortage of human resources, gaps in infrastructure and out of pocket spending (OOPS) by the patients.

Towards achieving UHC, Odisha introduced several reforms for making health care accessible, affordable and equitable while assuring quality, as below:-

Accessible:

Difficult area initiatives: For improving healthcare service delivery in difficult areas various steps have been taken like notification of difficult villages, which is annually notified by Collector & District  Magistrate; provision of alternative transportation facilities with the introduction of a stretcher, Bike Ambulance, Boat ambulance, Reimbursement  scheme (Rs. 1000/- per case); mobile Health Unit (MHU)at all tribal blocks; and Maternity Waiting Homes for expectant mother from notified difficult villages.

Attracting & retaining of Doctors: Place-based incentive up to Rs. 40,000/- per month for MBBS Doctors and up to Rs. 80,000/- per month for Specialists; additional weightage for PG entrance to Doctors serving in difficult areas; corpus fund @ Rs. 1 Crs per district; dynamic assured career progression scheme for Doctors with assured promotion at 7 years, 14 years and 21 years; restructuring of Odisha Medical & Health Service Cadre with  increasing of posts in Pay Band-IV from 35 to 433; creation of 3,330 new posts of Doctors and 26,000 posts of Paramedics as per IPHS norms and establishment of 4 new Medical Colleges with 7 more Medical Colleges in the pipeline.

Empanelment of Pvt. Hospitals: 197 Pvt. Hospitals have been empanelled for provisioning of free health care services to economically vulnerable families.

Affordable:

Free Healthcare Services for all at all public health facilities up to Medical Colleges under the Biju Swasthya Kalyan Yojana(BSKY) with waiving of all user fees; hot cooked meal for patient attendants at AAHAR Centers; strategic purchasing of services in PPP mode for critical care services and high-end diagnostic services.

Equitable:

Special assistance for cashless services at empanelled Private Hospitals up to Rs. 5 lakhs per family per year for economically vulnerable families and an additional Rs. 5 lakhs for the women members of the beneficiaries’ families covering over 70 lakh families.

Quality:

Monitoring patient feedback as part of “Mo Sarkar” initiatives; strengthening ancillary services such as Housekeeping & Cleaning Services, Linen & laundry, Security, Lift, Electrician, Plumber, Attendant and Gardening under State specific scheme NIRMAL with an investment of about Rs. 2,000 Crs for five years; promotion of Kayakalpa, LaQshya and NQAS; introduction of healthcare investment promotion policy; and Steady increase in public health spending with 1.48% of GSDP in the year 2018-19.

Governance:

Defined charter for the Department under ‘5T’ Concepts (Transparency, Time, Teamwork, Technology and Transformation) for effective governance and response to peoples’ needs; ‘Mo Sarkar’ initiatives for peoples’ feedback on healthcare service delivery; and PAR based progress on 5 T charter with the provision of award schemes (additional promotion, LTC abroad, foreign training, additional monthly salary and cash award).

Programme Outcomes:

33% increase in footfall both in OPD and IPD within a year with 670,53,362 instances of free healthcare services recorded in a year.

44% improvement in the availability of Medical Officers in KBK and KBK+ Districts.

Over 92 % of patients are satisfaction on the healthcare services at the Public Health Facilities.

There is a marked reduction in out of pocket spending (OOPS).

Financial Implication: Annually more than Rs.1712.76 Crores are being spent under State Budget schemes excluding NHM budget.

Implementation Partners: Health & Family Welfare Department, other line Departments, Development Partners, Private Providers and premier health institutes outside the State.

Scalability: Sustained and multi-pronged strategies adopted over the years backed with a steady increase in investments in health care has created a strong foundation in the state to achieve Universal health coverage. Implementation of these strategies can provide evidence and guidance for other states to develop plans for achieving UHC.