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%
DHH SDH CHC Jyoti Hospital
Bed Occupancy Rate (FY 2015-16)
Pvt. Hosp.
GENERAL SURGERIES
20
Source: Primary data from DHH & Pvt. hospital & Secondary
data from NHM Odisha
▪ 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%
DHH SDH CHC Jyoti Hospital
IPD to Surgery Conversion (FY 2015-16)
Pvt. Hosp.
INSTITUTIONAL DELIVERIES
22
Source: Primary data from DHH & Pvt. hospital & Secondary
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
Source: Primary data from DHH & Pvt. hospital & Secondary
data from NHM Odisha
▪ 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
DHH SDH CHC Jyoti Hospital
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
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