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