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Technical due diligenceDistrict : Khorda
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 Khorda has 84 Govt. and 41 private health care facility with a bed
strength of 5789 beds only.
• Among the Public health care facilities Capital Hospital account the highest percentage
of OP Consultations (39%) and IP admission (45%)in the FY 2015-16 years.
• Bed occupancy rate at DHH (126.2 %) and Capital Hospital(155%) is much above the
optimum level of 80% indicating a need for additional bed strength in the district to
meet the rising demand.
• For the FY 2015-16 ,Surgeries performed at the district are majorly minor surgeries (68
%) . Of all the surgeries performed at DHH only 8 % surgeries are major surgeries.
• As per the primary and secondary data, good utilization of OT at DHH and Capital
Hospital are indicated with 4 and 5 surgeries respectively per OT per day. However
92% of these are minor surgeries.
• For the FY 2015-16 , 24% percent of the total deliveries conducted at the district
constitutes of the C-Section deliveries, which is much above the industry standard.
• For the FY 2015-16 overall lab test accounts for majority(75%) Of total diagnostic. X-ray
constitutes 13% whereas USG constitutes only 7% of the total diagnostic procedures .
3
SUMMARY
• Present resources are scarce to cater to the existing demand. It can be inferred that at
secondary care level only 48 % of the existing demand is being met for OPD and 28% for
IPD.
• Considering the WHO norm of beds per 1000 population, the district falls short of 2910
beds (i.e. a gap of 33.4 % beds).
• Considering the WHO norm of 1 doctor per 1000 population , the district has a
shortfall of 2245 doctors.
• Considering the WHO norm of 2 nurses per 1000 population , the district has a shortfall
of 4915 nurses.
• Patients tend to spend mostly on diagnostic tests and medicines especially as they had
to purchase them from external facilities.
• Majority of people interviewed said they depend on savings for their health related
cost. Only 14% of the patients surveyed had health insurance as a primary source of
health related costs, indicating a need for awareness in insurance coverage.
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.
10
Khorda (District HQ Town)
Bhubaneswar (State Capital)
SECTION 3:
DISTRICT PROFILE
11Source :
Census of India – 2011, Odisha
* RSBY status 2015-16, Odisha
Khorda (District HQ Town)
Bhubaneswar (State Capital)
• Khorda is the 25th district
in terms of size and 5th in
terms of population.
• Khorda is the 1st
urbanized district in state
having only 48.16
percent of its population
living in urban areas.
• Khorda has 29th rank in
terms of sex ratio in the
state.
DEMOGRAPHIC PROFILE
Particulars Odisha Khorda
Total Population 4,19,74,218 2,251,673
Urban population 16.6% 48.16%
Decadal population
growth rate14.05% 19.94%
Mean household size 4.35 4.56
BPL households* 44,08,070 141,241
BPL Population* 1,91,75,105 643,506
BPL % 46% 29%
12
HEALTH INDICATORS
Source : Annual Health Survey Report 2011-12 , khorda
* Maternal Mortality Ratio is of Central Division
222
45
72
100
18.98.4
230
39
59
79
19.88.2
178
3144
55
22.27.1
Maternal MortalityRatio*
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, Khorda
Sepsis1.8%
Asphyxia14.5%
LBW27.3%
Pneumonia5.5%
Fever related1.8%
Others49.1%
Odisha - Khorda Causes of Infant & Child Deaths against Total Reported Infant & Child Deaths-
Apr'15 to Mar'16
Khordha - Causes of Infant & Child Deaths -Apr'15 to Mar'16
Measles 0
Diarrhoea 0
Fever 1
Sepsis 1
Pneumonia 3
Asphyxia 8
Others (for 1 month to 5 years)
13
Others (for age upto 4 weeks of birth)
14
Low Birth Weight (LBW) 15
Total 55
Causes of deaths (above 6 years of age)
14
Source : HMIS Data Analysis 2015-16 , Khorda
Diarrhoeal Diseases
0.7%Tuberculosis
0.7%
Respiratory Diseases (Other
than TB)12.6%Malaria
0.7%
Other fever Related
2.1%
Heart Disease/ Hypertension
related 38.5%
Neurological Disease
including strokes
2.1%
Trauma/Accidents/ Burn Cases
4.2%
Suicide 2.1%
Animal Bites & Stings 2.1%
Known Acute Disease
0.7%
Known Chronic Disease
4.9%
Causes not known 28.7%
Odisha - khorda - Cause of deaths 6 yrs & above against total reported deaths 6 yrs & above - Apr'15 to Mar'16
Causes of deaths (above 6 yrs of age) Apr'2015-March'16
Causes 6-14 yrs 15-55
yrsAbove 55yrs Total
HIV/AIDS - - - -
Malaria - 1 - 1
Tuberculosis - - 1 1
Diarrhoeal Diseases - - 1 1
Known Acute Disease - - 1 1
Animal Bites & Stings 1 - 2 3
Other fever Related 1 - 2 3
Suicide - 2 1 3
Neurological Disease including strokes - - 3 3
Trauma/Accidents/ Burn Cases - 2 4 6
Known Chronic Disease - 3 4 7
Respiratory Diseases(other than TB) - 3 15 18
Causes not known 2 15 24 41
Heart Disease/ Hypertension related 2 14 39 55
Total Deaths 6 40 97 143
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 1 146
Capital Hospital
Bhubneswar1 563
Sub-divisional hospitals 0 0
Community Health
Centers13 204
Primary Health Centers
& IDH 66 6
Other hospitals / Area
Hospital 3 18
Private Hospitals 41 5,415
Total 125 6,352
Govt. Beds15%
Pvt. Beds85%
Share of Govt. & Pvt. Beds in district
17
ABOUT DISTRICT HEADQUARTERS HOSPITAL,KHORDA
Total number of
beds
146
Service specialties Internal medicine, General
surgery, Gynecology and
obstetrics, Neonatology,
Pediatrics, Orthopedics,
Ophthalmology, ENT Dentistry, TB
& Chest, Emergency
Diagnostic
facilities
X-ray, USG,CT-Scan, ECG,
TMT, Holter monitor,
Endoscopy, A-scan,
Audiometry,Laboratory
Operating rooms
and Labour
tables
2 major OT, 4 labour tables
Other clinical
facilities
Blood bank, Pharmacy,
Physiotherapy, Speech
therapy
Outsourced
Support facilities
Laundry, Dietary, Biomedical
waste management,
Security, Housekeeping
18
Major Private Healthcare Facilities
Private Facilities Beds
Sayed Memorial Hospital, Kudiarybazar,
Jatni 40
Sai Saburi Clinic 28
Mahima Hospital 25
Nature Tech Hospital, 24
Jyochhana Hospital, Kuhuri. 20
Park Land Hospital 20
Jeevanjoiti Nursig Home 20
Sathi Nursinghome, Nirakarpur 20
Jeevanjoiti Nursig Home 20
Chatrurbhuja Jenamani Memorial Hospital 20
Maa Tarini Nursing Home, Sri Bihar, Khurda. 15
Prachi Hospital & Research Centre, At-
Paltan Padia 14
Biswanath Nursing Home, Jatni, 12
At Bhubaneswar
Pradyumna Bal Memorial Hospital, KIIT
Campus, 1000
Hi-Tech Medical College & Hospital 500
Institute of Medical Science and SUM
Hospital 500
Apollo Hospital 350
Advanced Medical Research Institute(AMRI)
Hospital Ltd 312
Kalinga Hospital, Chandrasekharpur,
Bhubaneswar 250
Ayush Hospital & Trauma Care 120
Private Facilities Beds
Ayush Hospital & Trauma Care 120
Annapurna Memorial Hospital 100
Swarna Hospital 107
Vivekananda Medical Mission Ltd 106
Gandhi Hospital 100
Sunshine Hospital 100
Aditya Care Hospital Ltd. 100
Kar Clinic & Hospital Pvt. Ltd 60
Neelachal Hospital Pvt. Ltd 54
ESI Hospital 50
Hemalata Hospital Limited 50
Urban Health and Training Centre, of
Kalinga Institute of Medical Science 50
Sara Gastro & Laproscopic Hospital 50
Sparsh Hospital & Critical Care Pvt. Ltd 50
Shree Hospitals 50
Jagannath Healthcare 40
LV Prasad Eye Institute 38
Usthi Hospital and Research Centre,
N4,1/1,IRC Village, Bhubaneswar 32
Baidyanath Memorial Hospital & Research
Centre 32
Sanjeevani Medicare 30
Institute of Gastro & Kidney Care Pvt.Ltd. 30
Sunflower Nursing Home, Budha Nagar,
Bhubaneswar 20
19
OPD Consultations
Source: Primary data from DHH and Other & Pvt
hospital & Secondary data from NHM Odisha
▪ OPD consultations have consistently increased over the years at all the public health facilities.
▪ During FY 2015-16, per day OP consultations at DHH was 1043 and 2324 at Capital hospital , whereas on an average per day OPD per CHC was 150.
▪ For FY 2015-16 Pvt.Hosp.3 had the highest number of OP consultations, of which per day OP consultation was 150.
▪ For FY 2015-16, among the studied facilities Capital hospital had the highest percentage of OP consultations (39%).
DHHCapitalHosp.
CHC AMRI KalingaAdityaCare
Arogya
2013-14 225,446 604,279 484,108 0 0 0 0
2014-15 240,670 604,252 574,750 0 0 0 0
2015-16 312,754 697,203 587,309 72,000 72,000 45,000 6,000
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
OPD Consultations
17%
39%
33%
4%4% 3% 0%
Facility wise share of OPDs (FY-2015-16)
DHH
Capital Hosp.
CHC
AMRI
Kalinga
Aditya Care
Arogya
Note: OPDs for health facilities (Pvt.Hosp.1, Pvt.Hosp.2, Pvt.Hosp.3 &
Pvt.Hosp.4 Hospital) is not available for FY 2013-14 & 2014-15)
Pvt.Ho
sp.1Pvt.Ho
sp.2
Pvt.Ho
sp.3Pvt.Ho
sp.4
Pvt.Hosp.1
Pvt.Hosp.3
Pvt.Hosp.4
Pvt.Hosp.2
20
IPD Admissions
Source: Primary data from DHH and hospital &
Secondary data from NHM Odisha
▪ For FY 2015-16, Capital Hospital had the highest share of Inpatient admission (45%).
▪ During FY 2015-16, per day IP admission at DHH was 59, 194 at Capital Hospital and on an average 6 admission per day per CHC.
▪ For FY 2015-16, IP admissions at the studied private facilities was 15 % of which Pvt.Hosp.1 had 30 IP admissions per day.
DHHCapitalHosp.
CHC AMRI KalingaAdityaCare
Arogya
2013-14 23,507 66,389 35,458 0 0 0 0
2014-15 25,303 65,387 43,477 0 0 0 0
2015-16 21,689 70,804 40,645 10,950 9,125 3,650 730
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
IPD Consultations
Note: IPDs for health facilities (Pvt.Hosp.1, Pvt.Hosp.2, Pvt.Hosp.3 &
Pvt.Hosp.4 Hospital) is not available for FY 2013-14 & 2014-15)
14%
45%
26%
7%6%
2%0%
Facility wise share of IPDs (FY-2015-16)
DHH
Capital Hosp.
CHC
AMRI
Kalinga
Aditya Care
Arogya
Pvt.Ho
sp.1Pvt.Ho
sp.2
Pvt.Ho
sp.3Pvt.Ho
sp.4
Pvt.Hosp.1
Pvt.Hosp.3
Pvt.Hosp.4
Pvt.Hosp.2
BED UTILIZATION
21Source: Primary data from DHH & Pvt. hospital &
Secondary data from NHM Odisha
▪ The ideal 6-10% industry standard for OP to IP
conversion was noted at all the public health facilities,
however Pvt.Hosp.1 witnessed the highest conversion
of 15% indicating a popular private health care facility
among the others.
▪ BOR at all public health facilities is much above the
optimum level of 80%, indicating the reason of
preference for private healthcare facilities among the
population .
7%
10%
7%
15%
13%
8%
12%
DHH CapitalHosp.
CHC AMRI Kalinga AdityaCare
Arogya
OPD to IPD Conversion (FY 2015-16)
126.2%
155.0%
42.0%60.0% 60.0%
40.0%
DHH CapitalHosp.
AMRI Kalinga AdityaCare
Arogya
Bed Occupancy Rate (FY 2015-16)
Pvt.Ho
sp.1Pvt.Ho
sp.2
Pvt.Ho
sp.3Pvt.Ho
sp.4
Pvt.Ho
sp.1
Pvt.Ho
sp.2Pvt.Ho
sp.3
Pvt.Ho
sp.4
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(68%).
▪ For the FY 2015-16, of all the surgeries performed at
DHH, only 8 % comprised of major surgeries.
▪ Of the total surgeries for FY 2015-16 , 49% of the
surgeries was conducted at CHC, however 99% of
these surgeries were minor surgeries.
▪ Private hospitals together accounts for 35% of the total
surgeries in the FY 2015-16.
Facility Name Major Minor TOTAL
DHH 103 1,213 1,316
Capital Hosp. 1,616 740 2,356
CHC 80 11,810 11,890
Pvt.Hosp.1 2,155 1,080 3,235
Pvt.Hosp.2 2,520 720 3,240
Pvt.Hosp.3 1,000 200 1,200
Pvt.Hosp.4 190 600 790
TOTAL 7,664 16,363 24,027
Major32%
Minor68%
Overall proportion of Major & Minor Surgeries (FY 2015-16)
OT UTILIZATION
23
Source: Primary data from DHH & Pvt. hospital &
Secondary data from NHM Odisha
▪ Data indicate good utilization of OT at DHH and
Capital Hospital with 4 surgeries per OT per day at
DHH. However 92% of these are minor surgeries.
▪ The IP to surgery conversion at Pvt.Hosp.4 is higher
than 100% indicating IP admissions being mostly
surgical cases.
.
Name of FacilityNumber 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 8 2,426 8.1 1.0 2 4.0Capital Hosp. 16 6,760 22.5 1.4 4 5.6
CHC 21 11,940 39.8 1.9 13 3.1Pvt.Hosp.1 13 5,592 18.6 1.4 12 1.6Pvt.Hosp.2 17 3,600 12.0 0.7 9 1.3Pvt.Hosp.3 6 1,200 4.0 0.7 4 1.0Pvt.Hosp.4 3 910 3.0 1.0 1 3.0
11% 10%
29%
51%39%
33%
125%
DHH CapitalHosp.
CHC AMRI Kalinga AdityaCare
Arogya
IPD to Surgery Conversion (FY-2015-16)
Pvt.Ho
sp.1
Pvt.Ho
sp.2
Pvt.Ho
sp.3Pvt.Ho
sp.4
INSTITUTIONAL DELIVERIES
24Source: Primary data from DHH & Pvt. hospital &
Secondary data from NHM and DHS Odisha
▪ For FY 2015-16,C-sections performed at the district constitute 24% of the total deliveries conducted at the district which is much above the industry standard of <15%.
▪ In 2015–16, DHH performed 18 deliveries per day (@15normal and 3 C-section).
▪ For FY 2015-16, majority of C-section (69 % ) has been carried out at Capital Hospital.
Name of
Facility
2013-14 2014-15 2015-16
Normal
Delivery
C -
Section
Normal
Delivery
C -
Section
Normal
Delivery
C -
Section
DHH 5,685 951 5,525 1,050 5,364 1,110
Capital
Hosp. 7,630 3,935 7,663 4,120 7,120 4,404
CHC 8,241 135 7,452 88 6,486 50
Pvt.Hosp.1 NA NA NA NA 912 365
Pvt.Hosp.2 NA NA NA NA 120 360
Pvt.Hosp.4 NA NA NA NA 60 120
Sub Total 21,556 5,021 20,640 5,258 20,062 6,409
83%
62%
99%
71%
25%
33%
17%
38%
1%
29%
75%
67%
DHH
Capital Hosp.
CHC
AMRI
Kalinga
Arogya
Facility wise proportion of Institutional deliveries (FY 2015-16)
Normal Delivery C - Section
Normal Delivery
76%
C -Section
24%
Category of Institutional Deliveries (FY 2015-16)
NA: Data not available
Pvt.Hosp.1
Pvt.Hosp.4
Pvt.Hosp.2
DIAGNOSTICS PROCEDURES
25
Source: Primary data from DHH & Pvt. hospital & Secondary
data from NHM Odisha
▪ Overall Lab tests accounts for majority (75%) of total
diagnostics.
▪ X-ray and USG constitute of only 13% and 7% of the
total diagnostic procedures conducted at the district.
▪ For FY 2015-16, data indicate CHC alone conducts
majority of the diagnostic procedures (27%), however all
the tests are laboratory tests.
▪ For FY 2015-16, all the studied private hospitals
together perform (50% ) of the total diagnostics.
NA: Data not available
Diagnostic Test X Ray USG ECG CT Scan Lab Tests
DHH 5,596 1,720 1,436 0 52,317
Capital Hosp. 15,158 2,998 10,305 2,484 99,225
CHC NA NA NA 0 218,759
Pvt.Hosp.1 36,000 26,150 2,400 300 85,000
Pvt.Hosp.2 36,500 21,900 5,400 5,475 90,000
Pvt.Hosp.3 15,000 1,500 15,000 2,400 54,750
Pvt.Hosp.4 0 0 720 0 15,000
61,069
130,170
218,759
149,850 159,275
88,650
15,720
DHH CapitalHosp.
CHC AMRI Kalinga AdityaCare
Arogya
Facility wise total diagnostics (FY-2015-16)
Pvt.Ho
sp.1
Pvt.Ho
sp.2
Pvt.Ho
sp.3Pvt.Ho
sp.4
26
ECONOMIC SEGMENT OF PATIENTS
Note: estimations given are based on discussion
with ADMO Medical, Medical Superintendent and
Hospital Managers of above facilities
20
40
35
5
DHH
BPL (Belowpoverty line)
APL - LowIncome
APL - Middleincome
APL - Highincome
30
40
2010
Capital Hosp.
BPL (Belowpoverty line)
APL - LowIncome
APL - Middleincome
APL - Highincome
15
65
20
Pvt.Hosp.1
APL - LowIncome
APL - Middleincome
APL - Highincome
20
60
20
Pvt.Hosp.2
APL - LowIncome
APL - Middleincome
APL - Highincome
30
50
20
Pvt.Hosp.3
APL - LowIncome
APL - Middleincome
APL - Highincome
10
85
5
Pvt.Hosp.4
APL - LowIncome
APL - Middleincome
APL - Highincome
27
MODE OF PAYMENT BY PATIENTS
Note: estimations given above are based on discussion with
ADMO Medical and Hospital Manager of above hospitals
Free30%
Cash60%
RSBY7%
BKKY3%
DHH
Cash33%
RSBY39%
BKKY22%
OSTF6%
Capital Hosp.
Cash78%
Pvt. Insuranc
e11%
CGHS11%
Pvt.Hosp.1
Cash50%
Pvt. Insuranc
e30%
Corp. Insuranc
e / Sponsor
ed20%
Pvt.Hosp.2
Cash67%
Pvt. Insuranc
e22%
Corp. Insuranc
e / Sponsor
ed11%
Pvt.Hosp.3
Cash 100%
Pvt.Hosp.4
28
SECTION 5:
CATCHMENT AREA & REFERRALS
29
CATCHMENT OF CITY HOSPITAL
Catchment
Type
Name of the
blockPopulation
Primary Khordha 136,244
Secondary Other Blocks 2,115,429
30
SOURCE OF PATIENT INFLOW
Source: estimations given above are based on
discussion with Management of concerned hospitals
60
30
10
DHH
From within thedistrict town
From the districtother than thedistrict townOther districts
30
30
40
Capital Hosp.
From within thedistrict town
From the districtother than thedistrict town
Other districts
60%10%
30%
Pvt.Hosp.1
From within thedistrict town
From the districtother than thedistrict townOther districts
60
30
10
Pvt.Hosp.2
From within thedistrict town
From the districtother than thedistrict town
Other districts
70
2010
Pvt.Hosp.3From withinthe districttown
From thedistrict otherthan thedistrict townOther districts
60
40
Pvt.Hosp.4
From within thedistrict town
From thedistrict otherthan thedistrict town
31
POINTS OF REFERRAL
Patients from DHH Khorda are
referred to Capital Hospital,
AIIMS Bhubaneswar and SCB
Cuttack.
Patients from Capital Hospital
are referred to AIIMS
Bhubaneswar and SCB
Cuttack.
Apart from SCB and AIIMS
Bhubaneswar, patients from
Capital hospital and DHH
Khorda are also referred to
various empanelled private
hospitals for tertiary care.
FacilityReferral
CentreDistance
DHH
Khorda
SCB Cuttack
AIIMS
Bhubaneswar
71 km
38 km
Capital
Hospital
SCB Cuttack
AIIMS
Bhubaneswar
37 km
11 km
32
▪ Nearest railway station : The East Coast
Railway has its headquarters in
Bhubaneswar. Bhubaneswar railway station is
one of the main stations of the Indian railway
network. It is connected to major cities by daily
express and passenger trains
▪ Road ways: The main Bhubaneswar inter-state
bus terminus is at Barmunda, from where
operators run buses connecting Bhubaneswar to
cities in Odisha and with the neighbouring states
of Andhra Pradesh,
Jharkhand, WestBengal and Chhattisgarh.
Bhubaneswar is connected to the rest
of Odisha and India by National Highways-NH 5,
which is a part of the Kolkata-Chennai prong of
the Golden Quadrilateral, NH 203, State Highway
13 (Odisha) and State Highway 27 (Odisha).
▪ Airport : Biju Patnaik International Airport, also
known as Bhubaneswar Airport, 3 kilometres
(1.9 mi) south of the city centre, is the major and
sole international airport in Odisha. There are
daily flights from Bhubaneswar
to Delhi, Mumbai, Kolkata, Chennai, Hyderabad
and Bangalore.
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
Estimate
d Gap
Gen Med 22 820,850 396,829 424,021
OBG 14 522,359 245,577 276,782
Pediatrics 12 447,736 191,539 256,197
Gen. Surgery 11 410,425 229,692 180,733
Orthopedic 9 335,802 167,464 168,338
ENT 7 261,179 121,889 139,291
Ophthalmology 7 261,179 116,849 144,331
Others
specialties18 671,604 322,428 349,176
TOTAL 100% 3,731,135 1,792,266 1,938,869
Total OPD Gap 52%
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 123,127 34,802 88,326
OBG 78,354 21,669 56,685
Pediatrics 67,160 16,853 50,307
Gen. Surgery 61,564 20,174 41,390
Orthopedic 50,370 14,976 35,395
ENT 39,177 10,725 28,452
Ophthalmology 39,177 10,086 29,091
Others
specialties100,741 28,308 72,432
TOTAL 559,670 157,593 402,077
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% 559,670 50% 279,835 839,505 108,254 731,251
USG 20% 746,227 35% 195,885 942,112 54,268 887,844
ECG 10% 373,113 60% 335,802 708,916 35,261 673,655
CT Scan 2% 74,623 5% 27,984 102,606 10,659 91,947
Lab Tests
(number of
patients)
60% 2,238,681 100% 559,670 2,798,351 615,051 2,183,300
* Considering industry standards 60% of OPD patients undergo at least 2 tests per patient. Hence,
demand number of OPD lab tests would be 4,477,362.
** Considering industry standards 100% of IPD patients undergo at least 5 lab tests per patient.
Hence, demand number of IPD lab test would be 2,798,351.
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
666 beds
13204 beds
00 beds
01146 beds
318 beds
415415 beds 5,789
The district of Khorda has 84 public and 41
private health care facilities with a total bed
strength of 5789 beds only.
Considering the WHO norm of 3.5 beds per 1000
population, the district with a population of 2485298
has a shortfall of 2910 beds (i.e. a gap of 33.44%
beds).
* Source : Bed Strength, DHS Odisha and Clinical
Establishment, DMET Odisha
Beds available Beds required as perWHO norm
5789
8699
Gap in bed availibility
39
GAP – DOCTORS AND NURSES
▪ There are 278 sanctioned positions for doctors, of
which 38 positions are vacant.
▪ Considering the WHO norm of 1 doctor per 1000
population, the district has a shortfall of 2245 doctors
* Source : District wise Incumbency list , DHS Odisha
▪ As per primary and secondary data collected There are
only 38 nurses posted in the district. ( 52 staff nurse,
4 Asst Matron).
▪ Considering the WHO norm of 2 nurses per 1000
population, the district has a shortfall of 4915 nurses.
* Source : Staff position list received from DHH Khorda and nursing
staff list from directorate of nursing, Odisha.
0
500
1000
1500
2000
2500
Doctors available Doctors required asper WHO norm
240
2485
Gap in doctors availibility
0
1000
2000
3000
4000
5000
Nurses available Nurses required
56
4971
Gap in nurses availibility
40
SERVICE AVAILIBILITY AND GAPS AT DHH KHORDA
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 100 – 200
bedded
41
SECTION 7:
FINDINGS OF GENERAL POPULATION
SURVEY
42
INCOME AND OCCUPATION
5%0%
55%
9%14% 14%
0%5%
Ag
riculture
Landle
ss
Labour/
Daily
wager
Se
rvic
e(g
ovt/pvt)
Bu
sin
ess
Housew
ife
Stu
dent
Unem
plo
yed
Oth
ers
Occupation of the respondents
0%5%
59%
23%14%
Annual family income of the respondents
77%
9%0%
14%
0%
From savings Loan fromfamily/friends
Sold assets Healthinsurance
Others
Source of health related costs
▪ Majority of the respondents were in service
followed by students & housewife with an
annual income not more than 200,000.
▪ Only 14% of the patients surveyed had health
insurance as a primary source of health
related costs, which indicates lack of
awareness in insurance coverage.
43
HEALTH SEEKING BEHAVIOUR
Yes always86%
Not always14%
Do you visit a doctor / health facility whenever someone is sick in your family?
0%
33%
67%
The doctor/hospitalis far from my
residence
Visiting adoctor/hospital is
expensive
The clinicalcondition is always
not that serious
Why, Not always?
Yes50%
No50%
Have you consulted /visited any other doctor /hospital before coming to this hospital, in
this instance and for this ailment?33%
17%
33%
17%
0%
A privatepractitioner
A privatehospital
A local govt.hospital
Districthospital
Others
What is the type of healthcare facility that you had visited before coming to this hospital?
The survey response indicates that most of the people visit health care facility every time when someone is sick in the
family and chose local Govt. Hospital, District Hospital, Private Practitioners & Private Hospital as per their personal choice
of health care facility..
44
HEALTH SEEKING BEHAVIOUR
0%
25%
75%
0% 0%
20% 20%
0%
40%
20%
My
Pre
ferr
ed
do
cto
rp
racti
ces
th
ere
I h
av
e b
ee
n v
isit
ing
th
efa
cilit
y f
or
a lo
ng
tim
e
Th
e f
ac
ilit
y is
la
rge
an
dm
os
t s
erv
ice
s o
ffe
red
un
der
on
e r
oo
f
I k
ne
w a
bo
ut
the r
ep
uta
tio
no
f th
e f
acilit
y f
or
its
qu
ality
of
care
Th
e s
taff
in
th
e f
acilit
yb
eh
aves w
ell w
hen
co
mp
are
d w
ith
oth
er
facilit
ies
Reason for choosing a hospital
Govt. hospital Pvt. Hospital
▪ While Large infrastructure & most of service availability were the main reasons for choosing a government healthcare facility.
Preference for doctors ,Personal relationship with doctors & their reputation were the main reasons for choosing a private
healthcare facility.
45
VISITING EXTERNAL FACILITIES
33%
58%
0%
10%
20%
30%
40%
50%
60%
70%
Yes No
Did you have to visit any other hospital/diagnostic center for any diagnostic test?
58%
42%
0%
10%
20%
30%
40%
50%
60%
70%
Yes No
Did you have to buy any medicine from an external pharmacy?
25% 25% 25%
0%
5%
10%
15%
20%
25%
30%
urine culture T3 T4 TSH Eye X ray
Tests that has been performed from other hospital/diagnostic centres
▪ 33% of the respondents at DHH, had visited
external diagnostic centre for Urine Culture
,Thyroid test , Eye X-ray and Eye scan. Non
availability of microbiology lab, required kit
for thyroid test & equipment for eye scan & x-
ray was found the reason for the same.
▪ A large percentage of respondents had to
purchase medicines from external pharmacy
due to unavailability of the required
medications,
46
REGULAR MEDICATION BEHAVIOUR
10%
90%
0%
20%
40%
60%
80%
100%
Yes No
Does any member of your family take regular medications? 33%
7%
23%
3%7%
3%0% 0% 0% 0%
23%
0%
5%
10%
15%
20%
25%
30%
35%
Common specialities of consultation
100%
0%
20%
40%
60%
80%
100%
120%
Hypertension/heart problem
Conditions for which patients take regular medications
▪ The findings indicate a high prevalence of chronic
diseases requiring continued treatment, with
hypertension and cardiac problem 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.
47
IP ADMISSIONS
40%
60%
Yes No
There was atleast one hospital admission in the family in the last one year
0%
100%
Government hospital Private hospital
Place of admission
0%
83%
17%
0%
This is the first 2-6 visits 7-12 visits >12 visits
Frequency of hospital visit before this 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 private hospital majorly for general surgery ailment followed by General Medicine & Pulmonology. The respondents had
undergone atleast two OP consultations before getting admitted in the hospital.
25%
50%
25%
Gen
era
lM
edic
ine
Gen
era
lS
urg
ery
Ch
est
me
dic
ine/T
B
Specialty of admission at hospital
48
SECTION 8:
FINDINGS OF OUTPATIENT AND
INPATIENT SURVEY
49
29% 29%
14%
29%
Ge
nera
l M
ed
icin
e
Ge
nera
l S
urg
ery
Ga
str
oe
nte
rolo
gy/s
urg
er
y
Uro
log
y/N
ep
hro
log
y
Specialty of the ailment of admission
5 0
128
340
0
166
Registration Consultation Diagnostictests
Medicines Any minorporcedure
Travel tohealth facility
Amount spent on visit to the hospital
Average (Rs)
▪ Majority of inpatient respondents at DHH were admitted for general surgery followed by general medicine , Nephrology, Urology and Gastro Enterology.
Majority of OP respondents had consulted for general medicine.
▪ Patients tend to spend mostly on medicines , diagnostic tests 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 1829/-
0%
50% 50%
<10,000 10,001-30,000 30,001-50,000
Amount spent during admission
60%
20% 20%
General Medicine Gynaecology andobstetrics
Opthalmology
Specialty of consultation
50
SECTION 9:
FINDINGS OF PHYSICIAN SURVEY
51
COMMON SPECIALITIES OF CONSULTATION BY GENERAL
PHYSICIAN
19% 19% 19%
7%
4%
11%
0% 0% 0% 0%
11% 11%
COMMON SPECIALITIES OF CONSULTATION BY GENERAL PHYSICIAN
52
ECONOMIC AND GEOGRAPHIC STRATIFICATION OF PATIENTS
14%
41%45%
Upper economic class Middle economic class Low economic class
Economic class of patients
44%
32%
24%
From within thetown/city
From the district otherthan the town/city
From adjacent districts
Geographic classification of patients
10%
38%
52%
Upper economic class Middle economic class Low economic class
Economic class of patients
36%
22%
42%
From within thetown/city
From the district otherthan the town/city
From adjacent districts
Geographic classification of patients
GENERAL PHYSICIAN RESPONSE SPECILAIST PHYSICIAN RESPONSE
53
REASON FOR REFERRAL
0% 0%
20%
0%
20%
0%
33%
27%
0%
8%
0% 0% 0%
8%
17%
33%
25%
8%
Your professionalaffiliation with
thehospital/referral
fee from thehospital
Proximity to yourclinic
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
Goodinfrastructureand high end
facilities
Good clinicalserice quality
Reasons to refer a patient to a particular hospital
Govt. Hospital Pvt. Hospital
54
SPECIALITIES OF CARE FOR WHICH PATEINT TRAVEL TO OTHER
CITIES
22%
19%
14%
11% 11%
8%
5% 5%
3% 3%
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 neurology and Oncology followed by cardiology, Nephrology and urology.
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.
25% 25%
17%
8%
0%
8% 8% 8%
14% 14%
0%
14% 14% 14% 14% 14%
Cardiology /cardiac surgery
Neurology /Neuro Surgery
Gastroenterology /
surgery
Cancer Urology Nephrology Orthopaedics Pediatrics andneonatalogy
SPECIALITIES OF CARE FOR WHICH PATEINT TRAVEL TO OTHER CITIES
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
Specialist, Diagnosis and
Treatment facilityCTVS
Neurology / Neuro Surgery
Specialists, Diagnostic and
treatment facilities CT Scan
Gastro enterology / surgery
Specialist,
Diagnosis and Treatment facility
Cancer All coresponding failities All discipline
Urology Lithotripsy
Nephrology
Specialists, Diagnostic and
treatment facilitiesDialysis
Orthopaedics
Specialist, Diagnosis and
Treatment facilityTrauma Care Centre
Pediatrics and neonatalogy
More Specialists, Diagnostic and
treatment facilitiesSNCU,PICU,NICU
THANK YOU
57
