district : cuttacksummary •the district of cuttack has 97 government health care facilities and...

1

Technical due diligenceDistrict : Cuttack

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

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3. The Government of Odisha and IFC, its consultants, employees and advisors also accept no liability of any nature, whether

resulting from negligence or otherwise, howsoever caused arising from reliance of any person upon the content of this document.

4. The Government of Odisha and/or IFC may, in its absolute discretion, update, amend or supplement the information, assessment

or assumptions contained in this document.

5. The issue of this document does not imply that the Government of Odisha is bound to award the projects to any bidder.

2

Summary• The district of Cuttack has 97 government health care facilities and 186 private hospitals with a

bed strength of 6951 beds only.

▪ SCB Medical college hospital comprises of 61% of the total OP consultations and 53% IP admission.

• OP to IP conversion has been higher than industry standards at all the public health facilities.

• SCB being the oldest and the premium medical college hospital, has a high BOR of 91.8 % besides

AHRCC being the only Govt. facility in the state to provide oncology services have a heavy patient

flow.

• Surgeries performed at government facilities are mostly minor in nature, for FY 2015-16, 14% of the

total surgeries performed at city hospital, Cuttack were major in nature.

• Data obtained from the survey indicates under utilization of OT at city Hospital with less than 4

surgeries per OT per day.

• Among the Public Health facility , SCB medical college conducted the highest rate of C-section(74%)

▪ Proportion of C-Sections to normal deliveries in district is 22%, which is a healthy trend.

▪ Overall Lab tests accounts for majority (85%) of total diagnostics . X-Ray, and USG constitutes 17%

and 2.3 % of total diagnostic procedure.

▪ It can be inferred that at secondary care level only 78% of the existing demand is being met for OPD

and 47 % for IPD

3

Summary▪ Considering the WHO norm of 3.5 beds per 1000 population, the district has a shortfall of 2805

beds (i.e. a gap of 29% beds).

▪ Considering the WHO norm of 1 doctor per 1000 population, the district has a shortfall of 2117

doctors.

▪ Considering the WHO norm of 2 nurses per 1000 population, the district has a shortfall of 4733

nurses.

▪ Large infrastructure and service availability are the most voted reason for choosing a government

hospital , whereas Preference for doctors for choosing a private physician clinic.

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

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

a need for awareness in insurance coverage.

▪ All the surveyed physicians indicated that patients from the district go to other districts / cities for

availing tertiary level healthcare, of which majority ailments pertain to cardiology and neurology

followed by urology and oncology

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.

District HQ Town

10

SECTION 3:

DISTRICT PROFILE

11

DEMOGRAPHIC PROFILE

Source :

Census of India – 2011, Odisha

* RSBY status 2015-16, Odisha

Particulars Odisha Cuttack

Total Population 4,19,74,218 2,624,470

Urban population 16.6% 28.05%

Decadal population

growth rate14.05% 12.12%

Mean household size 4.35 4.53

BPL households* 44,08,070 169,821

BPL Population* 1,91,75,105 769,532

BPL % 46% 29%

• Cuttack is the 17th district in terms of

size and 2nd in terms of population.

• Cuttack is the 5th urbanized district

in state having only 28.05 percent of

its population living in urban areas.

• Cuttack has 28th rank in terms of sex

ratio in the state.

District HQ Town

12

HEALTH INDICATORS

Source : Annual Health Survey Report 2011-12

* Maternal Mortality Ratio is of Central Division

222

38

61

88

19.56.8

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 Indicators

District Odisha India

Causes of deaths (Infants & Child)

13

Source : HMIS Data Analysis 2015-16, District Cuttack

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

Measles 0

Diarrhoea 1

Sepsis 1

Fever 2

Pneumonia 6

Asphyxia 15

Low Birth Weight (LBW) 33

Others (for 1 month to 5 years) 87

Others (for age upto 4 weeks of birth)

88

Total 233

Sepsis0.4%

Asphyxia6.4%

LBW14.2%

Pneumonia2.6%

Diarrhoea0.4%

Fever related0.9%

Others75.1%

Odisha - Cuttack - 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 Cuttack

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

Causes 6-14 yrs 15-55 yrs.

Above 55yrs Total

HIV/AIDS - 2 - 2

Malaria - 3 1 4

Tuberculosis - 8 4 12

Animal Bites & Stings 2 8 9 19

Trauma/Accidents/ Burn Cases 1 14 7 22

Suicide - 14 23 37

Respiratory Diseases(other than TB) - 15 23 38

Diarrhoeal Diseases - 4 37 41

Known Acute Disease 2 8 33 43

Neurological Disease including strokes - 10 59 69

Other fever Related - 15 89 104

Known Chronic Disease 2 49 109 160

Heart Disease/ Hypertension related 4 176 327 507

Causes not known 15 386 2440 2841

Total Deaths 26 710 3161 3899

15

SECTION 4:

SUPPLY ASSESSMENT

16

BEDS AVAILABILITY

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

NHM, DHS & DMET Odisha

Govt. Beds52%

Pvt. Beds48%

Share of Govt. & Pvt. Beds in district

0%

67%

33%

Primary, Secondary & Tertiary Healthcare Beds availability in district

Primary CareBeds

Secondary CareBeds

Tertiary CareBeds

Facility typeNo. of

facilities

Number

of beds

District Headquarters

Hospital 1 130

Sub-divisional hospitals 2 130

Community Health

Centers18 298

Primary Health Centers

& IDH 66 44

Other hospitals / Area

Hospital 10 747

Private Hospitals 186 3332

Medical Colleges 1 2,270

Total 284 6951

17

ABOUT DISTRICT HEADQUARTERS HOSPITAL,CUTTACK

Total number of

beds

130

Service specialties Internal medicine, General

surgery, Gynecology and

obstetrics, Neonatology,

Pediatrics, Orthopedics,

Ophthalmology, ENT Dentistry, TB

& Chest, Emergency

Diagnostic facilities X-ray, USG, ECG, Laboratory

Operating rooms and

Labour tables

1major OT, 1 minor OT, 3 labour

tables

Other clinical

facilities

Pharmacy, Physiotherapy, Speech

therapy

Outsourced Support

facilities

Laundry, Dietary, Biomedical

waste management, Security,

Housekeeping

18

ABOUT SCB MEDICAL COLLEGE HOSPITAL,CUTTACK

Total number of

beds

2270

Service specialties Internal medicine, General

surgery, Gynecology and

obstetrics, Neonatology,

Pediatrics, Orthopedics,

Ophthalmology, ENT Dentistry,

Emergency, Oncology,

Pulmolonoloy, Urology,

Nephrology, Cardiology,

Endocrinology, Kidney and Liver

transplant, Neurology

Diagnostic facilities X-ray, USG,CT-Scan, ECG, TMT,

Holter monitor,PFT,EEG,EMG,

Bronchoscopy,Colonoscopy,

Endoscopy, A-scan,

B -scan,Audiometry,Laboratory

Operating rooms and

Labour tables

2 4major OT, 6 minor OT,

16labour tables

Other clinical

facilities

Blood bank, Pharmacy,

Physiotherapy, Speech therapy,

Occupational therapy

Outsourced Support

facilities



Housekeeping

19

ABOUT SISHUBHAWAN,CUTTACKTotal number of beds 356

Service specialties Neonatology, Pediatrics,

Paediatrics Surgery

Diagnostic facilities X-ray, USG,ECG,Endoscopy,

Laproscopy,Laboratory

Operating rooms and Labour

tables

1 major OT, 1 minor OT,

Other clinical facilities Pharmacy, Physiotherapy,

Speech therapy

Outsourced Support facilities Laundry, Dietary, Biomedical

waste management,

Security, Housekeeping

20

ABOUT ACHARYA HARIHAR REGIONAL CANCER CENTRE,CUTTACK

Total number of

beds

281

Service specialties Radiation oncology, Surgical

oncology, Medical oncology, Bone

marrow transplant

Diagnostic facilities USG, CT Scan Hot lab,Theratron

780c cobalt unit, Bhabhatron- II

Telecobalt Unit, Simulix – HP

(Conventional Simulator Unit), 6-

15 MV LINAC,Gamma Medplus

(Brachytherapy unit), Telecobalt

unit, Somatom Definition AS64

CT-Scan

Operating rooms and

Labour tables

4major OT,

Other clinical

facilities

Pain and Palliative care

Outsourced Support

facilities



Housekeeping

21

Major Private Healthcare FacilitiesPrivate Facilities Beds

Panda Curie & Cancer Hospital Pvt. Ltd., Telengapentha 100

Rudra Hospital,Plot No-2292,Bhanpur 50

Gopabandhu Institute of medical Sciences, At:- Madhabpur,P.O: Mahakalpada Via:- Athagarh 25

Shanti Memorial Hospital, Cuttack 100

Sabarmati General Hospital ,Mahanadivihar 100

ASWINI Hospital, Sector-I, CDA 100

Sadguru Medical Pvt. Ltd,Jagatpur 100

Chanakya Hospital,Canal Road,Ranihat, Cuttack 80

SUN Hospital Pvt. Ltd., Tulsipur 68

SrustiHospital,Professorpara,Canal Road,Cuttack 50

Prime Hospital Ltd., Link Road 40

Health Care, Mahatab Road, Cuttack 35

General Nursing Home, Mangalabag 30

Om Suvam Hospital, Canal Road Ranihat Colleg Square 30

Cuttack Laproscopic Hospital, ,Badambadi,Cuttack 30

Care Hospital, Buxibazar, Cuttack 30

Add. Hosiptal Pvt. Ltd. Jhunupatna, College Square 30

Care & Cure Nursing Home, Santa Sahi, 27

Sarangi Clinic & Research Centre, Cuttack 27

J.P.M. Rotary Eye Hospital & Research Institute , Bidanasi 27

Popular Nursing Home & Hospital, Ring Road, Cuttack 25

Panda Medical Centre, Bepari Sahi, Buxibazar, Cuttack 25

SBM Hospital Pvt. Ltd. Balikuda,Gopalpur 25

Sarala Hospital,College Square 25

Surakshya Nursing Home & Advance Centre for Maternity & Children, Cuttack 24

Padhi Medical Centre, Mangalabag, Cuttack 24

Ratna Hospital,Mangalabag,Cuttack 24

Melvin Jones Lions Eyes Hospital, Buxibazar, 23

The Child Care, Talatelanga Bazar 22

Advance Orthopaedics, Ranihat 21

Life Institute of Health & Research, Plot No-2558, Link Road, Cuttack 20

Ideal Nursing Home, CDA Market Buxi Bazar, Cuttack 20

22

OPD Consultations

Source: Primary data from DHH, SCB MCH & Pvt

hospital & Secondary data from NHM Odisha

▪ OPD consultations have consistently increased over the years at SCB MCH, City Hospital ,CHC’s and AHRCC.

▪ Among the private hospital, for FY 2015-16 , Pvt.Hosp-3 had the highest OP consultations with 90 OP consultations per day.

▪ During FY 2015-16, per day OP consultations at City Hospital was 1057,SCB MCH was 6629 , Sishubhawan was326 and AHRCC was 115.

▪ SCB Medical College shared the highest percentage of OP consultations (61%)

Facility Name 2013-14 2014-15 2015-16

City Hospital 229,847 224,576 317,036

SDHs 196,078 201,812 198,943

CHCs 518,949 562,646 591,580

Pvt.Hosp-1 4,222 4,084 5,346

Pvt.Hosp-2 393 543 706

Pvt.Hosp-3 NA 27,137 27,219

Pvt.Hosp-4 7,200 7,700 8,320

Sishubhaban 107,796 110,381 97,764

AHRCC 29,740 32,866 34,423

SCB MCH 1,099,328 1,479,543 1,988,646

TOTAL 2,193,553 2,651,288 3,269,983

Pvt.Hosp-1

Pvt.Hosp-2

Pvt.Hosp-3

Pvt.Hosp-4

23

IPD Admissions

Source: Primary data from DHH, SCB MCH & Pvt


▪ For FY 2015-16, SCB MCH shred the highest percentage of IP admissions (53%).

▪ Per day IP admissions at the public health facilities for FY 2015-16 was 8 at City hospital, 434 at SCB MCH, 68 at AHRCC and 53 at Sishubhaban.

▪ Among the studied private hospitals Pvt.Hosp-3 had the highest IP admission with around 16 IP admissions per day for the FY 2015-16.

Facility Name 2013-14 2014-15 2015-16

City Hospital 3,123 6,837 2,823

SDHs 23,544 21,375 23,637

CHCs 46,560 58,149 56,559

Pvt.Hosp-1 2,130 2,391 2,593

Pvt.Hosp-2 1,193 1,166 1,152

Pvt.Hosp-3 NA 6,046 5,927

Pvt.Hosp-4 1,200 1,400 1,633

Sishubhaban 16,039 20,082 19,420

AHRCC 17,540 23,004 24,832

SCB MCH 120,880 162,250 158,420

TOTAL 232,209 302,700 296,996

Pvt.Hosp-1

Pvt.Hosp-2

Pvt.Hosp-3

Pvt.Hosp-4

BED UTILIZATION

24Source: Primary data from DHH SCB MCH & Pvt. hospital &

Secondary data from NHM Odisha

▪ OP to IP conversion has been higher than industry

standards at all the public health facilities except City

Hospital/DHH which is only 1%.

▪ It is to be noted that although OP consultations at

Pvt.Hosp-2 hospital has been low in comparison to

the public health facilities, it still has a higher OP to IP

conversion. As opined by hospital manager of Balaji,

patient flow to Balaji are majorly surgical

interventions.

▪ SCB being the oldest and premier medical college

hospital the rate of inpatient admission is very high ,

and thereby a high BOR of more than the optimum

BOR of 80%.

▪ The BOR of AHRCC is calculated against the actual

bed strength, however there were numerous floor

beds observed during the onsite due dilligence

survey.

▪ AHRCC being the only government hospital in the

state to provide oncology services, a heavy patient

flow is observed at the facility.

1%12% 10%

49%

163%

22% 20% 20%

72%

8%

OPD to IPD Conversion (F-2015-16)

32.0%21.7%

10.1%

45.0%

16.1%

59.8%

96.8% 91.8%

Bed Occupancy Rate (FY 2015-16)

GENERAL SURGERIES

25Source: Primary data from DHH, SCB MCH & Pvt. hospital &


▪ Considering data for FY 2015-16 Surgeries

performed at the district are majorly minor surgeries.

(64%).

▪ For the FY 2015-16, of all the surgeries performed

at DHH, only 14% comprise of major surgeries.

▪ Of the total surgeries for FY 2015-16 , 76% of the

surgeries was conducted at SCB MCH, however

61% of these surgeries were minor surgeries.

▪ The studied private hospitals together accounts for

only 5% of the total surgeries in the FY 2015-16

Facility Name Major Minor TOTAL

City Hospital 1,019 539 1,558

SDHs 863 3,932 4,795

CHCs 1,247 6,967 8,214

Pvt.Hosp-1 737 290 1,027

Pvt.Hosp-2 50 17 67

Pvt.Hosp-3 550 600 1,150

Pvt.Hosp-4 820 1,548 2,368

Sishubhaban 131 1,104 1,235

AHRCC 1,121 1,362 2,483

SCB MCH 28,721 45,719 74,440

TOTAL 35,259 62,078 97,337

65%

18% 15%

72% 75%48% 35%

11%

45% 39%

35%

82% 85%

28% 25%52% 65%

89%

55% 61%

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

Major Minor

Major36%

Minor64%

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

OT UTILIZATION

26Source: Primary data from DHH, SCB MCH & Pvt.


▪ Data indicate under utilization of OT at City

Hospital with less than 4 surgeries per OT per day.

▪ The IP to surgery conversion at Pvt.Hosp-4 is

highest. The hospital being the most well known and

trusted facility, a larger portion of the middle income

level population prefer undertaking surgery and

admission there, many well known private

practioners refer their patients for surgery to this

hospital.

▪ Pvt.Hosp-4 also holds a good record of successful

Bariatric surgery in the district town.

.

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

City Hospital 17 2,028 6.8 0.4 2 3.4

SDHs 15 5,647 18.8 1.3 4 4.7

CHCs 49 8,225 27.4 0.6 18 1.5

Pvt.Hosp-1 3 1,120 3.7 1.2 2 1.9

Pvt.Hosp-2 4 74 0.2 0.1 3 0.1

Pvt.Hosp-3 4 1,176 3.9 1.0 4 1.0

Pvt.Hosp-4 5 2,445 8.2 1.6 4 2.0

Sishubhaban 6 1,235 4.1 0.7 2 2.1

AHRCC 16 2483 8.3 0.5 4 2.1

SCB MCH 135 78912 263 1.9 32 8.2

72%

24%15%

43%

6%20%

150%

6% 10%

50%

IPD to Surgery Conversion (FY-2015-16)

INSTITUTIONAL DELIVERIES

27Source: Primary data from DHH, SCB MCH & Pvt.

hospital & Secondary data from NHM and DHS

Odisha

▪ For FY 2015-16, C-sections constituted 22% of the total institutional deliveries in the district which is a little higher than the industry standard of <15% C-sections.

▪ Among the public health facilities, SCB medical college conducted the highest rate of C-section (74%).

▪ In 2015–16, City Hospital performed 5 deliveries per day (@4normal and 1 C-section).

▪ 74 % of the total C-sections during FY 2015-16 has been carried out at SCB Medical College.

Name of

Facility

2013-14 2014-15 2015-16

Normal

Delivery

C -

Section

Normal

Delivery

C -

Section

Normal

Delivery

C -

Section

City Hospital 1,305 339 1,137 291 1,687 470

SDHs 5,293 1,098 4,628 1,236 3,473 852

CHCs 12,883 116 11,989 62 11,171 11

Pvt.Hosp-1 28 67 34 85 31 93

Pvt.Hosp-2 10 25 12 22 9 7

Pvt.Hosp-3 5 10 12 113 17 26

Pvt.Hosp-4 12 60 17 72 22 77

SCB MCH 5,337 4,654 5,274 4,612 5,349 4,472

Sub Total 24,873 6,369 23,103 6,493 21,759 6,008

78% 80%100%

25%56%

40%22%

54%

22% 20%0%

75%44%

60%78%

46%

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

Normal Delivery C - Section

Normal Delivery

78%

C -Section

22%

Category of Institutional Deliveries (FY 2015-16)

DIAGNOSTICS PROCEDURES

28

Source: Primary data from DHH, SCB MCH & Pvt. hospital &


▪ Overall Lab tests accounts for majority (85%) of total

diagnostics.

▪ X-ray and USG constitute of only 17% and 2.3% 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 SCB Medical College (60%).

▪ The tests conducted at the studied private facilities

constituted 9% of the total diagnostics.

▪ Among the private facilities, Pvt.Hosp-1 conducted the

highest number of diagnostic tests of which 91% were

lab tests.

NA: Data not available

Diagnostic

TestX Ray USG ECG CT Scan Lab Tests

City Hospital 4,966 NA NA 0 79,727

SDHs NA NA NA 0 10,942

CHCs NA NA NA 0 220,757

Pvt.Hosp-1 3,487 2,292 1,144 1,852 89,801

Pvt.Hosp-2 1,094 999 792 1,024 NA

Pvt.Hosp-3 15,937 1,639 9,362 5,714 NA

Pvt.Hosp-4 7,080 5,444 2,537 1,111 28,320

Sishubhaban 120,216 4,835 NA NA 149,214

AHRCC 1,459 NA NA NA 43,258

SCB MCH 56,644 31,392 NA 28,740 1,087,523

84,693

10,942

220,757

98,576

3,909

32,652

44,492

274,265

44,717

1,204,299

City Hospital

SDHs

CHCs

Sun Hospital

Sabarmati

Ashwini

Shanti

Sishubhaban

AHRCC

SCB MCH

Facility wise total diagnostics (FY-2015-16)

Pvt.Hosp-1

Pvt.Hosp-2

Pvt.Hosp-3

Pvt.Hosp-4

29

ECONOMIC SEGMENT OF PATIENTS

Note: estimations given are

based on discussion with ADMO

Medical and Hospital Manager

BPL30%

APL -Low

Income40%

APL -Middle income

20%

APL -High

income10%

City Hospital

APL -Low

Income10%

APL -Middle income

60%

APL -High

income30%

Pvt.Hosp-1

BPL20%

APL -Low

Income15%

APL -Middle income

35%

APL -High

income30%

Pvt.Hosp-2

APL -Low

Income10%

APL -Middle income

70%

APL -High

income20%

Pvt.Hosp-3

BPL15% APL -

Low Income

15%APL -Middle income

50%

APL -High

income20%

Pvt.Hosp-4

BPL40%

APL -Low

Income30%

APL -Middle income

20%

APL -High

income10%

Sishubhaban

BPL20% APL -

Low Income

20%

APL -Middle income

40%

APL -High

income20%

AHRCC

BPL60%APL - Low

Income15%

APL -Middle income

15%

APL - High income

10%

SCB MCH

30

MODE OF PAYMENT BY PATIENTS

Note: estimations given above are based on

discussion with ADMO Medical and Hospital

Manager

Free10%

Cash70%

RSBY10%

BKKY10%

City Hospital

Cash47%

RSBY21%

BKKY16%

OSTF16%

Sishubhaban

Free10%

Cash40%

RSBY20%

BKKY15%

OSTF15%

AHRCC

Free10%

Cash60%

ESIS5%

CGHS5%

RSBY5%

BKKY5%

OSTF10%

SCB MCH

Cash50%Pvt.

Insurance

30%

Corp. Insuranc

e10%

BKKY10%

Pvt.Hosp-1

Free3%

Cash85%

Pvt. Insuranc

e10%

ESIS2%

Pvt.Hosp-2

Free10%

Cash40%

Pvt. Insuranc

e40%

ESIS5%

CGHS5%

Pvt.Hosp-3

Cash60%

Pvt. Insuranc

e30%

ESIS10%

Pvt.Hosp-4

31

SECTION 5:

CATCHMENT AREA & REFERRALS

32

CATCHMENT OF CITY HOSPITAL

Catchment

Type

Name of the

blockPopulation

Distance

from district

HQ

Primary Cuttack 441693 -

Secondary

Barang 221411 8

TangiChoudwar

157801 34

Salepur 193938 35

Athagad 144670 40

Nischintakoili 188599 41

District Headquarters Hospital

Block Headquarters

Catchment

Type

Name of the

blockPopulation

Distance

from district

HQ

Secondary

Jagatsingpur 362189 45

Banki 115402 47

Mahanga 186930 55

Narasingpur 157201 57

Tigiria 74639 57

Badamba 149793 80

Patients also

come from nearby

bordering districts

such as Jajpur,

Kendrapada,

Jagatsingpur &

Dhenkanal

33

SOURCE OF PATIENT INFLOW

Source: estimations given above are based on

discussion with Management of concerned hospitals

70%

50%

20%

30%

20%

50%

20%

30%

25%

30%

45%

35%

10%

15%

20%

10%

5%

20%

35%

35%

70%

35%

60%

60%

City Hospital

Sun Hospital

Sabarmati

Ashwini

Shanti

Sishubhaban

AHRCC

SCB MCH

Source of Patients inflow at studied facilities (in%)

From within the district town

From the district other than the district town

Other districts

Pvt.Hosp-1

Pvt.Hosp-2

Pvt.Hosp-3

Pvt.Hosp-4

34

POINTS OF REFERRAL

Name of FacilityReferral

District/City/State

Name of referral

centre

City Hospital Cuttack SCB Cuttack

Pvt.Hosp-1 Cuttack SCB Cuttack




Sishubhaban Cuttack -

AHRCC Mumbai Tata Memorial Centre

SCB MCH New Delhi AIIMS New Delhi

35

▪ Nearest railway station : Cuttack

Junctionis one of the important stations on

the Howrah , Kolkata-Chennai mainline of

the East Coast Railway and falls under the

Khurda Road division. A branch line

to Paradeep starts from Cuttack. It is

connected to all parts of India through trains

run by the Indian Railways

▪ Road ways: As per the new

numbering National Highway

16 runsfrom Chennai to Kolkata.

National Highway 55 connects Cuttack

with Sambalpur.

Feeder State Highways connect Cuttack

to Jajpur, Paradeep, Talcher, Angul,

Kendrapara and nearby towns in Cuttack

district.

▪ Airport : The nearest commercial airport is

the Biju Patnaik Airport at Bhubaneswar,

about 28 km away.

CONNECTIVITY & TRANSPORT

36

SECTION 6:

DEMAND-SUPPLY-GAP

ASSESSMENT

37

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

38

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 22 924,337 719,396 204,941

OBG 14 588,215 457,798 130,417

Pediatrics 12 504,184 359,698 144,486

Gen. Surgery 11 462,169 392,398 69,771

Orthopedic 9 378,138 294,298 83,840

ENT 7 294,107 228,899 65,209

Ophthalmology 7 294,107 228,267 65,840

Others

specialties18 756,276 589,228 167,048

TOTAL 100% 4,201,534 3,269,983 931,551

Total OPD Gap 22%

Gen Med

OBG

Paediatrics

Gen. Surgery

Orthopaedic

ENT

Opthalmology

Others specialties

Gap assessment of OPD specialty mix

Estimated Demand Actual Suppy

39

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 138,651 65,420 73,231

OBG 88,232 41,579 46,653

Pediatrics 75,628 32,670 42,958

Gen. Surgery 69,325 35,640 33,686

Orthopedic 56,721 26,730 29,991

ENT 44,116 20,790 23,326

Ophthalmology 44,116 20,595 23,521

Others

specialties113,441 53,573 59,868

TOTAL 630,230 296,996 333,234

Total IPD Gap 53%

Gen Med

OBG

Paediatrics

Gen. Surgery

Orthopaedic

ENT

Opthalmology

Others specialties

Gap assessment of IPD specialty mix

Estimated Demand Actual Supply

40

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% 630,230 50% 315,115 945,345 209,424 735,921

USG 20% 840,307 35% 220,581 1,060,887 46,601 1,014,286

ECG 10% 420,153 60% 378,138 798,291 13,835 784,456

CT Scan 2% 84,031 5% 31,512 115,542 38,441 77,101

Lab Tests

(number of

patients)

60% 2,520,920* 100% 630,230** 3,151,150 1,674,730 1,476,420

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

demand number of OPD lab tests would be 5,041,841 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 3,151,150

41

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

Medical

College

Total Bed

strength

6644 beds

18298 beds

2130beds

01130beds

910 beds

1863332 beds

12270 beds 6951

The district of Cuttack has 97 public and 186

private health care facilities with a total bed

strength of 6951 beds only.

Considering the WHO norm of 3.5 beds per 1000

population, the district with a population of

27,87,415 has a shortfall of 2805 beds (i.e. a

gap of 29% beds).

* Source : Bed Strength, DHS Odisha and Clinical

Establishment, DMET Odisha

0

2000

4000

6000

8000

10000

Beds available Beds required asper WHO norm

6951

9756

Gap in bed availibility

42

GAP – DOCTORS AND NURSES

▪ There are 670 doctors available in the district including

DHH and SCB medical college.

▪ Considering the WHO norm of 1 doctor per 1000

population, the district has a shortfall of 2117 doctors

* Source : District wise Incumbency list , DHS Odisha

▪ As per primary and secondary data collected There are

only 842 nurses posted in the district. (7 nursing

sister and 831 staff nurse, 2 Asst Matron, 1 Matron ,1

Chief Matron).

▪ Considering the WHO norm of 2 nurses per 1000

population, the district has a shortfall of 4733 nurses.

* Source : Staff position list received from SCB Cuttack, City

Hospital and other surveyed Govt. hospital and nursing staff list

from directorate of nursing, Odisha.

0

500

1000

1500

2000

2500

3000

Doctors available Doctors required asper WHO norm

670

2787

Gap in doctors availibility

0

1000

2000

3000

4000

5000

6000

Nurses available Nurses required

842

5575

Gap in nurses availibility

43

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

SECTION 7:

FINDINGS OF GENERAL

POPULATION SURVEY

INCOME AND OCCUPATION

0%5%

10%

23%

35%

10%8%

10%

Occupation of the respondents

0%

15%

53%

28%

5%0%

Annual family income of the respondents

70%

3% 0%

28%

0%

From savings Loan fromfamily/friends

Sold assets Healthinsurance

Others

Source of health related costs

▪ Majority of the respondents were housewife

followed by people in business & service with an

annual income not more than 200000

▪ 28 % of the population surveyed had savings as

there primary source of health related costs which

shows increasing awareness among people.

HEALTH SEEKING BEHAVIOUR

Yes always

50%

Not always

50%

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

family?

22% 22%

0%

56%

0%

A privatepractitioner

A privatehospital

A localgovt.

hospital

Districthospital

Others

What is the type of healthcare facility that you had visited before coming to this hospital?

Yes36%

No64%

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

this instance and for this ailment?

The survey response indicates that people visit

health care facility only when condition is really

serious and needs consultation of physician and

chose private practitioners and government

healthcare facility as per their choices.

HEALTH SEEKING BEHAVIOUR

0%

25%

33%

25%

0%

17%

0% 0% 0%

67%

33%

0% 0% 0% 0% 0% 0% 0%

My Preferred doctorpractices there

I have been visitingthe facility for a long

time

The facility is largeand most servicesoffered under one

roof

I knew about thereputation of the

facility for its qualityof care

The facility isproximate to my

residence

Low pricing ofservices and free

medicines

The staff in thefacility behaves well

when comparedwith other facilities

The facility is cleanwhen compared

with other facilities

It is a networkhospital in my

healthinsurance/corporate

tie-up

Reason for choosing a hospital

Govt. hospital Pvt. Physician clinic

Preference for the doctors were the major reasons for choosing private physician clinic . Service availability , reputation

of the facility and personal preference were the main reasons for choosing Govt. Healthcare Facility.

VISITING EXTERNAL FACILITIES

4%

96%

Yes No

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

diagnostic test?72%

28%

Yes No

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

▪ The survey indicates that 4 % of patients are

referred for diagnostic test out of DHH. Mainly

patients are going external centre for diagnostic

which are not available at DHH .

▪ 72 % of respondents had to purchase medicines

from external pharmacy due to unavailability of the

required medications.

100%

Endoscopy

Tests that has been performed from other hospital/diagnostic centres

REGULAR MEDICATION BEHAVIOUR

47%

53%

Yes No

Does any member of your family take regular medications?

31%

4%13%

18%

4% 2% 4% 2% 2% 2% 4% 4% 7%

Common specialities of consultation

▪ The findings indicate a high prevalence of chronic

diseases requiring continued treatment, with

gastric ailment, diabetes, and hypertensions being

major part 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.

29%

14%

29%

14% 14%

Hypertension Diabetes Cancer Orthopedic Gastric

Conditions for which patients take regular medications

IP ADMISSIONS

47%

53%

Yes No

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

year

29%

14%

29%

14% 14%

Ge

ne

ral

Medic

ine

Ge

ne

ral

Su

rge

ry

Ort

ho

pe

dic

s/j

oin

tre

pla

ce

me

nt

Ch

est

me

dic

ine/T

B

Ca

nce

r

Specialty of admission at hospital

100%

0%

Government hospital Private hospital

Place of admission

20%

64%

16%

0%

This is thefirst

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 47% of respondents who had family members

admitted atleast once in last one year and chose government hospital. Patients have admitted mostly for general

medicine followed by Orthopedic and general surgery . All respondents had undergone at least one OP consultations

before getting admitted in the hospital.

SECTION 8:

FINDINGS OF OUTPATIENT

AND INPATIENT SURVEY

30%

20%

10% 10%

0%

10%

20%

Specialty of the ailment of admission

5 0

106 117

0

42

Registration Consultation Diagnostictests

Medicines Any minorporcedure

Travel tohealth facility

Amount spent on visit to the hospital

Average (Rs)

13%

7% 7% 7% 7%

13%

7%

20%

7% 7% 7%

Specialty of consultation 86%

14%0% 0% 0% 0%

Amount spent during admission

▪ Majority of inpatient respondents at DHH were admitted for general medicine followed by Gastro Enterology , and

paediatric . Majority of OP respondents had consulted for paediatric followed by General Medicine , and nephrology.

▪ 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 1280/-.

SECTION 9:

FINDINGS OF PHYSICIAN

SURVEY

COMMON SPECIALITIES OF CONSULTATION BY GENERAL PHYSICIAN

20% 20%

0%

16%

0%

8%

0% 0%

20%

8% 8%

COMMON SPECIALITIES OF CONSULTATION BY GENERAL PHYSICIAN

ECONOMIC AND GEOGRAPHIC STRATIFICATION OF PATIENTS

22%

48%

30%

Upper economicclass

Middle economicclass

Low economicclass

Economic class of patients

98%

0% 2%

From within thetown/city

From the districtother than the

town/city

From adjacentdistricts

Geographic classification of patients

32%

38%

30%

Upper economicclass

Middle economicclass

Low economicclass

Economic class of patients

62%

22%16%

From within thetown/city

From the districtother than the

town/city

From adjacentdistricts

Geographic classification of patients

GENERAL PHYSICIAN RESPONSE SPECILAIST PHYSICIAN RESPONSE

REASON FOR REFERRAL

7%

13%

33%

7%

0%

20% 20%

33%

17%

25%

8%

17%

0% 0%

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

Reasons to refer a patient to a particular hospital

General Physician Specialist Physician

SPECIALITIES OF CARE FOR WHICH PATEINT TRAVEL TO OTHER CITIES

20%

16% 16%

12% 12% 12%

4% 4% 4%

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

Nephrology and cancer.

FACILITIES RECOMMENDED BY THE PHYSICIANS

Specialities General Physician

Specialist

Physician

Cardiology / cardiac

surgery

ECHO, TMT, Cath Lab,

Holter

ECHO, TMT, Cath

Lab,EEG

Pulmonology / Thoracic

Surgery

Spirometry,

Broncoscopy

Neurology / Neuro

Surgery EEG, EMG, CT-Scan EEG, EMG, CT-Scan

Gastro enterology /

surgeryEndoscopy, Colonoscopy

Endoscopy,

Colnoscopy

Cancer Chemotherapy Chemotherapy

Urology Lithotripsy Lithotripsy

Nephrology Dialysis Dialysis

Orthopaedics

C-arm, Specialized Ortho

OT C-arm, CT-Scan

Gynaecology & ObstetricsUSG USG

Paediatrics and

neonatalogyPICU, NICU PICU

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

facilities for the corresponding specialties.

THANK YOU

59

district : cuttacksummary •the district of cuttack has 97 government health care facilities and...

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