Odisha’s interim budget reaffirms a high level of political commitment to health. Under its hockey loving Chief Minister Naveen Patnaik, the state has been scoring spectacular goals in health while preferring flair over fanfare. Key population health indicators have shown a remarkable improvement in the last two decades. It has exemplified commitment to universal health coverage (UHC) through unparalleled financial coverage and rapidly expanding service coverage. It is investing in institutional growth for creating a larger and better skilled health workforce and is expanding healthcare infrastructure.
The two key indicators of UHC are financial coverage and service coverage. Under Biju Swasthya Kalyan Yojana (BSKY), health services are provided free to all persons in all government hospitals. These extend from outpatient consultation to intensive care and surgery. These services are provided free of cost even to persons from other states or countries. Providing needed health services free of cost, while being agnostic to resident status or citizenship is the hallmark of humanistic UHC.
Around 85 per cent of the population are also eligible for healthcare in over 800 reputed private hospitals across 17 states. Financial support for this is provided by the state - up to Rs 5 lakh per family and up to Rs 10 lakh for women members of the family. Each month, over 1.3 lakh patients receive cashless healthcare costing Rs260 crore in private hospitals across the country.
The BSKY programme operates on an online, paperless platform and monitors quality of service through feedback calls (98 pc positivity reported). From May 1, 2024, the BSKY scheme will be extended to cover all sections of the rural population who were not covered earlier. Through a BSKY-Nabin card, they will be eligible for advanced hospital care inside and outside Odisha. Provision of free drugs and diagnostics has also been beneficial in reducing the financial burden of healthcare to citizens. Under the Niramaya scheme, poor families are estimated to have saved Rs 1,000 crore through free supply of drugs. Free diagnostic services, under the Nidaan scheme, also saved them an estimated Rs 240 crore.
Ambulance services have been augmented for emergency transport by road and water. Super-specialist care is being extended to remote parts of the state through ‘Mukhya Mantri Vayu Swasthya Seba’. Average response time has come down from 30 to 20 minutes. The budget of 2024-25 proposes Rs 350.27 crore for strengthening emergency transport services.
Service coverage too has improved markedly, with increased investments in healthcare infrastructure and health workforce. With launch of eight new medical colleges and two new postgraduate institutes over the past 6 years, capacity to train medical professionals has grown. The number of medical undergraduate seats has grown from 321 to 2,525 and those for specialist courses from 254 to 1,044. Odisha University of Health Sciences was launched in 2023 to advance education across several streams of health sciences.
Transformation of the SCB medical college and hospital in Cuttack is underway, with an allocation of Rs 4,500 crore over 5 years. Strengthening of all public healthcare facilities has commenced, under a new ‘Ama Hospital’ scheme. Cancer care is being advanced, through a newly- established Bagchi Sri Shankara Cancer Hospital and a 200-bed state-of-the-art cancer hospital being set up in partnership with Tata Memorial Centre and the Department of Atomic Energy. Under the Odisha Comprehensive Cancer Care Plan, it is proposed to establish 11 cancer hospitals across the state, at a cost of Rs 1,000 crore. A Bagchi-Karunashraya Palliative Care Centre is under construction in Bhubaneshwar at a cost of Rs 110 crore.
To ensure that this high level of commitment to a comprehensive and compassionate UHC is backed up by financial resources, allocation for health has reached a level of 8 pc in the latest state budget. This is a level that was recommended by the 15th Finance Commission and urged by the NITI Aayog. Odisha has led other states in raising its allocation to health to that high watermark.
Odisha is also among the few states which have introduced designated public health posts in health services. This too has improved efficiency in design, delivery and evaluation of health programmes. By demonstrating a strong combination of political will, professional skill and administrative acumen, Odisha has become a role model for health system transformation.
Dr K Srinath Reddy
Distinguished Professor of Public Health, PHFI