OUTCOME BUDGET 2015-16 Health and Family Welfare Department Government of Odisha 2015-16 Outcome Budget CONTENTS EXECUTIVE SUMMARY (cid:9) 4 CHAPTER I. INTRODUCTION (cid:9) 18 (cid:9) CHAPTER 2: OUTCOME BUDGET 2015-16 30 (cid:9) CHAPTER 3: REFORM MEASURES AND POLICY INITIATIVES 31 CHAPTER4: REVIEW OF PAST PERFORMNACES (cid:9) 52 CHAPTER 5: FINANCIAL REVIEW (cid:9) (cid:9) 58 CHAPTER 6: GENDER, SCHEDULED CASTE (SC)J SCHEDULED TRIBE (ST) BUDGETING Department of Health & Family Welfare, Govt. of Odisha Outcome Budget 2015-16 EXECUTIVE SUMMARY I. An Overview The Department of Health and Family Welfare (DHFW) is responsible for providing affordable and quality health care services to the people of Odisha, especially to the disadvantaged groups in backward and tribal districts. The department also provides family welfare services aimed at population stabilization and deals with all public health matters including drug control. DHFW functions through Secretariat, eight Directorates', Director of AcharyaHarihara Regional Cancer (AHRCC), Director of Capital Hospital, Project Director OSACS and Drugs Controller Administration. The Department is headed by a Principal Secretary. State Health Budget contained in Demand for Grants Nos. 12 for the year 2015-16comprises of schemes under State Plan (SP), Central Plan (CP), Centrally Sponsored Plan (CSP) and Non- Plan (NP). The SP includes the total provision for the activities planned by Odisha State AIDS Control Society (OSACS) and National Health Mission (NHM), Odisha. This document presents Outcome Budget 2015-16 for DHFW covering Demand for Grants Nos. 12. The outcome budget provides an overview of the objectives, financial outlays, quantifiable deliverables, projected outcomes, and scheme implementation process (implementing agency/funds flow) and timeline.The outcome budget is expected to be available for public information and scrutiny and thereby strengthen public participation in the delivery of health care and family welfare services at the grass root level. The structure of presentation of the Outcome Budget 2015-16 is summarised below: Chapter I: This chapter presents an overview of health vision, policy, institutional set up along with organogram, brief description of major schemes that are under implementation, and funds flow mechanism. Chapter II: This chapter contains in tabular form Outcome Budget 2015-16 in the prescribed format. Chapter III: The recent policy and reform initiatives taken by DHFW are summarised in thischapter. Chapter IV:Past performance of activities under Plan and Non-Plan for the year 2014-15 up to December'2014and for the year 2013-14and activities under NHM for the year 2014- 15till Dec 2014 and 2013-14with respect to the budgetary allocation for these years aresummarised in this chapter. This chapter also includes scheme wise revised estimate and surrender/saving for the year 2013-14. 'These Directorates are: Directorate of Health Services; Directorate of Family Welfare; Directorate of Medical Education, Training & Research; Directorate AYUSH; NHM Mission Directorate; State Institute of Health & Family Welfare, Directorate of Public Health and Directorate of Nursing. Department of Health & Family Welfare, Govt. of Odisha 1 Outcome Budget 2015-16 Chapter V: To put Outcome Budget 2015-16 into a proper perspective, financial review of outlay over the period from 2013-14 to 2015-16 is provided in this chapter. Chapter VI: This chapter highlights separately, outlay under SC-SP, TSP and budget for womenfor the year 2015-16. II. Programme Implementation, Monitoring, and Evaluation DHFW functions through Secretariat, eight Directorates2, Director AcharyaHarihara Regional Cancer Centre, PD OSACS and Drugs Controller Administration. The department is headed by a Principal Secretary. The health care and family welfare schemes are implemented and monitored by the respective Directorates. At the district level, Chief District Medical Officer (CDMO) is in overall charge of providing health care services, while Sub Divisional Medical Officer (SDMO) is responsible for functioning of Sub-Divisional Hospital (SDH), Medical Officers (MOs) are in charge of Community Health Centers (CHCs) and Primary Health Centers (PHCs). All schemes under National Health Mission (NHM) are implemented and closely monitored by the Mission Directorate. State Programme Management Unit provides technical support to the State Health Mission. The Mission Directorate is the Secretariat to the Mission.The Directorate comprises Programme Managers and a group of specialists in the areas of social development, human resource development, Economics, BCC, M&E, Public Private Partnerships, Accounts/financial analysis etc. The district health societies operate through the ZillaSwasthyaSamities (ZSSs) and the District Programme Management Units (DPMUs). The Block Programme Management Units (BPMUs) are responsible for preparation of block and village level plans, monitoring and implementation of government programmes, training of ASHA, inter-sector co-ordination, and developing public private partnerships for health care service. RogiKalyanSamities (RKSs) have been formed to undertake management of the health institutions up to PHC level through community participation. At present, RKSs are operational at 32 District Hospitals (DHs), 27 SDH and 377 CHCs. Under NHM's mandate of decentralized planning, GaonKalyanSamities (GKS) are being constituted in the State. Formed at the revenue village level, GKS is envisaged as a community level platform designed to facilitate health and sanitation related activities in particular and development programmes of the village in general. There are now 45,380 functional GKS in the state. In general, programme monitoring and evaluation mechanism includes: 2These Directorates are: Directorate of Health Services; Directorate of Family Welfare; Directorate of Medical Education, Training & Research; Directorate of AYUSH; NHM Mission Directorate; Nursing Directorate and State Institute of Health & Family Welfare and Director of Public Health. Department of Health & Family Welfare, Govt. of Odisha 2 Outcome Budget 2015-16 Regular Fixed Day Review Meeting, at different levels: (cid:226) Monthly fixed day meetings at all levels (cid:226) Monthly district level review by Collector (cid:226) RDC level review by Revenue Divisional Commissioners )=. Quarterly CDMO conference chaired by the Health Minister, GoO (cid:226) Video conference with District Collectors by Chief Secretary • Monitoring of Schemes through IT enabled services: (cid:226) Mission Connect — A 'Closed User Group (CUG)' connecting of all frontline health service providers established (cid:226) Review through Video Conferencing (cid:226) Web based MCH Centre monitoring system (cid:226) Web based PIP Monitoring system Si. Web based HRMIS (cid:226) GIS in Public Health );> Biometric Attendance system (cid:226) MHU tracking through G PS • 3rd Party Intervention Monitoring Plan (Zonal& District level): This is a new initiative introduced under M&E interventions with representatives from GoO, NGOs, development partners, civil society partners and individual consultants. The M&E composite group would be engaged to monitor overall planning and progress of zone wise districts comprising of ten districts. This will help to know about the overall district performance and expenditure trend along with their issues so that those aspects could be addressed at higher level. • Web based Hospital Management Information System (HMIS): The following steps are being taken under this mechanism (cid:226) Facility based data capturing (cid:226) Training/ orientation to all block level reporting personnel as well as Health Worker— Female (cid:226) Installation of dedicated HMIS Server for quick data retrieval )?. Facility-wise Infrastructure Data Capturing (e.g. Building, Basic Amenities, Deliverable services & HR) )=. Setting up of HMIS based feedback mechanism • Mother and Child Tracking System (MCTS): For tracking of the various Maternal and Child Health (MCH) schemes and evaluation of the benefits derived, a MCTS system is being implemented. Ill. Public Information System Important policy documents, plans, reports are available in the website of the Department for public scrutiny. These includeinter alia:Odisha Health Policy and Perspective Plan • Mission Statement and NHM-Programme Implementation Plan(PIP) • Odisha Drug Policy Department of Health & Family Welfare, Govt. of Odisha 3 Outcome Budget • Annual Budget, Outcome Budget and Annual Activity Report Besides, DHFW is open to Right To Information Act. CHAPTER 1.INTRODUCTION 1.1 Health Care System and Organizational Structure In Odisha, public health care services are provided by the Department of Health and Family Welfare (DHFW) under the Ministry of Health and Family Welfare. DHFW functions through Secretariat, eight Directorates, Director AcharyaHarihara Regional Cancer Centre, PD OSACS, Director Capital Hospitaland Drugs Controller Administration. The department is headed by a Principal Secretary. Exhibit 1.1 shows the Organogram of the department. At the district level, Chief District Medical Officer (CDMO) is in overall charge of providing health care services, while Sub Divisional Medical Officer (SDMO) is responsible for functioning of Sub-Divisional Hospital (SDH), Medical Officers (MOs) are in charge of Community Health Centers (CHCs) and Primary Health Centers (PHCs). Like in other states, there exists a state health society called Odisha State Health and Family Welfare Society (OSHFWS) and district level health societies known as ZillaSwasthyaSamities (ZSSs) for implementing various vertical programmes such as Reproductive and Child Health (RCH), tuberculosis, leprosy, malaria and blindness. Under National Health Mission (NHM), all the societies for individual vertical programmes are merged with the respective ZSS in all the districts. State Programme Management Support Unit (SPMSU) acts as the secretariat to the State Health Mission and DSHFWS. Headed by a Mission Director, SPMSU provides technical support to the State Health Mission through its pool of skilled professionals for RCH and other National Disease Control Programmes. The district health societies operate through the ZillaSwasthyaSamities (ZSSs) and the District Programme Management Units (DPM Us). The Block Programme Management Units (BPMUs) are responsible for preparation of block and village level plans, monitoring and implementation of Government programmes, training of ASHA, inter-sector co-ordination, and developing public private partnerships for health care service. RogiKalyanSamities (RKSs) have been formed to undertake management of the health institutions up to PHC level through community participation. At present, RKSs are operational at 32 District Hospitals (DHs) and 377 CHCs. Under NHM's mandate of decentralized planning, GaonKalyanSamities (GKS) are being constituted in the State. Formed at the revenue village level, GKS is envisaged as a community level platform designed to facilitate health and sanitation related activities in Department of Health & Family Welfare, Govt. of Odisha 4 Outcome Budget 2015-16 particular and development programmes of the village in general. There are now 45,380 functional GKS in the state. The AIDS control programme is implemented by Odisha State AIDS Control Society (OSACS). Currently National AIDS Control Programme (NACP) - Phase IV (20012— 2017), is in progress. Exhibit 1.1: Organogram of Department of Health and Family Welfare (DoH&FW) Minister-H&FW Spl. Secretary Addl. Secretaries FA-cum —it. Secretary Principal Secretary(cid:9) ---> Jt. Secretaries Dy. Secretaries AFA WI II (cid:9) 4' (cid:9) Under Secretaries 49 (cid:9) 4(cid:9) +(cid:9) 4(cid:9) +(cid:9) + DHS(cid:9) DFW(cid:9) DPH(cid:9) MD-NHM(cid:9) SIHFW(cid:9) Director(cid:9) DCA(cid:9) DMET PD- -Ayush OSACS (cid:9) +(cid:9) 4(cid:9) +(cid:9) 4(cid:9) + Director- +(cid:9) 49 Nursing Addl.(cid:9) Addl(cid:9) JD-Technical(cid:9) Dy(cid:9) Dy(cid:9) Dy(cid:9) superinten Directo(cid:9) Directo(cid:9) Directo(cid:9) Directo(cid:9) Drug(cid:9) dents of 3 Director- JD- Finance(cid:9) MCH, rsilt.(cid:9) rs/Jt.(cid:9) rs(cid:9) IS(cid:9) Control SVPPGIP, AHRCC Direct(cid:9) Directo(cid:9) HRD(cid:9) ler NInnam, Director- rs Capital Hospital '11(cid:9) if(cid:9) 41(cid:9) 4 CDMO/CMO(cid:9) SDMO(cid:9) DPMU(cid:9) Inspect(cid:9) Drug -÷ ors(cid:9) Inspect 4 ADMO-(cid:9) ADMO-(cid:9) ADMO- Health Medical(cid:9) 1W (cid:9) PH Officer PMU MOIL-CHC DSMO, DTO Department of Health & Family Welfare, Govt. of Odisha 5 Outcome Budget 2015-16 1.2 Health Facility and Human Resource As shown in Table 1.1, Odisha has got fairly large network of health facilities. There are now 3 state owned and 5 private medical colleges (having total intake capacity of 1050 MBBS and 250 BDS); 32 districts headquarter hospitals; 27 sub-divisional hospitals; 377 community health centers; and 79 other hospitals. The state also has 8 Ayurveda hospitals (5 state owned and 3 private colleges) and 6 Homeopathic hospitals (4 state owned colleges and 2 private colleges).At the grass root level, health care services are delivered through 1226 primary health care centers; 6,688 sub-centers; 560 Homeopathic dispensaries; 619 Ayurvedic dispensaries; and 9 Unani dispensaries. Table 1.1: Health facilities in the state Health Facility Number Medical College and Hospitals 3 District Hospitals (30 districts + Capital Hospital, BBSR & R.G.H, RKL) 32 Sub-Divisional Hospitals 27 Community Health Centers 377 Other Hospitals 79 Infectious Disease Hospitals 5 Training Centers 5 Primary Health Centers (N) & others 1,226 Sub-Centers 6,688 A.N.M. Training Schools 18 G.N.M. Training School 4 M.P.H.W.(Male) Training School 3 Ayurvedic Hospitals 2 Ayurvedic College & Hospitals 3 Ayurvedic Dispensaries 619 Homoeopathic College & Hospitals 4 Homoeopathic Dispensaries 560 Unani Dispensaries 9 Medical College — Private 5 At present, there are 66 ANM schools (18 state owned schools), 28 GNM schools (4 state owned schools), 7 B.Sc. (N) colleges (only one government college), one Post Basic B.Sc. (N) college (state owned), and one M.Sc. (N) college (state owned). The government has proposal to expand nursing institutions and strengthen existing nursing schools and colleges and the central government has agreed in principle to provide funding support. Department of Health & Family Welfare, Govt. of Odisha 6 Outcome Budget Like other states, the state is faced with shortage of medical and paramedical staff. Against sanctioned post of 25,510, posts of 3,246 (13%) still lying vacant. There exist vacant posts for 434doctors, 261 staff nurses, 99 pharmacists, 199 lab technicians, and 63 radiographers. Table 1.2 show's the detailed manpower position. Table 1.2: Human resource position 2014-15 Designation Sanctioned In-place Vacant Doctor 4,842 4,312 530 Pharmacist 1,945 1,846 99 Staff Nurse 2,124 1,863 261 Lab Technician (Path) 843 644 199 Multi-Purpose Health Worker - Male 4,670 3,562 1,108 Multi-Purpose Health Worker - Female 7,907 7,319 588 Radiographer 194 131 63 Multi-Purpose Health Supervisor - Male 1,597 1,328 269 Multi-Purpose Health Supervisor - Female/ Lady 1,228 1,017 211 Health Visitor Ophthalmic Assistant 197 183 14 25,547 22,205 3,342 Total Table 1.2: Human resource position 2013-14 Sanctioned In-place Vacant Designation 4,805 4,371 434 Doctor Pharmacist 1,945 1,846 99 Staff Nurse 2,124 1,863 261 Lab Technician (Path) 843 644 199 Multi-Purpose Health Worker - Male 4,670 3,562 1,108 Multi-Purpose Health Worker - Female 7,907 7,319 588 194 131 63 Radiographer Multi-Purpose Health Supervisor - Male 1,597 1,328 269 Multi-Purpose Health Supervisor - Female/ Lady 1,228 1,017 211 Health Visitor Ophthalmic Assistant 197 183 14 25,510 22,264 3,246 Total 1.3 Health and Nutrition Status Odisha has made considerable progress over the decades in reducing Total Fertility Rate (TFR) and Crude Birth Rate (CBR). NFHS-3 shows that TFR in Odisha at 2.4 births per woman is slightly lower than all India average of 2.7 births per woman in India. Similarly, crude birth rate at 19.6 per 1000 population (SRS 2013) is less than the country average of 21.4 per INN Department of Health & Family Welfare, Govt. of Odisha 2015-16 Outcome Budget 1000 population. The low values of CBR and TFR indicate that Odisha is approaching towards the replacement level. Leaving aside low CBR/TFR, Odisha lags far behind the country in terms of Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR). Though IMR has been falling rapidly over the years, the state's IMR at 51 per 1000 live births (SRS 2013) continues to be the second highest in India after Madhya Pradesh and Assam which have IMR of 54 per 1000 live births. The state's MMR at 235 per 100,000 live births (SRS 2010-2012) has improved from 258 per 100,000 live births (SRS 2007-2009) but it is still way above the national average of 178 per 100,000 live births. According to AHS 2012-13, MMR of Odisha is 230 per 100,000 live births. Odisha also has a high prevalence of malnutrition among children and women. According to NFHS-3 data, 45 percent of children under-five year are stunted (too short for their age indicating chronic malnutrition) while 20 percent are wasted (too thin for their height indicating acute malnutrition). Taking into account both chronic and acute malnutrition, 40 percent of children under-five year are underweight.Among adult women, 41 percent suffer from malnutrition. Anemia is another major health problem in the state. NFHS-3 data shows that almost two- third (65 percent) of children in 6-59 months age group are anemic. Among women, 61 percent have anemia. NFHS-3 further reveals that 69 percent of pregnant women and 65 percent of women who are breastfeeding are anemic. As per the UNICEF Coverage Evaluation Survey 2009, the percentage of women who availed a full ANC care package (comprising 3 ANC checkups, 1 TT injection and 100+ IFA tables) was a low as 37.5%. Malaria is the foremost public health problem of Odisha. Odisha contributes maximum to the malaria burden of the nation. In 2007, nearly 22 percent of malaria cases and 20 percent of malaria deaths were reported from Odisha. Though most of the districts show Falciparum malaria, the problem is severe in southern and western districts with a predominant tribal population. 1.4 Schemes and Activities The Department of Health and Family Welfare executes several schemes to ensure adequate health care services to the people of Odisha. While implementing these schemes, steps are being taken to cater to the health needs of the people in the rural areas, particularly in the tribal and backward regions of the State. This section provides a brief description of the key schemes currently under implementation by DHFW. 1.4.1 State Plan National Health Mission (NHM) Department of Health & Family Welfare, Govt. of Odi