A pathway to UHC for Odisha

Abstract Introduction This study examines Odisha’s health system. It attempts to ascertain the systemic interventions that could significantly improve its performance. Methods To guide its analysis, the study uses the Control Knobs Framework with three additional ‘knobs’ of One Health, social determinants of health, and public health added to the five in the original framework. For its performance analysis, it draws on data from multiple sources, including the India Health Systems Project, which studied the Odisha health system in some detail. The study carries out an evidence synthesis using national and global literature to arrive at its recommended interventions. Results The study finds that Odisha effectively has two health systems within the state – one for its eastern (coastal) and western districts (Health System A) and another for its northern, southern, and central, tribal-dominated districts (Health System B). Health System A is much better equipped and much further along in its epidemiologic transition, while Health System B is much more poorly equipped and still needs to fully address its maternal and child health burden. Both health systems have high levels of hypertension, potentially driven by a universally high salt diet. These systems also have an out-of-pocket expenditure level greater than 50% and poor responsiveness ratings, particularly for Health System B. Discussion On the One Health front, its high dependence on small-farm agriculture, low levels of urbanisation, and extensive forest cover make it imperative for the state to implement short and long-term strategies to address climate change, prevent disease spillovers from animals to humans, and build pandemic preparedness. To improve health outcomes, the state can intervene to improve social determinants of health and address public health concerns. To transform its health systems, the state can substantially reform the manner in which it pays the public sector, defragment its health budgets, and take steps to nudge the private sector toward offering Managed Care. For Health System A, the government needs to focus on strengthening its primary care capabilities, while for Health System B, it would need to prioritise augmenting its hospital capacity.