title: Closing the health and nutrition gap in Odisha, India: A case study of how transforming the health system is achieving greater equity.
abstract: Health equity is high on the international agenda. This study provides evidence of how health systems can be strengthened to improve health equity in a low-income state. The paper presents a case study of how the Government of Odisha in eastern India is transforming the health system for more equitable health and nutrition outcomes. Odisha has a population of over 42 million, high levels of poverty, and poor maternal and child health concentrated in its Southern districts and among Scheduled Tribe and Scheduled Caste communities. Conducted between 2008 and 2012 with the Departments of Health and Family Welfare, and Women and Child Development, the study reviewed a wide range of literature including policy and programme documents, evaluations and studies, published and grey material, and undertook secondary analysis of state level household surveys. It identifies innovative and expanded provision of health services, reforms to the management and development of human resources for health, and the introduction of a number of cash transfer and entitlement schemes as contributing to closing the gap between maternal and child health and nutrition outcomes of Scheduled Tribes, and the Southern districts, compared to the state average. The institutional delivery rate for Scheduled Tribes has risen from 11.7% in 2005-06 to 67.3% in 2011, and from 35.6% to 79.8% for all women. The social gradient has also closed for antenatal and postnatal care and immunisation. Nutrition indicators though improving are proving slower to budge. The paper identifies how political will, committed policy makers and fiscal space energised the health system to promote equity. Sustained political commitment will be required to continue to address the more challenging human resource, health financing and gender issues.
authors.affiliation: Technical Management Support Team (TMST), Behind Capital Hospital, 1st Floor of NVPDCP (National Vector Borne Disease Control Program), Bhubaneswar, Odisha, India. Electronic address: dthomas@granegger.net.
authors.forename: Deborah
authors.initials: D
authors.lastname: Thomas
authors.affiliation: Technical Management Support Team (TMST), Behind Capital Hospital, 1st Floor of NVPDCP (National Vector Borne Disease Control Program), Bhubaneswar, Odisha, India.
authors.forename: Biraj Laxmi
authors.initials: BL
authors.lastname: Sarangi
authors.affiliation: Department of Women and Child Development, Government of Odisha, Secretariat, Bhubaneswar, Odisha, India.
authors.forename: Anu
authors.initials: A
authors.lastname: Garg
authors.affiliation: Department of Health and Family Welfare, Government of Odisha, Secretariat, Bhubaneswar, Odisha, India.
authors.forename: Arti
authors.initials: A
authors.lastname: Ahuja
authors.affiliation: Department of Women and Child Development, Government of Odisha, Secretariat, Bhubaneswar, Odisha, India.
authors.forename: Pramod
authors.initials: P
authors.lastname: Meherda
authors.affiliation: Department of Health and Family Welfare, Government of Odisha, Secretariat, Bhubaneswar, Odisha, India.
authors.forename: Sujata R
authors.initials: SR
authors.lastname: Karthikeyan
authors.affiliation: Technical Management Support Team (TMST), Behind Capital Hospital, 1st Floor of NVPDCP (National Vector Borne Disease Control Program), Bhubaneswar, Odisha, India.
authors.forename: Pinaki
authors.initials: P
authors.lastname: Joddar
authors.affiliation: Technical Management Support Team (TMST), Behind Capital Hospital, 1st Floor of NVPDCP (National Vector Borne Disease Control Program), Bhubaneswar, Odisha, India.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Kar
authors.affiliation: Technical Management Support Team (TMST), Behind Capital Hospital, 1st Floor of NVPDCP (National Vector Borne Disease Control Program), Bhubaneswar, Odisha, India.
authors.forename: Jeetendra
authors.initials: J
authors.lastname: Pattnaik
authors.affiliation: Technical Management Support Team (TMST), Behind Capital Hospital, 1st Floor of NVPDCP (National Vector Borne Disease Control Program), Bhubaneswar, Odisha, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Druvasula
authors.affiliation: Technical Management Support Team (TMST), Behind Capital Hospital, 1st Floor of NVPDCP (National Vector Borne Disease Control Program), Bhubaneswar, Odisha, India.
authors.forename: Alison
authors.initials: A
authors.lastname: Dembo Rath
mesh_terms: D002648:Child; D005260:Female; D006078:Government Programs / Q000379:methods / Q000458:organization & administration; D006291:Health Policy / Q000191:economics; D054625:Healthcare Disparities / Q000191:economics / Q000639:trends*; D006801:Humans; D007194:India; D008297:Male; D044342:Malnutrition / Q000191:economics; D000068101:Maternal-Child Health Services / Q000458:organization & administration; D011203:Poverty; D011247:Pregnancy; D012959:Socioeconomic Factors
keywords: Health equity; Health systems strengthening; India; Odisha State