1.1 Through a planned process since 1947, there has been an expansion in infrastructure and systems for providing health care services throughout Orissa. Orissa has adopted Central Government norms, guidelines, policies and programmes for this development.
1.2 In recent years, there have been a number of additional statewide initiatives to enhance the reach and quality of health care to improve the health of people. These include the multi disease surveillance system; several measures towards streamlining drug procurement, distribution and rational use of drugs; total risk coverage for five major communicable diseases through the Panchabyadhi Chikitsa Scheme; the Infant Mortality Rate Reduction Mission; mandatory prepost graduate placement of doctors to serve in difficult areas; establishment of district cadres for paramedical staff, among others. It is a matter of pride that in several of these areas Orissa has been a pioneer and positive results are seen. District level initiatives have piloted important components of primary health care such as community participation, improved mobility assistance for field staff, support to training and health education systems, maintenance of built assets and equipment, use of low cost construction for primary health centres and sub-centres. All these have led to improved capacity and confidence of health service providers and improved health care. The Policy and Strategic Planning Unit (PSPU) has initiated work on policy areas including health financing. These involvements have led the State Health and Family Welfare Department to develop a Vision for 2010 and to this policy statement.
1.3 Since the year 1947, there has been a gradual improvement in the health status of the population due to several factors including developmental and educational interventions, economic improvement and better health care services. While the Infant Mortality Rate (IMR) has declined from 135 in 1981 to 97 in 1989, it is still one of the highest in India – much above the national average of 70. The Crude Death Rate (CDR) has declined from 15.4 per 1000 population in 1971 to 13.1 in 1981 and 10.6 in 1999. Rural urban differences remain (for 1999 rural, IMR-100, urban IMR – 65; rural CDR 11.1, urban CDR 7.1). The Crude Birth Rate (CBR) has declined substantially from 34.6 per 1000 population in 1971 to 33.1 in 1981 and 24.1 in 1999 (rural 24.6, urban 20.3, all India 26.1). The gender ratio (females per 1000 males) is 972 in 2001, which has increased from 971 in 1991 and is higher than the all India level of 933 in 2001. Orissa is on its way to achieving population stabilization with an annual growth rate of 1.59% (2001 census), against the all India figure of 2.13%. The life expectancy for 1996-2001 is projected as 58.5 years for males and 58.1 years for females, up from 54.1 and 51.9 years for males and females respectively in 1981-86. Indicators of nutritional status among women and children and burden of diseases indicate a substantial proportion of preventable morbidity and mortality. The people of Orissa experience a large number of disasters – about 40 major disasters in 50 years – that adversely affect health and development and health care services.
1.4 It is in this context that an integrated health policy statement is being articulated for the comprehensive, planned development of the entire health sector (public, voluntary, private; allopathic and Indian systems of medicine as well as homeopathy); and to address key determinants of health (nutrition, water supply, sanitation, environmental hazards); in order to improve the health of people and their access to care. This state health policy draws upon the National Health Policy 1983 and 2002. Central policies regarding specific health related issues, such as education for health sciences (1989), nutrition (1993), drug policy (1988 and 1994), pharmaceutical policy (2001), Medical Council of India guidelines (1997), blood banking (1997), the elderly (1998), Population Policy (2000) and others continue to be the guiding documents. The Orissa State Integrated Health Policy developed by the Health and Family Welfare Department, Government of Orissa, indicates directions for health improvement in a state-specific context, as health is a State subject under the Constitutional framework of India. It helps to actualise the Vision Statement for 2010 by providing a framework within which strategies and operational plans are developed, implemented and reviewed
The Mission of the Health and Family Welfare Department, Government of Orissa, is to facilitate improvement in the health status of the people of Orissa with their participation, and to make available health care in a socially equitable, accessible and affordable manner within a reasonable timeframe, creating partnerships between the public, voluntary and private health sector and across other developmental sectors. Medium and long-term goals are derived from the Vision 2010, and some of the specific goals are given in Section 8.