LEARNING BRIEF SERIES

Odisha Health Sector Nutrition Plan (OHSNP): An Integrated

and Equitable HNWASH Approach for Enhanced Outcomes
Overview
The Odisha Health Sector and Nutrition Plan (OHSNP) was implemented by the Government of Odisha between April 2008
and March 2015 with financial and technical support through the UK Department for International Development (DFID).
OHSNP translates the Odisha Health Vision (2010) into action and is aligned with the National Rural Health Mission, with the
expected outcome of increased use of quality Health, Nutrition, Water and Sanitation (HNWASH) services by the poor.

Objectives
i) Improved access to priority HNWASH services in underserved areas
ii) Public health management systems strengthened
iii) Positive health, nutrition and hygiene practices and health seeking behaviour of communities improved
iii) Improved use of evidence in planning and delivery of equitable HNWASH services
Initially (from 2008-12) the major focus was on health reform and system strengthening, led by the Department of Health
and Family Welfare (DHFW). From 2010-15 this evolved to include additional strategies to reduce under-nutrition, led by the
Department of Women and Child Development (DWCD), and from 2012-15 DWCD and the Rural Development Department
(RDD), including innovative demand side models for community mobilisation and empowerment. During the seven years of
OHSNP, evidence and understanding has been generated at different levels, from design to implementation, monitoring and
results, and shared with the departments through a series of reports produced by the Technical and Management Support
Team (TMST). Learning has been incorporated into a series of suggestions for models and approaches that can be
incorporated into future Government of Odisha policy and strategy development.
OHSNP has particularly focused on the adoption of a holistic public health approach through stronger convergence between
the relevant departments, a strong focus on equity and balanced attention to both supply and demand side models. Based
on evidence from the Odisha specific Concurrent Monitoring Survey carried out in 2013-14 (CCM-II) and comparing this with
results from NFHS-3 (2005-06), ten key messages have been identified for policy makers.
1. Mortality indicators improved: There have been
substantial reductions in mortality rates for neonates
(down to 21.7 from 45.4 per 1,000 live births), infants
(down to 29.6 from 64.7 per 1,000 live births) and children
under five years (down to 35.2 from 90.6 per 1,000 live
births), as shown in Figure 1. Further attention to newborn
care will be critical to address the high rates of death in the
first month of life, as currently two thirds of all deaths of
children under-five years occur in this period. The
estimated maternal mortality ratio (down to 168.1 per
100,000 live births, shown in Figure 2) has in fact exceeded
the OHSNP target of 200.
2. Equity gap closing: There has been considerable success in
reducing the child mortality equity gap for scheduled tribe
children, as shown in Figure 3.
3. Service utilisation increasing and equity gap reduced: As
shown in Figure 4, excellent progress has been achieved in
closing the equity gap for utilisation of essential maternal,
neonatal and child services by scheduled tribe women,
including antenatal care, institutional delivery, postnatal
care and immunisation.
4. Quality of care improving: Whilst the increased utilisation
of maternal, neonatal and child health services, particularly
by the poorest, is encouraging, the importance of assuring
quality of services was also recognised, especially for
institutional delivery. This was addressed through a quality
improvement planning intervention in the maternity wards
of six district headquarter hospitals, yielding very positive
results. Expansion to all district headquarter hospitals is
planned.
5. Vulnerable groups have complex needs: Despite strong
progress in coverage, some differences in outcomes remain,
in the form of higher mortality rates for newborns, infants
and children under-five vulnerable populations, reflecting
the complex and multiple disadvantages of these groups
and reinforcing the need to continue prioritising equity.
6. Availability of health staff increased: Extensive reform of
human resource management systems has been successful
increasing the availability of frontline health staff and
expanding service provision. The increase in number of
health staff on the ground is particularly noticeable for staff
nurses (53% increase), doctors (39%) and ANMs
(33%).
7. Nutrition practices: Child under-nutrition remains a
concern, as there has been no change since NFHS-3.
Attention is needed to further increase the good practices
being promoted, such as breast feeding within an hour of
birth (currently 42%), provision of solid or semi-solid food
for infants aged 6-9 months (47%), ensuring an adequately
diverse diet for children aged 6 months to 2 years (16%) and
iron and folic acid supplementation for girls aged 10-19
years (18%).
8. Nutrition and WASH: To reduce the persisting burden of
high child under-nutrition, underlying determinants of
under-nutrition need to be addressed, with an emphasis on
inter-sectoral convergence. Of particular importance are
improving clean water supply, sanitation and hygiene
practices through interventions that will continue under
the DFID WASH programme.
9. Convergence matters: Convergence between the DHFW and DWCD has greatly increased and joint budgeting,
implementation and monitoring will continue to be important for a broader multi-sectoral approach to Health, Nutrition,
Water, Sanitation and Hygiene in the State.
10. Shakti Varta as a global model: The innovative Shakti Varta participatory learning and action initiative, which has been
successful in enabling local self-help groups to identify and solve their local HNWASH problems is an important model,
not just for Odisha but globally, as it also empowers women and communities with essential knowledge and
understanding of good HNWASH practices and promotes a self-help approach.
OHSNP programmes have been successful in increasing demand for HNWASH services, while at the same time
strengthening supply side systems and increasing service coverage. Particularly innovative are the community based models,
such as Shakti Varta, and modified models of community led total sanitation have also been successfully piloted and will
continue post March 2015 under the DFID WASH Programme. Sweeping human resource reforms have contributed greatly
to increased availability of services, and the benefits will be increasingly evident in the years to come. This combination of
approaches has made significant inroads into reducing the equity gap for essential service utilisation, particularly for
scheduled tribes.
Strong administrative and political leadership for HNWASH has been an important factor in the success of programmes,
combined with greatly improved convergence across the relevant departments and increased budgets. For the future, the
most urgent policy initiatives are a multi-sectoral nutrition policy and a convergent solid and liquid waste management
policy. It will also be important to continue investing in capacity building at all levels, particularly at the grassroots for
frontline service providers and communities to ensure the delivery of quality services and empowerment of communities to
take charge of their own development and live healthier lives.

2008 - 2015

ODISHA HEALTH SECTOR AND NUTRITION PLAN