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Nick McTurk University of Dundee

Life, Death and Development on the Margins: Infant and Child Mortality and the Health Interventions of the State in Orissa, India. Nick McTurk University of Dundee. Outline of Presentation. Context of Orissa The determinants of Infant and Child Mortality in India and Orissa

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Nick McTurk University of Dundee

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  1. Life, Death and Development on the Margins: Infant and Child Mortality and the Health Interventions of the State in Orissa, India Nick McTurk University of Dundee

  2. Outline of Presentation Context of Orissa The determinants of Infant and Child Mortality in India and Orissa Differential impacts of Health infra-structure in India’s States Introducing Orissa’s State Healthcare System Healthcare in Orissa: a Strengths, Weaknesses, Opportunities & Threats analysis Conclusions: marginality and mortality

  3. Political Map of India State of Orissa

  4. District Map of Orissa Hilly Interior Primary Research Locations Coastal Plains

  5. Region Infant Mortality Rate 1991 Infant Mortality Rate 2000 India 80 68 Worst Orissa 124 95 Three Madya Pradesh 117 87 Indian States Uttar Pradesh 97 83 Sub-Saharan Africa 104 - Worst Mali 161 - Three Mozambique 149 - S-S African Countries Guinnea-Bissau 148 - Infant Mortality Rates in 1991 and 2000 Sources: Sen, A. (1999); Sample Registration System (2000)

  6. Rural IMR 1991 Rural IMR 2001 Female Literacy -0.725** -0.698** Hospital Beds -0.688** -0.758** Male Literacy -0.661** -0.502* Safe Water Access -0.571* 0.054 (1991 Data) Determinants of Infant Mortality (India 1991 and 2001 Secondary Data) * Statistically significant at 0.05 ** Statistically significant at 0.01

  7. Standard Residual Outliers for Hospital Beds per Million and Infant Mortality in Rural India 1991 2001

  8. IMR 1991 CMR 1991 IMR 1999 Females well educated -0.753** -0.776** Female Literacy -0.800** Sched. Caste 0.547 0.726** PHC 0.579** Utility Access -0.523 -0.560* PHC -0.176 Determinants of Infant and Child Mortality (Orissa 1991 and 1999 Secondary Data) -0.151 * Statistically significant at 0.05 ** Statistically significant at 0.01

  9. Determinants of Neonatal, Infant and Child Mortality (Orissa Primary Data) Poverty (NMR, IMR & CMR) Distance to Health Facility (NMR & IMR) Poor Healthcare Practice (NMR, IMR & CMR) Scheduled Caste & Other Backward Class (IMR & CMR) Utility Access (IMR & CMR)

  10. Spatialities of Infant Mortality and Health Infrastructure Rural IMR (1999) PHC/million (2001)

  11. The State Healthcare System Tertiary Institutions 11 Specialist Hospitals 3 College Hospitals Cities District Towns District H.Q. Hospitals Secondary Institutions Community Health Centres (Serve 80 – 120,000) Primary Health Centres (Serve 20 – 30,000) Rural Orissa Primary Institutions Sub-Centres (Serve 3 – 5,000) I.C.D.S. (Serve 900-1200)

  12. S.W.O.T. analysis of the State Healthcare System

  13. Strengths and Weaknesses of the State Healthcare System Strengths Targeted at the poor Utilised by the poor (Modest) attributable mortality reductions Weaknesses Resource, facility and staff shortages Rife political interference and corruption Some policies are incommensurate with assistance of the poor

  14. PHC/population by District

  15. Opportunities and Threats to the State Healthcare System Opportunities Joined-up government Investment in primary services Intensified utilisation of media resources Threats Ineffective referral function Poor reputation Financial and spatial inaccessibility

  16. Patient Referral within the State Healthcare System 11 Specialist Hospitals 3 College Hospitals Tertiary Institutions Patient Referral District H.Q. Hospitals 48% (of first referrals) Patient Referral Secondary Institutions Community Health Centres (Serve 80 – 120,000) Patient Referral Primary Health Centres (Serve 20 – 30,000) Primary Institutions Self Referral 36% (of first referrals) Sub-Centres (Serve 3 – 5,000) I.C.D.S. (Maternal and Child Health Outreach Services)

  17. Orissa’s Infant and Child Mortality decline lags behind other States in India because of lack of investment in rural State Healthcare and Development infrastructure. Socio-Spatial inequalities in survival are tempered by… Spatial marginality and healthcare access: Orissa’s population is 87% rural, predominately inhabiting small villages scattered across inaccessible terrain, poverty reduces mobility, restricting access to State healthcare facilities. Social marginality and healthcare access: The Scheduled Caste & and Other Backward Class groups who depend upon ineffective State services suffer higher mortality rates than other groups with more financial and socio-political clout. Conclusions: marginality and mortality

  18. Thanks for listening Nick McTurk University of Dundee n.j.mcturk@dundee.ac.uk

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