Credit: Options/India
Children happy with ASHA, Odisha, India

Improving health, nutrition, water and sanitation services, Odisha

Odisha is one of the poorest states in India, with a large proportion of people living below the poverty line. High undernutrition, a high disease burden and inequalities between access to health services for men and women still persist. However, in recent years, Odisha has made significant progress in making health services available to more mothers and children, expanding immunisation and safe delivery. This has led to reductions in the numbers of maternal and child deaths – including for scheduled tribes, who have often lagged behind other groups in improvements in health.

The Odisha state government is working to increase the availability of and access to quality essential health, WASH and nutrition services, targeting in particular the poorest people, those residing in rural areas, and women and children.

Since 2008, we have been supporting the government of Odisha in improving the health and nutrition of its population, leading a DFID-funded programme of technical support working closely with government counterparts in country. Our experts work as an integral part of government departments at state and district levels to support stronger convergence between the health, nutrition and WASH sectors, in line with state plans to:

  • improve access to health, nutrition, water and sanitation services in underserved areas
  • strengthen public health management systems
  • improve health, nutrition and hygiene practices and the health-seeking behaviour of communities through initiatives to change behaviour
  • improve use of evidence in planning and delivery of equitable health, nutrition, water and sanitation services
  • strengthen institutions, ensuring the building of skills and capacity to implement and sustain reforms beyond the life of our support.

Between 2008 and 2012, we worked on health reform and systems strengthening, led by the Department of Health and Family Welfare, and helped set up district-level support to the Department of Women and Child Development. From 2012, in partnership with IPE Global, we increased our focus on nutrition, water, sanitation and hygiene. We provided intensive support in 15 nutritionally vulnerable districts in Odisha, geared towards improving the availability and quality of WASH services. We worked with communities to promote the use of these – and broader health and nutrition – services. We also developed ways in which communities could engage with local government and service providers to ensure that services are responsive to their needs, and that the government could be held to account when high quality services are not available.

Project achievements

  • We supported the government in Odisha to improve access to health services across the population through Village Health and Nutrition Days. We supported reforms to the management and development of human resources for health. We introduced cash transfer and entitlement schemes, to support mothers caring for infants and avoid early growth faltering.
  • We established monitoring systems to track the health of vulnerable groups and determine those in need of financial support to access health services.
  • A State Equipment Maintenance Unit was established to improve the hospital equipment management system and utilisation of equipment at facility level.
  • We supported a state-wide communications campaign to promote the use of long-lasting insecticide-treated mosquito nets, and the Swasthya Kantha – an interactive village health display to promote use of health services.
  • The Shakti Varta initiative worked with more than 10,000 women’s self-help groups to reach around 20 million people, strengthening women’s empowerment for increasing health, nutrition and sanitation outcomes.
  • We supported the large-scale introduction of telemedicine and a single mobile phone group for all health workers.
  • As a result of the government’s approach and commitment to promoting equity, the institutional delivery rate for Scheduled Tribes rose from 12 per cent in 2005/6 to 70 per cent in 2014, and from 35 per cent to 82 per cent for all women.
  • The proportion of mothers and children perceiving postnatal care within 48 hours of birth increased to 55 per cent from 30 per cent between 2005/6 and 2014.
  • The proportion of children immunised increased from 52 per cent in 2005/6 to 75 per cent in 2013
  • The number of people with sustainable access to drinking water sources increased from 18 million in 2008/09 to 21.2 million in 2013/14 with a target of 30 million for 2015/16.


The institutional delivery rate increased from 35% to 82% between 2005/6 and 2014

Postnatal care within 48 hours of birth increased from 30% to 55% in the same period

The proportion of children immunised increased from 52% to 75% between 2005/6 and 2013

More than 200 villages became open defecation free during 2015

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