Vision

What I believe about public health in Odisha.

Thirty years of working inside the system. This is what I think it needs — and what I think stands in the way.

I entered medicine because, in the village where I grew up, the difference between a child who lived and a child who died often came down to whether a doctor could be reached in time. I wanted to be that doctor. For thirty years, that is what I have been. Somewhere along the way, the work changed. Not the surgery — surgery is still surgery. But the system around the surgery: the wards, the supply chains, the staffing, the recruitment, the promotions, the rules that decide whether a young doctor will stay in a tribal posting or quietly move to a private hospital in a metro. That system has frayed. Not in ways the headlines capture, but in the daily, accumulated ways that anyone who has worked inside it can see. I led OMSA through a long campaign for the Dynamic Assured Career Progression scheme. We won, eventually. We won because we were patient, because we were honest about what the state could afford, and because we refused to let the demand be reduced to a slogan. That experience taught me something important: that speaking clearly from inside the system, based on what you have actually seen, carries more weight than speaking from the outside with better intentions and less information. So this is why I am writing. The next decade will decide whether Odisha's public health system serves the people who built it, or becomes a thing that exists only on paper while everyone who can afford to do so seeks care elsewhere. Thirty years of working inside it has given me a particular view of what is broken and what would fix it. That view should be in the open.

The pillars

1. Public health that actually reaches the public.

Government hospitals do extraordinary work with diminishing resources. The answer is not more announcements; it is more functioning operating theatres, more stocked pharmacies, more nurses paid on time. Reform begins where the patient meets the system.

2. Doctors retained, not replaced.

DACP was about stopping the slow drain of experienced government doctors into private practice. We have to do for nurses, technicians, and rural health staff what we eventually did for doctors. Career dignity is the cheapest form of retention.

3. Tribal health is not a side project.

Koraput, Kandhamal, Rayagada, Malkangiri — these districts contain some of the most underserved patients in India. The state's posture toward tribal health must become continuous and accountable.

4. Medical education that produces doctors who stay.

We train doctors to leave. The curriculum, the postings, the incentives all point one direction: away from the public system. This is not an accident; it is a design. The design can be redesigned.

5. Women's health beyond maternal mortality.

Odisha has made real progress on maternal mortality. We have not made comparable progress on women's health between 20 and 50 — cervical cancer, diabetes, mental health. The metrics we celebrate have shaped the care we deliver. We need new metrics.

6. Honest data, public dashboards.

The state collects health data continuously. Most of it never sees daylight. A public, real-time dashboard would change behaviour overnight.

What I stand by

  • I will not claim what I cannot support with evidence.
  • I will not blame the doctor at the bedside for the failure of the system that placed him there.
  • I will not pretend public health is a problem solvable by a single grand scheme. It is solved one functioning hospital at a time, in places where the cameras do not go.
  • My own family uses the public health system. If I believe it should work well for everyone who depends on it, I have to believe that includes the people I love.

A word directly

If you have read this far, you have given me more attention than most people give a doctor’s writing. I would like to use that attention well. If you disagree with anything above — and you should disagree with some of it — write to me at connect@narayanrout.com. The arguments I have not yet heard are the ones I most need to.