Webinar: The role of private sector pharmacies in financial hardship in India: a health system analysis in the state of Odisha


This session held on August 24, 2022 focused on a health system analysis of the causes of high catastrophic health expenditure (CHE) in the state of Odisha in India. Odisha has the second-highest rates of CHE across India, but also has a public insurance program that covers 80% of the population and widely-used public facilities where drugs are provided free-of-charge. We designed and fielded 10 innovative surveys, including surveys of private sector pharmacies and households that captured extensive information about healthcare seeking. We find that private pharmacies fulfill an essential health system function in Odisha – providing 13% of outpatient visits and supplying the vast majority of drugs. Eliminating spending on private drugs would reduce CHE by more than half in Odisha. The public insurance program, in contrast, was not widely used and explained little variation in CHE. To reduce financial hardship in Odisha, the role currently fulfilled by private sector pharmacies must be considered alongside shortcomings in the public provision of drugs and the lack of outpatient care and drug coverage in public insurance programs.

The session concluded with a discussion of the broader approach to health systems analysis used in India Health Systems Reform Project, which emphasizes the systemic nature of the underlying causes of health system performance and the importance of the interactions between public and private actors.


  • Dr. Annie Haakenstad is an Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Annie is a faculty on the Health Systems team at IHME, where she focuses on financial risk protection, health financing, and disparities in access to health services, with a focus on reproductive and maternal health.
  • Dr. Winnie Yip is Professor of the Practice of Global Health Policy and Economics in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health. Her research focuses on health system evaluations and the design and testing of innovative health system interventions to improve equitable access to efficient and good quality health care. She integrates economics, organization theory, management, and political economy to examine the use of national and state-level policy levers to produce delivery system change. She currently applies this approach to developing viable and effective models of population health based integrated delivery systems in China and India.
  • Anuska Kalita is a Visiting Scientist and India Health System Specialist at the Harvard T.H. Chan School of Public Health. She has worked in the health sector for more than 16 years, in India and other countries in South Asia. Before joining Harvard, she worked with the Gates Foundation and The World Bank and was involved in designing India’s nationwide community health worker program and the National Health Policy (2017). Her research focuses on quality of care, citizens’ perceptions and satisfaction, and political economy in mixed health systems with public and private sector interactions. Anuska is currently pursuing her doctoral degree at Harvard.


  • World Bank, Health Nutrition and Population
  • Health Financing Global Solutions Group
  • Joint Learning Network
  • India Health Systems Reform Project of the Harvard T.H. Chan School of Public Health, for which funding from the Bill and Melinda Gates Foundation is gratefully acknowledged.


  • Haakenstad, Annie, Anuska Kalita, Bijetri Bose, Jan E Cooper, and Winnie Yip. “Catastrophic Health Expenditure on Private Sector Pharmaceuticals: A Cross-Sectional Analysis from the State of Odisha, India.” Health Policy and Planning 37, no. 7 (August 3, 2022): 872–84. https://doi.org/10.1093/heapol/czac035.