This performance audit of National Rural Health Mission in Odisha for the period 2007-08 to 2012-13 revealed that planning was deficient due to non preparation of perspective plans and annual action plans at the State, District and Block level, District Health Action Plan was prepared for only four out of 30 districts. Gaon Kalyan Samiti (GKS) meant to work as community level platform to facilitate public health activities were belatedly formed and still 63 GKSs remained to be formed in targeted villages. Also delay in formation of GKS led to short receipt of GoI assistance of Rs 18.52 crore. There were delays in release of GoI installments upto 157 days due to delay in submission of Project Implementation Plan (PIP) by State. Spending efficiency at State Level ranged between 36 and 66 per cent of funds available during 2007-13. State healthcare spending remained below three percent of total budget against prescribed eight per cent due to less allocation by the State. Though maternal mortality rate was reduced from 303 in 2007-08 to 237 in 2011-12, yet the same was above the national average. Similarly, infant mortality rate was reduced from 71 to 57 against the national average of 55 to 44 during 2007-12. Despite increasing trend of institutional deliveries in the State, position was not satisfactory in Koraput, Nabarangpur, and Kalahandi districts where it remained between 13 to 64 per cent. Delivery of Health care was affected due to absence of required health institutions in the State as per Indian Public Health Standards (IPHS) norms. There were shortages of 3284 SHCs (33 per cent) and 370 PHCs (23 per cent). Despite stipulation in IPHS to have their own buildings, 91 PHCs and 2969 SHCs were functioning in private buildings in the State. Due to lack of adequate monitoring, progress on infrastructure was not satisfactory as only 2491 (50 per cent) works were completed out of 5028 works sanctioned during 2007-13. Of the above, 1051(21 per cent) works were lying incomplete after incurring expenditure of Rs 40.01 crore and the balance 1486 (29 per cent) works were not yet started. Facilities for pathological tests were not available in 13 (54 per cent) test checked CHCs whereas X-ray and Electro Cardiogram (ECG) were not available in all the 24 test checked CHCs. Against IPHS norms for posting of 10,594 doctors in the State, 5077 doctors were sanctioned and 3435 (32 per cent) were in position as of March 2013. Though 1075 specialist under 17 categories were essential for DHHs, only 603 specialists were available. Similarly, as against requirement of 20,064 health workers for SHCs in the State, 10914 (54 per cent) were in position. No staff nurse and lab technicians (LTs) were posted despite stipulation in IPHS to post five Staff Nurses and two LTs in each PHC. Besides, 59 per cent (1534) of pharmacists were found short in PHCs. Training programme for skill development fell short of the target by 29 percent during 2007-13. Services of trained doctors were not utilised as 17 trained doctors in Skilled Birth Attendance (SBA) and 11 in Life Saving Anesthesia Skill (LSAS) were not deployed for respective service. All types of essential drugs were not available in sampled DHHs, CHCs and PHCs. Drugs of Not of Standard Quality (NSQ) of Rs 5.80 lakh and Life expired drugs of Rs 0.74 lakh were administered to patients. Monitoring was weak, inadequate holding of meetings by State and District Health Missions, non formation of Health Planning and Monitoring Committee were noticed. Thus, the objectives of the mission t o provide accessible, affordable, reliable and quality health care to the rural population sought to be achieved through NRHM remained largely unfulfilled.