The paper examines the state of the health sector in Orissa, a state with approximately half of its population living below the poverty line, high disease burden, and weak economy. After providing an overview of public health services and their performance in Orissa, the paper examines the various initiatives taken by the state government for reforming the health sector and for mobilising resources. The role of the private sector in health outcomes is also discussed and an evaluation of the public health systems in Orissa is made in the paper.