The Minister of Health and Family Welfare in a recent event stated that health is an individual’s most precious possession and he reminded the in-service doctors that the prestige of the department and the health of the citizens lie in their hands. However, safe for a few exceptions the prestige of almost all the medical centres and agencies under the department is presently pretty low among the people. On the other hand, the other report card about the health of the citizens will be the annual statistical data that the department and the various agencies maintain. It indicates that the reach of the department to all the people of the state is still questionable.
Nagaland at present has 560 health centres and 11 District Hospitals one each in all the districts and 1 mental hospital. The accessibility is around 3600 people per centre. According to the report from the department there are around 492 allopathic doctors and 46 Ayush doctors in the state assisted by another 1829 health workers made up by 625 General Nursing and Midwifery(GNM), 1145 Auxiliary Nursing Midwifery (ANM) and 59 Lady Health Visitor (LHV). Earlier reports have shown that there is an excess of lower level health workers in the state but a shortage of specialists, surgeons, radiographers and even paediatricians. In 2015-16 the department had a budget expenditure of about 320 crores as per its annual administrative report. The irony is that the infrastructure of most of the health centres is in shambles. It is also failing to act as the first line of defence in the rural areas before a patient is referred to a higher better equipped hospital. There are continued complaints of most of the centres in the remote areas that are almost non functional except for the routine immunization and other campaigns. But even in immunization, the figures show that Nagaland has failed miserably when the coverage achieved for total immunization stood at less than 40% the last two annuals.
There is already a total trust deficit that has engulfed the minds of the people with the existing system very successfully changing the mindset that the government run health centres provide inferior treatment. The very object of the government for affordable treatment to improve the general health of the population has been utterly defeated in the state. As evident in almost all the government departments, the main objective is set aside and the other benefits like employment, contracts, money etc. have taken precedence. The communitisation of the health centres and its success is still debatable with too much emphasis on representation/inclusion on district/region/town/village lines thus overlooking the real coverage area with reasonable amount of health workers stationed at the centres. The people are also at fault since demands for health centres are aplenty but impartial monitoring of the centres after commissioning is at present questionable.
The present scenario also affects the economy resulting in disproportionate growth among the people in some way. Patients are still treated by the same doctors at a private run health centre of which there are allegations of some doctors incorrectly availing NPA allowances. The cost of medicine is higher with no subsidies and parents have to pay for immunization at a private health centre. A huge amount of money is going out to the medicine and healthcare companies outside the state. The recent disclosure in India that targets are set by the medicine companies through their medical representatives (MRs) in India is a serious concern that the Dept of H&FW also need to immediately look into in the state. The American example is noteworthy indicator when the US government after years of debate passed Bills for more affordable health care for the citizens. Else the health sector is one of the highest profit making industry in the US with negligible welfare programme and high cost of treatment.
Sadly for the people of the state, the appointment of doctors bypassing the selection procedures as laid down, the back door appointments, still takes precedence than the actual running of the health centres in the state. If monitoring is strictly done for the better functioning of the numerous health centres and the health workers attached to it then the department will not be as attractive as now for those who are in it purely for the sake of employment.
