The Past and Future of North East Healthcare
Everyone agrees that North East has impressive health indicators such as IMR. But development is impossible without good governance. Evidence proves that prevalence of communicable and non-communicable diseases are major concerns in this region. And gives more reason to believe that sector is ready for re-engineering. An HE report.
Even several decades after independence, several north-eastern states are still in the throes of shortage of human resources and quality healthcare service delivery.
“The healthcare sector in North Eastern states of India is yet to develop in terms of physical infrastructure, and affordable service delivery to patients, specially, in case of women and children,” says Dr Pranti Dutta Assistant Professor, University of Science and Technology, Meghalya.
Dutta believes that digitalization can revive healthcare sector of northeast. “North Eastern states are situated geographically in remote area and has poor connectivity with the mainland India. Improving quality availability of service delivery through digital mechanism is an emerging aspect of the NER healthcare sector. Patient can have adequate guidance from renowned health institutions by sending reports and images and online conversations. This will also help to reduce travel time and cost as well as people’s health-seeking behavior will be improved. One of the highly recommended areas is maternal healthcare. Digitalization in maternal healthcare can improve monitoring, tracking and referral system for pregnant women,” she explains..
Ethnically, culturally and historically northeastern states are different from the rest of the India. And several policies have been introduced by both Central and State government to boost the healthcare delivery in the region.
Ayushman Bharat is one of the recent government programmes implemented in North East India to expand the coverage of health insurance. Maternal healthcare policies have been implemented under National Rural Health Mission and Integrated Child Development Programme to improve maternal health outcome by increasing number of safe and institutional delivery and higher coverage of antenatal care. Janani Suraksha Yojana (JSY), introduction of ANM and ASHA workers at grassroots level, 108 & 102 ambulance services and Mobile Medical Unit are some examples. Assam Government has also introduced a policy for eradication of anemia namely Mission Tejaswee, and Adoroni, an ambulance facility for pregnant women and newborn to and fro of health institutions.
But is it enough? Probably not. Local experts point out that local innovation and adaptation is important. "As an organization, working on health at the grass root level, we understand the implication and importance of inclusive growth and health for all. The Centre for North East Studies and Policy Research (C-NES) set up in the year 2000 has been working in the remote Brahmaputra river islands for the past nearly 10 years through the Boat Clinics supported by the NHM, Govt of Assam in a public-private partnership mode. 15 Boat Clinic units service the target islands with basic health services, probably for the first time since independence, for most. Many of the beneficiaries had never seen an injection or even a doctor before,” says Bhaswati Goswami, Communications Officer, C-NES, Guwahati, Assam
Goswami adds that local innovation and adaptation is vital. “Surely a “one size fits all” will be ineffectual in our area of work as also in the region with so much variety in terms of socio- economic profiles of the communities to be covered and otherwise. To make healthcare inclusive we need to penetrate deep, win the communities over with trust and sustained services, understand them and their need and so work towards it with local support. We need to hand hold and show them the way, giving them a sense of ownership of the programme. Social sector must play a much bigger role in the health care scenario.”
The focus needs to be more on preventive and strengthening of quality primary healthcare services. Awareness sessions and tips on health and hygiene in local dialects (so many of them in the region) on regular sustained basis will go a long way in making healthy communities. Convergence of the various health-related government departments is essential.
Measuring the Mood of Doctors
Dr Caleb Harris, Associate Professor and Head, Department of Surgical Oncology, NEIGRIHMS, Shillong too is critical.
“The northeast region, with its ethnic diversity and difficult terrain poses a problem to to overall development.The incidence of cancer in Northeast India is twice of the rest of India. Further, some of the northeastern states have the dubious distinction of being the No. 1 states for certain cancers in the world. Meghalaya for Esophageal Cancer, Nagaland for nasopharyngeal cancer, Mizoram for stomach cancer, Arunachal Pradesh for liver cancer. The difficult terrain and poor public transport systems compound the problem of access to scarce cancer treatment facilities,” he adds.
Harris says that while most people feel the high incidence of cancer could be attributed to genetic susceptibility to cancer, it cannot be declared so without evidence. “The number of tobacco users in the northeast is double than the rest of the country. Hence two-thirds of the cancers here are caused by tobacco. State governments have adopted measures to improve the tertiary care, by starting medical colleges. But the primary healthcare services must be strengthened and the existing central institutions should function more efficiently to cater to the health needs of public. The health insurance schemes of states like Meghalaya and Assam have also been very helpful to the patients,” he explains.
India allocates the least amount to health in its budget, lesser than even some of the SAARC countries, and even this amount is unspent at times. Poor public spending on health leads to high out-of-pocket expenditure on health. In the Northeast, the perceived need to travel to other cities for treatment aggravates the costs.
“While Ayushman Bharat seems to be a good scheme, it is too early to comment on the roll out of the scheme. But if its implemented well, it should be a boon to the patients of this region. The main problem with improving access to healthcare in the Northeast region is the unavailability of the human resources. Health departments and education department must encourage more people to take up courses beneficial for the sector. Also, delays in implementation of healthcare projects need to be curbed. More than anything, prevention of cancer needs a lot of attention, with special attention to curtailing the use of tobacco, betel nut and alcohol,” he concludes.
So, what can be a lasting cure for the festering wound called northeast?
The North-east region houses approximately 3.8% of total Indian population as of 2018. Taking into consideration the international norms of health are professional availability as per population, WHO norms state the requirement of 1 doctor per 1000 population and 2 nurses per 1000 population. NER has a supply gap of 36,009 registered doctors of which taking an attrition percentage of 20 per cent, a total number of 28,007 doctors can be considered available. To meet the WHO requirement of 1 doctor per 1000 population, North-east requires additional 22, 958 doctors.
Dr Jyoti Rama Das, Co-founder and Managing Partner of Integra Ventures, believes it’s imperative that leadership focuses on healthcare workforce. “NER has a total of 43,642 registered nurses, considering an attrition percentage of 20 per cent it has 34,914 nurses. Based on the WHO norm of 2 nurses per 1000 population NER has a higher overall gap of 66 percent nurses. NER has lower availability of nurses i.e. 0.7 nurse against national average of 1 nurse per 1000 population. In NER there is one nurse per 1483 population whereas at country level there is 1 nurse per 890 people.
“In order to address the problem of resource constraint following steps can be taken by the government as well as the private sector in order to boost the health fraternity of the region. First, addition of seats in the existing colleges or institutes with limited or no infrastructural changes. Second, addition of seats in the existing colleges or institutes with major infrastructural changes. Third, exploring PPP models and encouraging private players with various tax incentives and minimising establishment norms to set up colleges and institutes in the region. Fourth, technological upgradation with computer assisted learning and conducting webinars.
“Also there are various issues in commissioning and running a government college or institute. In many cases it can be seen that the management of government healthcare institutes face fund crunch in operational and capital expenditure. This may be due to difficulty in sanctioning the amount from Central government and/or respective state governments due to frequent series of communication and permissions from officers at Centre as well as the state governments. So a limited financial authority (upto an extent) can be given to the management to take some financial decisions,” he concludes.