Dr. Longri Kichu
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’’, says the constitution of the World Health Organization. It also mentions ‘Health’ as a fundamental right for every human being. The definition of health is vast with endless possibilities. In India, Health is a state subject wherein the state has to ensure its citizens are not denied their right to a healthy life. Every state has a department of Health and Family Welfare which spearheads the challenge. But ‘health’ is a complex phenomenon and is not limited to drugs, health workers and hospitals. The health of a nation is highly dependent on its socioeconomic determinants, many of which are outside the purview of the Health Department. Nutrition (availability/ dietary practises), per capita income, hygiene and sanitation, traditional practises/ beliefs, literacy, governance, and health seeking behaviour are all directly linked to health. I’ll discuss in brief the most important sectors which deals with these crucial determinants and the challenges;
1. Social Welfare / Women and Child Development / ICDS
The Integrated Child Development Services has a direct bearing on the health of children and mothers. Supplementary nutrition of children and mothers, pre -school education, health education, growth monitoring and Immunization remain the core functions of ICDS. Anganwadis work in the community through the Anganwadi Centres in most villages. It is imperative that thesethesecentres function optimally along with the workers. ASHAs from the health department and Anganwadis have toconstantly work together to reach the desired objectives. There should be a collective effort to conduct quality Village Health and Nutrition Days in every village. It is encouraging to see that officials from ICDS and health department have started to coordinate in some places. Undernutrition indicators in children from NFHS-4(National Family Health Survey)show stark variations between districts with some showing alarming levels of even Severe Acute Malnutrition (as high as 9.8%). Such districts need focus and prioritisation in the state action plan. The department has a huge responsibility in shaping the future of children and mothers in Nagaland.
2.Department of School Education: Public schools have penetrated to the most interior areas in the state. The quality of human resources manning the public education system is second to none. There is only a win-win situation here. The potential of teachers to bring about social behavioural changes in the community is much unutilised. Proper hand washing (after mid-day meals), hygiene and sanitation talk, Immunization, nutrition education, tobacco control and many more can be done effectively by these trusted people in the society. Centrally sponsored programmes like WIFS (Weekly Iron Folic Acid Supplementation), mid-day meals, School Health Programme, Diarrhoea control fortnight and deworming (National Deworming Days) are schools specific health programmes which needs utmost dedication from the school department and teachers.Teachers have been at the war front in tackling many public health issues. The eradication of Poliomyelitis from India would not have been possible had it not been for the active involvement of teachers in many states.
3. Rural Development/ PHED : Public Health has its origins in sanitation and drinking water. I am sure more lives were saved by an improvement in sanitation and access to clean drinking water than by the discovery of some drugs. Some health units in Nagaland have major issues with access to 24/7 running water and proper toilets. For instance, conducting institutional deliverieswithout running water becomes difficult since the risk of infectionmayoutweigh the benefits. It gets more relevant in this age of antibiotic resistance where hospital acquired infections are getting more difficult to treat. Hospital waste management is again an area which needs major investment and coming together of all allied departments. Rural sanitation and waste management has been added under MGNREGA.Health should come before the rest. It is of much essence that ‘health’ is reflected and given due importance in the village development plan
4. Food and Civil Supplies/ Agriculture/ Horticulture/Fishery: While there is an explosion of multi cuisine restaurants in some towns, we have a larger chunk of population highly dependent at the mercy of the sun and rains.Public Distribution System has to be revitalised urgently to meet our growing needs in the realisation of the much talked about Food Security. Denying entitlements to children and the poor is a crime. Many regions are still on a heavily skewed carbohydrate only diet. Diversification of diet becomes very important if we really have to address malnutrition. The allied agriculture departments should invest in areas where undernutrition indicators are the worst. We are not meeting our health goals anytime if nutrition is not addressed holistically.
5. Economics and Statistics: Public health and planning heavily depend on valid data. SRS (Sample registration system) and NFHS (National family health survey) is where the state turns to for mortality and service delivery indicators. But we have problems with the sampling units of both. For smaller states, Civil Registration System (CRS) becomes the most reliable option to understand mortality and fertility indicators till the district level. While birth registration has greatly improved, registration of deaths is one area that seriously needs a relook. The HMIS (Health management Information system) under National Health Mission and CRS under economics and statistics can work together to understand deeper.
6. Administration: Coordination between various departments for improving health indicators is a big task we are faced with now.The administration has a big challenge to lead and coordinate these sister departments in the form of task force meetings, supervisory visits and prioritising health in the state, district and block development plans. When India was declared Polio free, the first credit went to the general administration, and for many right reasons.
7.The Community: I saved the most important for the last.‘Communitisation’of public institutions is what Nagaland gave to the nation. Our rich ‘social capital’ was the base for it. It roughly translates to transferring ‘responsibility/ownership’ of public institutions like hospitals to the people. There is a lot the community can do in improving the quality of hospital care, tackling undernutrition and improving sanitation and hygiene. The possibilities are limitless and it doesn’t have to do with ‘money’every time. Some villages have looked into staff quarters, approach road to hospitals, toilets, running water and renovation of the hospital complexes very effectively. The Village Health Committee needs to be proactive in tackling local health issues. Can the community look at the implementation of Mid- day Meals? Can the Community build quarters for health workers? Can we demand our entitlements under PDS? Can we mobilise our children for Immunization? Can we demand the health staff to be regular at their place of posting? Can we look at the functionality of Anganwadi Centres? The answer is a ‘YES ‘to all of it.But we need a ‘bridge’ between the community and the System. Not everyone is aware of their rights and entitlements. Not everyone has access to information. To anyone reading this, can you be an agent to bridge that awareness gap?! In your colony. In your village. And just right where you are. The various unions (Students’, women), the Church, the social media warriors, the youth and the numerous informed individuals are the bridges that’s sorely found to be missing in our society.
Health is a dynamic concept with ever evolving challenges and opportunities. We are faced with the dual problem of increasing lifestyle ailments (Cancer, Diabetes, Hypertension, Cardio vascular diseases, mental disordersetc) at one spectrum and the persistence of sub-Saharan like health issues (malnutrition, communicable, vector-borne diseases) at the other. These challenges need the highest coordination between Health and other allied sectors at all levels. Our society needs more dialogue, understanding and enlightenment. The media, civil society, educational institutions and the Churches have a big role to play as the other government functionaries. It is easier said than done but I am optimistic of a healthier Nagaland and for the ‘Nana’ in each of our homes.