On August 9, the State’s Department of Health and Family Welfare launched Health & Wellness Centres (HWCs) programme under Ayushman Bharat at Urban Primary Health Centre Seikhazou, Kohima.
An optimistic Nagaland’s Minister for Health & Family Welfare, Pangnyu Phom noted during the launching that the Government of India had envisaged upgrading all the 1.5 lakh Sub-Centres to HWCs by December 2022. Nagaland is also committed to upgrade the 56 Sub-Centre, two PHC and three UPHC to HWCs in phase wise manner during the financial year 2018-19, he informed.
Ayushman Bharat has two important components: National Health Protection Scheme (NHPS) and HWCs. The NHPS will cover over 10 crore poor and vulnerable families providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization and subsume the on-going centrally sponsored schemes such as – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
With the objective of bringing “health care system closer to the homes of people,” the HWCs, first proposed in National Health Policy 2017, envisage to provide comprehensive health care, including for non-communicable diseases and maternal and child health services, including free essential drugs and diagnostic services.
This revamp of the primary health system is much needed and crucial as huge amount of money is spent seeking better health care in Nagaland. For instance, the total state’s expenditure on health till fiscal year 2017-18 stood at Rs. 10,156 crore, out of which Rs. 588 crore was on public health, the National Health Profile 2018 informed. Yet, a person in rural Nagaland spent, on an average, Rs. 11,652 out of own pocket as medical and non medical expenditure on every hospitalization. In urban Nagaland, this expenditure shot up to Rs. 17, 216.
With such expenses, the State is expected to score highly in both qualitative and quantitative delivery of healthcare. However, the overall status of health care when compared with other states, is abysmally below par. Within the states, there are sharp regional disparities in the provision of healthcare. Maternity care and child immunization are the worst performers in most surveys. Nagaland also languished at the bottom of the National Institution for Transforming India (NITI) Aayog’s Health Index Report released this year.
At another level, the healthcare in the state is limited by colossal dearth of workforce, the core components of healthcare delivery.
The annual Rural Health Statistics (RHS) regularly highlights such deficiencies. The latest RHS data informed that as of March 31, 2017, out of 126 functioning Public Health Centres in Nagaland, none had the mandatory 3 or 4 doctors in place, only 20 had 2 doctors while 89 were managed by a lone doctor. In the Community Health Centers, out of 21 Surgeons and Pediatricians required respectively, there were 2 each. All the CHCs were in want of a Physician. Overall, out of 84 total specialists needed at the CHCs, only 8 were available. As of March 31, 2017, Nagaland had 396 medical sub-centres, 126 Primary Health Centres and 21 Community Health Centres, according to the National Health Profile report.
The National Health Systems Resource Centre’s overview of Public Health Workforce in Nagaland also noted that one of the major constraints was “developing and meeting the required target and goal of providing adequate and assured number of doctors” in the health units. For instance, specialists’ status in all First Referral Unit Hospitals (FRUs) in the state were nil except for ‘inadequately’ in Kohima, Mokokchung and Dimapur.
While lack of a medical college and cessation of post creation in the state were cited as the primary reasons, it also observed the lack of “standard transfer and posting system” and “rationalization of manpower as per workload” which need to be corrected immediately.
Such somber realities often come in the way of implementation, notwithstanding lofty intention and assertion. For overall improvement of ‘health and wellness,’ it is imperative for reorientation of priorities from all stakeholders.